Integrated Care Pathways and Networks: Implementing Governance Innovations in Quebec's Health and Social Services System

摘要

Context : Provinces across Canada are seeking new and innovative ways to manage the efficiency, effectiveness and quality of their healthcare systems. The implementation of integrated care pathways is viewed as an answer to the problem of fragmentation of care. We conducted a developmental evaluation to study the implementation of integrated care pathways in one healthcare organization and it network in Quebec. Objective : In this study we describe the development of the integrated care pathways and analyze the process of governance innovation within a developmental framework. We seeks to understand how change in governance occurred and its impact of primary healthcare deliveries through intersectorial network. Design : Using a qualitative approach, we conduct a process analysis with three case study with multilevel of analysis. The analysis used a conceptual framework based on the Complex Adaptive Systems (CAS) approach of multi-level governance (Maillet, 2016) and Organizational Knowledge Creation theory (Nonaka, 2007). Empirical data were collected through documentation, observation (N=23), and semi-structured interviews with key informants (N=20). Results : Our preliminary results give a detail account of the practices put in place by the implementers and the impacts of the feedback on the adaptation processes. Our findings highlight the role of sense-making processes primarily to help promote change. The results also identify the struggle to disseminate the knowledge gained from the project within the rest of the organization. Finally, our results identify several individual, organizational, program design and contextual factors that facilitated and/or impeded the implementation of the integrated care pathways within and outside the healthcare organization. Conclusion : Our study provided interesting insights into how the development came about and what adaptation processes were successful to bring change in the governance. Our results will be of interest for health care decision makers aiming to better respond to the needs of users and to increase their participation at all levels of organization and networks.