Stakeholder Views on Solutions to Improve Health System Performance

Brousselle, Astrid; Contandriopoulos, Damien; Haggerty, Jeannie; Bréton, Mylaine; Rivard, Mélina; Beaulieu, Marie-Dominique; Champagne, Geneviève; Perroux, Mélanie

doi:10.12927/hcpol.2018.25547

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…While we anticipated that different stakeholder groups might have opposing views, our data shows that challenges and solutions were generally agreed upon by the different types of stakeholders. This is consistent with another study conducted in Québec that found general agreement between health professionals and decision-makers on solutions to improve the health system [26]. Our study adds to this by mobilizing local citizens as well.…”

Section: Feasibility Of Our Approachsupporting

confidence: 92%

Improving delivery of care in rural emergency departments: a qualitative pilot study mobilizing health professionals, decision-makers and citizens in Baie-Saint-Paul and the Magdalen Islands, Québec, Canada

Fleet

Turgeon-Pelchat

Smithman

et al. 2020

BMC Health Serv Res

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Background: Emergency departments (EDs) in rural and remote areas face challenges in delivering accessible, high quality and efficient services. The objective of this pilot study was to test the feasibility and relevance of the selected approach and to explore challenges and solutions to improve delivery of care in selected EDs. Methods: We conducted an exploratory multiple case study in two rural EDs in Québec, Canada. A survey filled out by the head nurse for each ED provided a descriptive statistical portrait. Semi-structured interviews were conducted with ED health professionals, decision-makers and citizens (n = 68) and analyzed inductively and thematically. Results: The two EDs differed with regards to number of annual visits, inter-facility transfers and wait time. Stakeholders stressed the influence of context on ED challenges and solutions, related to: 1) governance and management (e.g. lack of representation, poor efficiency, ill-adapted standards); 2) health services organization (e.g. limited access to primary healthcare and long-term care, challenges with transfers); 3) resources (e.g. lack of infrastructure, limited access to specialists, difficult staff recruitment/retention); 4) and professional practice (e.g. isolation, large scope, maintaining competencies with low case volumes, need for continuing education, teamwork and protocols). There was a general agreement between stakeholder groups. Conclusions: Our findings show the feasibility and relevance of mobilizing stakeholders to identify contextspecific challenges and solutions. It confirms the importance of undertaking a larger study to improve the delivery of care in rural EDs.

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Section: Feasibility Of Our Approachsupporting

confidence: 92%

Improving delivery of care in rural emergency departments: a qualitative pilot study mobilizing health professionals, decision-makers and citizens in Baie-Saint-Paul and the Magdalen Islands, Québec, Canada

Fleet

Turgeon-Pelchat

Smithman

et al. 2020

BMC Health Serv Res

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show abstract

“…En plus d'un meilleur contrôle des dépenses, les projets de réforme des systèmes de santé font face à un autre impératif, soit un renouvèlement de l'offre de soins [1]. Alors que les opérations de restructuration décrétées par les gouvernements engendrent des bouleversements importants auprès des acteurs interdépendants du système de santé, elles ne mènent pas toujours à la concrétisation des changements prévus [1][2][3][4][5][6]. Ces constats raniment un intérêt pour l'étude des instruments à la disposition de l'État dans sa gouverne ; ils suscitent des interrogations nouvelles sur les possibilités et les limites des États pour entreprendre et mener des transformations majeures.…”

Section: Introductionunclassified

Le difficile pilotage d’une réforme d’un système de santé : cas du Nouveau-Brunswick (Canada)

Collin¹,

Lamothe²

2020

Santé Publique

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réservés pour tous pays.La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que dans les limites des conditions générales d'utilisation du site ou, le cas échéant, des conditions générales de la licence souscrite par votre établissement. Toute autre reproduction ou représentation, en tout ou partie, sous quelque forme et de quelque manière que ce soit, est interdite sauf accord préalable et écrit de l'éditeur, en dehors des cas prévus par la législation en vigueur en France. Il est précisé que son stockage dans une base de données est également interdit.

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“…Daniels et al [22] hold that a better understanding of the level of congruence amongst stakeholder perspectives on a healthcare innovation is “ important for addressing tensions between stakeholders and therefore for creating coherent and implementable policy ” (p. 492). Several studies recognise multiple stakeholders as key informants whose differing perspectives may serve as contextual evidence that can inform the development of healthcare policies and practices [2324252627].…”

Section: Introductionmentioning

confidence: 99%

Multiple Perspectives Analysis of the Implementation of an Integrated Care Model for Older Adults in Quebec

Bréton¹,

Wankah²,

Guillette³

et al. 2019

Int J Integr Care

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Introduction:Integrated care models for older adults are increasingly utilised in healthcare systems to overcome fragmentations. Several groups of stakeholders are involved in the implementation of integrated care. The aim of this study is to identify the main concerns, convergences and divergences in perspectives of stakeholders involved in the implementation of a centralised system-wide integrated care model for older adults in Quebec.Theory and methods:Qualitative multiple-case study. Semi-structured interviews of key stakeholders: policymakers (n = 11), providers (n = 29), managers (n = 34), older adult patients (n = 14) and caregivers (n = 9), including document analysis. Thematic analysis of the views of stakeholders along the lines of the six dimensions of the Rainbow Model of Integrated Care.Results:While patients/caregivers were mostly concerned by their unmet individual needs, policymakers, managers and providers were concerned by structural barriers to integrating care. Stakeholders’ diverse perspectives indicated implementation gaps in a top-down implementation context.Conclusion:Mandated system-wide integration appears to have structural, organizational, functional, and normative transformations, but its clinical changes are more uncertain in view of the observed divergent perspectives of actors. It will be interesting to explore if the systemic changes are precursors of clinical changes or, on the contrary, explains the lack of clinical changes.

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Stakeholder Views on Solutions to Improve Health System Performance

Cited by 4 publications

References 22 publications

Improving delivery of care in rural emergency departments: a qualitative pilot study mobilizing health professionals, decision-makers and citizens in Baie-Saint-Paul and the Magdalen Islands, Québec, Canada

Improving delivery of care in rural emergency departments: a qualitative pilot study mobilizing health professionals, decision-makers and citizens in Baie-Saint-Paul and the Magdalen Islands, Québec, Canada

Le difficile pilotage d’une réforme d’un système de santé : cas du Nouveau-Brunswick (Canada)

Multiple Perspectives Analysis of the Implementation of an Integrated Care Model for Older Adults in Quebec

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