Regional planning implementation and its impact on integration of a mental health care network

Abstract

This article questions the effectiveness of a managerial tool in changing a health-care system. The process of implementing regional planning and its impact on creating integrated service networks is examined, using a case study and a multi-dimensional analytic model. This model highlights the influence of contextual, structural, cultural and dynamic factors on forming networks. The regional planning developed in the province of Québec (Canada), aimed at a major transformation of the mental health-care system. In each district, organizations working with people who have serious mental disorders were mobilized to plan and implement a more coordinated, continuous and diversified supply of services, under the direction of a regional health body. This study outlines the limitations of regional planning as a tactic for transforming the system. It recommends instead developing more diversified integration strategies to further the process of forming integrated service networks within a complex system. In conclusion, a brief discussion deals with the difficulties related to the study of systemic change implementation.

Implementing new modes of governance in the New Zealand health system: An empirical study

“…As several authors have noted, political and cultural requirements [24,47] and trusting relationships [19] are as important as formal modes and mechanisms of governance. Visiting US health commentators in 2007 noted: 'Kiwi culture is uniquely suited to the health system: expectations and sensitivities are in line with the scheme of this government run care' [48].…”

“…The strongest mechanism has been the collaboration between district health boards which emerged without government mandate, and effectively became a formal network. Despite reservations over the effectiveness of mandated networks [24] a number of systems are experimenting with these in the form of managed clinical networks and partnerships with community providers (e.g. Scotland).…”

“…Mechanisms for network relationships between independently governed provider organisations may be either voluntary or mandated by administrative arrangements, or some combination of the two [19,23]. Managerialist, or 'top down', approaches alone are not always successful in achieving collaboration or integration [19,23,24], with combinations of incentives and guidance producing better results [23]. The prospects for successful non-mandated horizontal relationships, however, rely on alternative mechanisms, including leadership and shared values [25], arrangements for managing relationships and the nature of the environment, including levels of competition [26].…”

La transformation des services de santé mentale et le rôle des pros

“…Bref, l'importance des modifications sousjacentes à l'actualisation du PROS et sa faible valeur instrumentale font qu'il a peu été institutionnalisé dans la pratique, bien qu'il ait fait l'objet d'une forte diffusion et que les acteurs s'y réfèrent régulièrement pour la gestion des services. Sa mise en oeuvre et son impact en matière de pratiques d'intervention, de comportements organisationnels, de la vision et de l'offre de services ont donc été limités, et s'inscrivent davantage dans un processus émergent (incremental changes : PETTIGREW, 1985 ;GREENWOOD et HININGS, 1993, 1996FLEURY, MERCIER et DENIS, 2002).…”

“…La mise en oeuvre de nouveaux « outils de gestion » pour réguler un espace social n'est pas facile, puisqu'ils tentent de supplanter les régulations déjà institutionnalisées dans un système. L'importance des modifications envisagées par une réforme et la complexité des outils de gestion mobilisés pour supporter ce dispositif encadrent son processus de développement et ses effets (FLEURY, MERCIER et DENIS, 2002). Vu la portée des transformations planifiées de l'organisation des services et des mécanismes à déployer pour la planification, la mise en oeuvre et les effets du PROS ne pouvaient qu'être limités.…”