BackgroundThe literature on integration indicates the need for an enhanced theorization of institutional integration. This article proposes path dependence as an analytical framework to study the systems in which integration takes place.PurposePRISMA proposes a model for integrating health and social care services for older adults. This model was initially tested in Quebec. The PRISMA France study gave us an opportunity to analyze institutional integration in France.MethodsA qualitative approach was used. Analyses were based on semi-structured interviews with actors of all levels of decision-making, observations of advisory board meetings, and administrative documents.ResultsOur analyses revealed the complexity and fragmentation of institutional integration. The path dependency theory, which analyzes the change capacity of institutions by taking into account their historic structures, allows analysis of this situation. The path dependency to the Bismarckian system and the incomplete reforms of gerontological policies generate the coexistence and juxtaposition of institutional systems. In such a context, no institution has sufficient ability to determine gerontology policy and build institutional integration by itself.ConclusionUsing path dependence as an analytical framework helps to understand the reasons why institutional integration is critical to organizational and clinical integration, and the complex construction of institutional integration in France.

The purpose of this study was to better understand why change initiatives succeed or fail in long-term care organizations. Four case studies from Québec, Canada were contrasted retrospectively. A constipation and restraints program succeeded, while an incontinence and falls program failed. Successful programs were distinguished by the use of a change strategy that combined "let-it happen," "help-it happen," and "make-it happen" interventions to create senses of urgency, solidarity, intensity, and accumulation. These four active ingredients of the successful change strategies propelled their respective change processes forward to completion. This paper provides concrete examples of successful and unsuccessful combinations of "let-it happen," "help-it happen," and "make-it happen" change management interventions. Change managers (CM) can draw upon these examples to best tailor and energize change management strategies in their own organizations.

The best-known theories on interdisciplinarity in the health and social care field seek to identify personal characteristics and organizational predispositions favourable to interprofessionnal collaboration. This paper proposes a reversal of this positioning through the theorization of interdisciplinarity in the health and social care field as a condition of the work of its professionals rather than one of their peculiar attributes. To achieve this reversal, we set out the epistemological foundations of the current debate on interdisciplinarity.

Aim: The PRISMA-France pilot project is aimed at implementing an innovative case management type integration model in the 20th district of Paris. This paper apprehends the emergence of two polarized views regarding the progression of the model's spread in order to analyze the change management enacted during the process and its effects.Method: A qualitative analysis was conducted based on an institutional change model. Results:Our results suggest that, according to one view, the path followed to reach the study's current level of progress was efficient and necessary to lay the foundation of a new health and social services system while according to the other, change management shortcomings were responsible for the lack of progress. Discussion: While neither of these two views appears entirely justified, analyzing the factors underlying their differences pinpoints some of the challenges involved in managing the spread of an integrated service delivery network. Meticulous preparation for the change management role and communication of the time and effort required for a wholesale institutional change process may be significant factors for a successful integrative endeavor.

Résumé Le présent article analyse la réceptivité en contexte français d’un modèle québécois d’intégration des services aux personnes âgées en perte d’autonomie à partir d’une étude de mise en oeuvre de projets pilotes sur trois sites français. L’étude de la réceptivité constitue un analyseur puissant des conditions de possibilité d’une mise à jour d’un système socio-sanitaire. Dans une perspective néo-institutionnaliste, l’article cherche à mieux comprendre comment se déploie pour un système socio-sanitaire particulier la capacité d’innover. Il se compose de trois parties. La première problématise la question de l’intégration, la seconde analyse l’évolution du système socio-sanitaire français, tandis que la dernière expose la réceptivité d’un modèle d’intégration au regard de cette perspective néo-institutionnaliste. Cette analyse de la réceptivité révèle une tension entre deux logiques d’action publique en France en matière d’intégration des services, soit celle de la réduction de la complexité systémique et celle de son animation.