Mergers and integrated care: the Quebec experience

Abstract

As a researcher, I have studied the efforts to increase the integration of health and social services in Quebec, as well as the mergers in the Quebec healthcare system. These mergers have often been presented as a necessary transition to break down the silos that compartmentalize the services dispensed by various organisations. A review of the studies about mergers and integrated care projects in the Quebec healthcare system, since its inception, show that mergers cannot facilitate integrated care unless they are desired and represent for all of the actors involved an appropriate way to deal with service organisation problems. Otherwise, mergers impede integrated care by creating increased bureaucratisation and standardisation and by triggering conflicts and mistrust among the staff of the merged organisations. It is then preferable to let local actors select the most appropriate organisational integration model for their specific context and offer them resources and incentives to cooperate.

Providers’ Perspectives on the Implementation of Mandated Local Health Networks for Older People in Québec

“…Our findings regarding the influence of merging organisations on the implementation of integrated care agree with those of Demers [60], who pointed out that mergers do not automatically lead to integrated practices because they can in fact negatively affect clinical practice. Nevertheless, the mergers seemed to create useful conditions even from the point of view of providers, for example by creating bridges with physicians.…”

Reorganising health and social care in Québec: a journey towards integrating care through mergers

“…Contandriopoulos et al [ 8 ] further point out that contemporary health services research literature suggests that administrative mergers, with the centralisation of decision-making powers that they entail, have not always been proven to improve the accessibility, quality, efficiency or performance of the healthcare system. Merging organisations seems to benefit inter-organisational collaborations at the management/administrative level, but yields fewer benefits at the clinical level, where providers still operate within organisational boundaries [ 22 ]. Furthermore, the size of the merged organisation has to be taken into consideration; for instance, there is a body of concurring scientific evidence suggesting that small administrative mergers serving a population of up to 100,000 may be beneficial, while larger organisational mergers may not be very efficient [ 23 ].…”

How To Build an Integrated Neighborhood Approach to Support Community-Dwelling Older People?

“…The rate and complexity of current reforms were detrimental to established community relationships and generated high levels of mutual distrust and insecurity throughout system levels. Professionals and organizations re-focused energy on individual interests [ 26 28 29 ], rather than working toward the common goal of improving care and support for older people. In line with previous findings, such dynamic environments hampered the development of an innovative culture [ 30 ].…”