“…In practical terms, national policy makers and managers in institutions need to identify and discuss good practice in order to design and implement successful health reforms [7].Our results demonstrate the need to also integrate an analysis of the risks of professional tensions related to political and managerial decisions in order to build health policies adapted to their implementation context.…”
Section: Instrumental Tensions Modifying Professional Practices and Behaviourmentioning
confidence: 86%
“…The main changes that occurred, enacted in regulations and laws, concern the policy, organisation and functioning of healthcare institutions in France [6]. The increase in the number of patients to care for, the complexity of the cases to be handled due to the ageing of the population, the development of chronic diseases, more and more expensive equipment and an unfavourable medical and nursing demography led to an increase in expenditure, a need to control resources and an overloading of physicians and nursing staff [7].…”
Background: Political and managerial reforms affect the health sector by translating into governance tensions. As identified in the public management literature, they come from the diffusion of management principles and practices from the business world. They manifest at four levels: institutional, organisational, managerial and instrumental. The objective of this research is to understand how these tensions express healthcare institutions with different status. Methods: We conduct a contrasting case study exploring the cases of two French healthcare institutions, one private for-profit (clinic) and one public not-for-profit (cancer treatment centre). Our analyses are mainly based on the content analysis of 32 semi-structured interviews conducted with staff (nurses, doctors, management and administrative staff) of these two institutions.Results: Our results show that these tensions can be distinguished into three categories (tensions on professional values, standards and practices) which are expressed differently depending on the type of healthcare institution and its main management characteristics.Conclusions: Unexpectedly, in the for-profit institution, the most intense tensions concern professional standards, whereas they concern professional practices in the not-for-profit institution. These analyses can help guide policy makers and health care managers to better integrate these tensions into their political and managerial decisions.
“…In practical terms, national policy makers and managers in institutions need to identify and discuss good practice in order to design and implement successful health reforms [7].Our results demonstrate the need to also integrate an analysis of the risks of professional tensions related to political and managerial decisions in order to build health policies adapted to their implementation context.…”
Section: Instrumental Tensions Modifying Professional Practices and Behaviourmentioning
confidence: 86%
“…The main changes that occurred, enacted in regulations and laws, concern the policy, organisation and functioning of healthcare institutions in France [6]. The increase in the number of patients to care for, the complexity of the cases to be handled due to the ageing of the population, the development of chronic diseases, more and more expensive equipment and an unfavourable medical and nursing demography led to an increase in expenditure, a need to control resources and an overloading of physicians and nursing staff [7].…”
Background: Political and managerial reforms affect the health sector by translating into governance tensions. As identified in the public management literature, they come from the diffusion of management principles and practices from the business world. They manifest at four levels: institutional, organisational, managerial and instrumental. The objective of this research is to understand how these tensions express healthcare institutions with different status. Methods: We conduct a contrasting case study exploring the cases of two French healthcare institutions, one private for-profit (clinic) and one public not-for-profit (cancer treatment centre). Our analyses are mainly based on the content analysis of 32 semi-structured interviews conducted with staff (nurses, doctors, management and administrative staff) of these two institutions.Results: Our results show that these tensions can be distinguished into three categories (tensions on professional values, standards and practices) which are expressed differently depending on the type of healthcare institution and its main management characteristics.Conclusions: Unexpectedly, in the for-profit institution, the most intense tensions concern professional standards, whereas they concern professional practices in the not-for-profit institution. These analyses can help guide policy makers and health care managers to better integrate these tensions into their political and managerial decisions.
“…Our study showed the implication of the concept of S-D L within a setting specific to oncology patients of telephone follow-up using the in-role and extra-role approach. It contributes to the S-D L literature transposed to care services management [ 27 , 32 ] and to the integrated care pathway literature [ 56 ] by showing how much we have to rethink the place of the patient in health services by relying on the nursing staff. Our work showed the paradoxical effects of setting up a remote monitoring service between the development of patients’ roles and an autonomy which remains relative (in-role and extra-role) and the creation of dependence on the monitoring service offered.…”
Background
The French healthcare system is characterised by a shift towards outpatient care and the desire to develop telemedicine affirmed in the collective commitment “Ma santé 2022” presented by President Macron in 2018. In France, remote patient follow up has recently been developed in the active phase of cancer treatment inspired by the patient navigation approach used in other countries. According to Service-Dominant Logic (S-D L), patients become more active. Their role in co-production of services is strengthened and their behaviours changed. Telephone follow-ups can contribute to modifying the relationship between the patient and the nurse navigators in charge of it, moving logically from a passive attitude from the patient to a more active one.
Methods
This study was carried out at Léon Bérard, a cancer control unit, in France. It concerned patients treated in an oncohaematology department, who benefited from telephone follow-ups carried out by nurse specialists during the active phase of their treatment. The multidisciplinary research team including social science researchers, physicians and carers developed a research protocol to study this pilot case. Essentially based on a qualitative approach, it was validated by the centre’s management to study this follow-up on patients’ behaviours. The 1st phase of the research, based on 24 semi-structured interviews with patients undergoing treatment undertaken from November 2018 to September 2019, is presented.
Results
The Telephone follow-up was a positive experience for all patients. The action of the nurse specialist helped to develop certain dimensions of in-role and extra-role behaviour that created value. The patients’ discourse has reported a positive follow-up in its clinical dimensions, its psychological dimensions and an enhanced quality of life. We detected a patient activation through their roles but it remained limited. The telephone follow-up also created a patient dependency.
Conclusions
The telephone follow-up is a relevant tool for patients undergoing treatment and it deserves to be more widely deployed. It brings comfort and creates a relationship based on trust but at the same time it limits the emancipation of the patient, which is a central element of the S-D logic and its empowerment.
The article supporting this method (Mériade & Rochette, 2020) examines how to apply a spatial approach including the geographical and relational dimensions to care pathways for their better integration within their territories. Based on the case study of a senology department of a French Cancer Diagnosis, Treatment and Research Center, we apply a mixed research methodology using qualitative data (synthesis documents, meeting minutes, in-depth interviews) and quantitative data relating to the mobility and geographical location of a cohort of 1798 patients treated in this center. The objective of this method is to combine, in a dynamic way, a relational and cartographic approach in order to describe integrated health care pathways in their territories. Our results show the inseparable nature of the relational dimension and the geographical approach to move towards greater integration of breast cancer care pathways. This inseparability is illustrated by an initial cartographic description of integrated care pathways in their territory, illustrated in our case study by four major pathway categories. This research provides answers to the difficulties observed by the health authorities in France concerning the implementation of coordinated patient pathways at the area level.
The first step of the method is to identify how pathway integration is expressed for professionals and patients.
The second step, continuing from the first, consists of observing the criteria for identifying the care pathways chosen by stakeholders (patients, healthcare institutions, city medicine).
The third step consists of representing, on a geographic map, the elements relative to the different criteria observed during the second step from the study of a cohort of patients.
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