Frédéric Gilbert, Jean-Louis Denis, Lise Lamothe, Marie-Dominique Beaulieu, Danielle D'amour and Johanne Goudreau
Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to…
Abstract
Purpose
Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec.
Design/methodology/approach
An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis.
Findings
The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of “intermediate change” and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery.
Research limitations/implications
This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation.
Practical implications
The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes.
Originality/value
This research is one of few studies to examine a primary care reform from emergence to implementation using a longitudinal multi-level design.
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Keywords
Tony Rey, Loic Le De, Frederic Leone and David Gilbert
The purpose of this paper is to develop a multidimensional approach for effectively managing natural disasters; this paper has three research objectives. First, it provides an…
Abstract
Purpose
The purpose of this paper is to develop a multidimensional approach for effectively managing natural disasters; this paper has three research objectives. First, it provides an analysis on the hydro-geomorphological effects of the cyclone in the urban context. Second, it proposes an analysis for the vulnerability and resilience recovery of the populations living in urban areas. Third, it specifies the implications for sustainable recovery and longer-term disaster risk reduction.
Design/methodology/approach
A detailed case study of the tropical cyclone Pam was carried out to identify hydro-geomorphologic effects and damages in an urban area and specific problems associated with managing natural disaster in Vanuatu.
Findings
The investigations reveal that living in an urban area increases a population’s exposure to hydrological, weather and sea-related risks. Whereas advice on cyclones seems to work very well, the coastal risks and floods seem to be underestimated with a very high exposure and vulnerability to risk. Pre-existing vulnerabilities were exacerbated after cyclone Pam. However, other communities have been able to reinforce their resilience through local initiatives. The government and outside aid were very quick to react, despite problems of coordination, exchange of information, communication and long-term strategy.
Practical implications
The bottom-up, top-down, local and global approaches, applied on the time scales, should lead to actions that will reinforce the ability of the people of Vanuatu to adapt to high-energy events and to the effects of climate change.
Originality/value
This paper highlights the importance of understanding how the urban communities are vulnerable to natural hazards and of strategies for increasing their resilience.
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Marie-Hélène Gilbert, Julie Dextras-Gauthier, Maude Boulet, Isabelle Auclair, Justine Dima and Frédéric Boucher
Maintaining a healthy and productive workforce is a challenge for most organizations. This is even truer for health organization, facing staff shortages and work overload. The aim…
Abstract
Purpose
Maintaining a healthy and productive workforce is a challenge for most organizations. This is even truer for health organization, facing staff shortages and work overload. The aim of this study is to identify the resources and constraints that influence managers' mental health and better understand how they are affected by them.
Design/methodology/approach
A qualitative approach was chosen to document the resources, the constraints as well as their consequences on managers in their day-to-day realities. The sample included executive-, intermediate- and first-level managers from a Canadian healthcare facility. A total of 62 semi-structured interviews were conducted. The coding process was based on the IGLOO model of Nielsen et al. (2018) to which an employee-related level was added (IGELOO).
Findings
Results highlight the importance of considering both resources as well as constraints in examining managers' mental health. Overarching context, organizational constraints and the management of difficult employees played important roles in the stress experienced by managers.
Practical implications
The results offer a better understanding of the importance of intervening at different levels to promote better organizational health. Results also highlight the importance of setting up organizational resources and act on the various constraints to reduce them. Different individual strategies used by managers to deal with the various constraints and maintain their mental health also emerge from those results.
Originality/value
In addition to addressing the reality of healthcare managers, this study supplements a theoretical model and suggests avenues for interventions promoting more sustainable organizational health.
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The concept of style is gaining momentum in organizational research. Focussing on its implications for strategy, this paper presents a conceptual and methodological framework to…
Abstract
The concept of style is gaining momentum in organizational research. Focussing on its implications for strategy, this paper presents a conceptual and methodological framework to make the notion of style operational and applicable to both research and practice. Style is defined here as a combinatorial, socially situated and semiotic device that can be organized into typologies – recurrent combinations of stylistic dimensions exerting a normative and semiotic function within and across contexts. The empirical analysis, situated in the field of electronic music, considers the music genres and the colour dimension of artists' appearance as components of their style. Results show how coherent style typologies normatively dominate the field and how non-conformist but coherent typologies correspond to superior creative performance. Operating as unifying device, style can transform varied and potentially confounding traits into distinctiveness and shed light on competitive market dynamics that cannot be fully explained via other theoretical constructs.
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Such reports as reach us go to prove that few, if any, attacks on library finances, such as are usually frequent in the municipal budgetting month of February, have been made this…
Abstract
Such reports as reach us go to prove that few, if any, attacks on library finances, such as are usually frequent in the municipal budgetting month of February, have been made this year; and that in spite of the fact that local rates have risen to an unprecedented extent throughout the Kingdom. This is our general impression, although librarians are somewhat reticent upon the matter. Last year we appealed for information as to reductions and retrenchments, but received little response; it appeared that the matter was not sufficiently interesting to librarians to make them express their views or state their experiences concerning it. Library finance is in spite of that a vital matter to us all, and the primary need in connexion therewith is accurate information. We therefore venture to repeat our request for news of the kind. It will be used with discretion.
Most of us have some favourite books which are read over and over again, and some might perhaps agree with Schopenhauer that “any book that is at all important ought to be at once…
Abstract
Most of us have some favourite books which are read over and over again, and some might perhaps agree with Schopenhauer that “any book that is at all important ought to be at once read through twice, partly because on a second reading the connexion of its parts will be better understood, and partly because we are not in the same temper and disposition on both readings.” “Every good book,” said Charles Bray, “is worth reading three times at least.” Certainly the pleasure obtained from a really good book can usually be repeated at least once later. The experience of many famous bookmen bears that much out.
Children's Book Week, which occurs during the last week of November, was first inspired by a speech delivered by E.W. Mumford of the Penn Publishing Company at the American…
Abstract
Children's Book Week, which occurs during the last week of November, was first inspired by a speech delivered by E.W. Mumford of the Penn Publishing Company at the American Booksellers Association (ABA) annual convention in 1912. Mumford regarded reading as an act of habituation. He said that a child raised on trashy novels will grow up to read such fare, but that a child instilled with a taste for better books will ultimately develop mature and catholic reading interests.