Search results

The purpose of this paper is to examine Canadian organizational and systemic factors that made it possible to keep wait times within federally established limits for at least 18 months.

The research design is a multiple cases study. The paper selected three cases: Case 1 – staff were able to maintain compliance with requirements for more than 18 months; Case 2 – staff were able to meet requirements for 18 months, but unable to sustain this level; Case 3 – staff were never able to meet the requirements. For each case the authors interviewed persons involved in the strategies and collected documents. The paper analysed systemic and organizational-level factors; including governance and leadership, culture, resources, methods and tools.

Findings indicate that the hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit.

The authors’ research highlights an important gradient between three cases regarding the factors that sustain waiting times. The paper show that the hospital factory model seems attractive in a super-specialized surgery context. However, patients are selected for simple surgeries, without complications, and so this cannot be considered a unique model.

Examines the dynamics of change that operated following preparations for accreditation. The study was conducted from May 1995 to October 2001 in a university hospital center in France after the introduction in 1996 of mandatory accreditation. An embedded explanatory case study sought to explore the organizational changes: a theoretical framework for analyzing change was developed; semi‐structured interviews, focus groups, and questionnaires addressed to the hospital's professionals were used and documents were collected; and qualitative and quantitative analyses were carried out. Professionals from clinical and medico‐technical departments participated most. Preparations for accreditation provided an opportunity to reflect non‐hierarchically on the treatment of patients and on the hospital's operational modalities by creating a locus for exchanges and collegial decision making. These preparations also led to giving greater consideration to results of exit surveys and to committing procedures to paper, and were a key opportunity for introducing a continuous quality program.

The purpose of this paper is to update the Global Model of Public Mental Health (GMPMH) in light of the WHO QualityRights project.

Being able to refer to international conventions and human rights standards is a key component of a genuine global approach that is supportive of individuals and communities in their quest for recovery and full citizenship. The GMPMH was inspired by the ecological approach in health promotion programs, adding to that approach the individuals as agents of mental health policies and legislation transformation. The GMPMH integrates recovery- and citizenship-oriented psychiatric practices through the Ottawa Charter for Health Promotion (WHO, 1986).

Updating the GMPMH through the WHO QualityRights Toolkit highlights the need for a new form of governance body, namely the Civic Forum, which is inclusive of local communities and persons in recovery. People with mental health disabilities, intellectual disabilities, and substance use conditions can be “included in the community” (UN Convention on the Rights of Persons with Disabilities, Article 19) only if the community is informed and welcoming, for instance through a Civic Forum and its organizing Local Council of Mental Health.

Transition from social marginalization to full citizenship represents a daunting challenge in public mental health care. An approach that focuses primarily on individuals is not sufficient in creating access to valued roles those individuals will be able to occupy in community settings. Instead, public intervention and debate are required to promote and monitor the bond of citizenship that connects people to their communities.

The GMPMH is the result of a conceptual cross-breeding between recovery and health promotion (WHO, 1986). The GMPMH is an offspring of the ecological approach in health promotion programs, adding to that approach individuals as agents of mental health transformation. It refers to international conventions and human rights standards as a central component of a genuine global approach. A community-based participatory research design is well suited, which includes a Civic Forum for local communities to become involved and supportive of service users in their quality and human rights assessments.