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Available. Open Access. Open Access
Article
Publication date: 28 June 2019

Sabina Abou Malham, Mélanie-Ann Smithman, Nassera Touati, Astrid Brousselle, Christine Loignon, Carl-Ardy Dubois, Kareen Nour, Antoine Boivin and Mylaine Breton

Centralized waiting lists (CWLs) for patient attachment to a primary care provider have been implemented across Canada, including Quebec. Little is known about the implementation…

1534

Abstract

Purpose

Centralized waiting lists (CWLs) for patient attachment to a primary care provider have been implemented across Canada, including Quebec. Little is known about the implementation of CWLs and the factors that influence implementation outcomes of such primary care innovations. The purpose of this paper is to explain variations in the outcomes of implementation by analyzing the characteristics of CWLs and contextual factors that influence their implementation.

Design/methodology/approach

A multiple qualitative case study was conducted. Four contrasting CWLs were purposefully selected: two relatively high-performing and two relatively low-performing cases with regard to process indicators. Data collected between 2015 and 2016 drew on three sources: 26 semi-structured interviews with key stakeholders, 22 documents and field notes. The Consolidated Framework for Implementation Research was used to identify, through a cross-case comparison of ratings, constructs that distinguish high from low-performing cases.

Findings

Five constructs distinguished high from low-performing cases: three related to the inner setting: network and communications; leadership engagement; available resources; one from innovation characteristics: adaptability with regard to registration, evaluation of priority and attachment to a family physician; and, one associated with process domain: engaging. Other constructs exerted influence on implementation (e.g. outer setting, individual characteristics), but did not distinguish high and low-performing cases.

Originality/value

This is the first in-depth analysis of CWL implementation. Results suggest important factors that might be useful in efforts to continuously improve implementation performance of CWLs and similar innovations.

Details

Journal of Health Organization and Management, vol. 33 no. 5
Type: Research Article
ISSN: 1477-7266

Keywords

Available. Open Access. Open Access
Article
Publication date: 27 May 2022

Paul Wankah, Mylaine Breton, Carolyn Steele Gray and James Shaw

The purpose of this paper was to develop deeper insights into the practices enacted by entrepreneurial healthcare managers to enhance the implementation of a partnership logic in…

1344

Abstract

Purpose

The purpose of this paper was to develop deeper insights into the practices enacted by entrepreneurial healthcare managers to enhance the implementation of a partnership logic in integrated care models for older adults.

Design/methodology/approach

A multiple case study design in two urban centres in two jurisdictions in Canada, Ontario and Quebec. Data collection included 65 semi-structured interviews with policymakers, managers and providers and analysis of key policy documents. The institutional entrepreneur theory provided the theoretical lens and informed a reflexive iterative data analysis.

Findings

While each case faced unique challenges, there were similarities and differences in how managers enhanced a partnership’s institutional logic. In both cases, entrepreneurial healthcare managers created new roles, negotiated mutually beneficial agreements and co-located staff to foster inter-organisational partnerships between public, private and community organisations in the continuum of care for older adults. In addition, managers in Ontario secured additional funding, while managers in Quebec organised biannual meetings and joint training to enhance inter-organisational partnerships.

Originality/value

This study has two main implications. First, efforts to enhance inter-organisational partnerships should strategically include institutional entrepreneurs. Second, successful institutional changes may be supported by investing in integrated implementation strategies that target roles of staff, co-location and inter-organisational agreements.

Details

Journal of Health Organization and Management, vol. 36 no. 6
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 19 March 2021

Jean-Sebastien Marchand, Mylaine Breton, Olivier Saulpic and Élizabeth Côté-Boileau

Lean-inspired approaches and performance management systems are being implemented in public healthcare organisations internationally. However, the literature is inconclusive…

677

Abstract

Purpose

Lean-inspired approaches and performance management systems are being implemented in public healthcare organisations internationally. However, the literature is inconclusive regarding the benefits of these management tools and there is a lack of knowledge regarding processes for large-scale implementation of these tools. This article aims to describe the implementation process and to better understand how this process influences the mandated performance management system.

Design/methodology/approach

This research is based on a comparative case study of three healthcare organisations in Canada. Data consist documents, non-participant observation and semi-structured interviews with key actors (n = 30). Analysis is based on a sociotechnical approach to management tools that considers organisational context, and the tool's technical substrate, theory of action and managerial philosophy.

Findings

Results show that despite a standardised national mandate, the tool as implemented varied between organisations in terms of technical substrate and managerial philosophy. These variations are explained by the flexibility of the technical substrate, the lack of clarity of the managerial philosophy, and some contextual elements. Successful implementation may rest upon high hybridization of the tool on these different dimensions. A precise and prescribed technical substrate is not sufficient to guarantee implementation of a managerial philosophy.

Practical implications

Mandated implementation of management tools may be more successful if it is explicit on the managerial philosophy, the technical substrate and the link between the two, and if it provides some leeway to adapt both to the organisational context.

Originality/value

This is one of the few studies to describe and analyse the process involved in mandated large-scale implementation of performance management systems in public healthcare organisations.

Details

Journal of Health Organization and Management, vol. 35 no. 5
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 14 August 2017

Brigitte Vachon, Ai-Thuy Huynh, Mylaine Breton, Louise Quesnel, Michel Camirand, Jeannette Leblanc and Sylvie Tardif

The purpose of this paper is to document health care needs expressed by people living with diabetes, describe the solutions they envisaged for improving the quality of primary…

576

Abstract

Purpose

The purpose of this paper is to document health care needs expressed by people living with diabetes, describe the solutions they envisaged for improving the quality of primary care (PC) services and empower them to make better use of PC services.

Design/methodology/approach

A participatory research approach was used. Six workshops were organised to provide diabetes patients with knowledge on available services and to engage them in sharing their experience. Group discussions were recorded. Data were analysed using the thematic analysis method.

Findings

In total, 79 persons living with diabetes for a mean of 13 years participated. Needs expressed were grouped under seven themes: assurance of satisfactory follow-up by a family physician, continuous access to services adapted to evolving needs, motivation to adopt and maintain healthy behaviours, maintenance of knowledge about diabetes, psychological support, financial constraints, and collaboration with secondary-level services. Patients proposed solutions for improving services that were grouped under five themes: facilitating access to services, disseminating information about available services, centralising diabetes information on the internet, offering personalised services and improving interprofessional collaboration.

Practical implications

Needs expressed by diabetic patients concern different aspects of care such as accessibility, organisation, coordination, and better dissemination and visibility of services. The solutions proposed by patients focussed on better access to information and interprofessional services.

Originality/value

The workshop format used in this study offers an original and interesting approach and tool for actively engaging patients in quality improvement of services.

Details

International Journal of Health Care Quality Assurance, vol. 30 no. 6
Type: Research Article
ISSN: 0952-6862

Keywords

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Article
Publication date: 9 December 2021

Élizabeth Côté-Boileau, Mylaine Breton, Linda Rouleau and Jean-Louis Denis

The purpose of this paper is to explore the appropriation of control rooms based on value-based integrated performance management tools implemented in all publicly funded health…

686

Abstract

Purpose

The purpose of this paper is to explore the appropriation of control rooms based on value-based integrated performance management tools implemented in all publicly funded health organizations in Quebec (Canada) as a form of legitimate sociomaterial work.

Design/methodology/approach

Multi-site organizational ethnographic case studies in two Integrated health and social services centers, with narrative process analysis of triangulated qualitative data collected through non-participant observation (163 h), individual semi-structured interviews (N = 34), and document review (N = 143).

Findings

Three types of legitimate sociomaterial work are accomplished when actors appropriate control rooms: 1) reformulating performance management work; 2) disrupting accountability work and; 3) effecting value-based integrated performance management. Each actor (tools, institutions and people) follows recurrent institutional work-paths: tools consistently engage in disruptive work; institutions consistently engage in maintaining work, and people consistently engage in creation work. The study reveals the potential of performance management tools as “effective integrators” of the technological, managerial, policy and delivery levels of data-driven health system performance and improvement.

Practical implications

This paper draws on theoretically informed empirical insights to develop actionable knowledge around how to better design, implement and adapt tool-driven health system change: 1) Packaging the three agents of data-driven system change in health care: tools, institutions, people; 2) Redefining the search for performance in health care in the context of value creation, and; 3) Strengthening clinical and managerial relevance in health performance management practice.

Originality/value

The authors aim to stimulate new and original scholarship around the under-theorized concept of sociomaterial work, challenging theoretical, ontological and practical conceptions of work in healthcare organizations and beyond.

Details

Journal of Health Organization and Management, vol. 36 no. 4
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 11 March 2014

Mylaine Breton, Lise Lamothe and Jean-Louis Denis

– The aim of this paper is to illustrate and discuss how healthcare organisations can act as institutional entrepreneurs in a context of change.

2086

Abstract

Purpose

The aim of this paper is to illustrate and discuss how healthcare organisations can act as institutional entrepreneurs in a context of change.

Design/methodology/approach

The authors conducted an in-depth longitudinal case study (2005-2008) of a healthcare organisation in the province of Quebec, Canada. Data collection consisted of real-time observations of senior managers (n=87), interviews (n=24) with decision-makers and secondary data analysis of documents.

Findings

The paper reports on the extent to which entrepreneurial healthcare organisations can be a driving force in the creation of a new practice. The authors analyse the development of a diabetes reference centre by a healthcare organisation acting as an institutional entrepreneur that illustrates the conceptualisation of an innovation and the mobilisation of resources to implement it and to influence other actors in the field. The authors discuss the case in reference to three stages of change: emergence, implementation and diffusion. The results illustrate the different strategies used by managers to advance their proposed projects.

Research limitations/implications

This study helps to better understand the dynamics of mandated change in a mature field such as healthcare and the roles played by organisations in this process. By adopting a proactive strategy, a healthcare organisation can play an active role and strongly influence the evolution of its field.

Originality/value

This paper is one of only a few to analyse strategies used by healthcare organisations in the context of mandated change.

Details

Journal of Health Organization and Management, vol. 28 no. 1
Type: Research Article
ISSN: 1477-7266

Keywords

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