IMPLEMENTING INTEGRATED SERVICES AT THE NATIONAL LEVEL: A VIEW OF 25 YEARS OF INNOVATIONS IN QUEBEC

摘要

For 25 years, Quebec has been very innovative in the integration of services. Integrated service models are innovations involving various operational components (Case management, etc.), that can be implemented in various ways: “let it happen, help it happen or make it happen”, and applied to different essential works for change management. Cloutier and collaborators (2015), describe four of such works:1. >A conceptual work, which involves the creation and communication of stable representations, which are helpful in guiding the action of the various actors.2. >A structural work, which consists of the consolidation of the regulatory aspects of the system, that is, the redistribution of formal action capacities of actors involved in the intended change.3. >An operational work, which involves the creation of conditions such that the actors who are targeted by the innovation actually experiment new ways of doing things.4. >A relational work, which involves the accompanying of various actors with diverse roles and intentions.This presentation summarizes the evolution of this movement of integration of services from the early 1990s until today through an analysis of the speech of 130 key witnesses of these transformations. Though we observe a strong conceptual continuity between successive reforms, it is clear that the movement seems to be moving on a conceptual standardization of the integration of services. Is the integration of services project inherently technocratic? Given the Quebec experience, it seems that yes, although this fact is less the result of conceptual models as of their empirical implementation.