Search

The term "social licence" has been used to describe which uses and users of health data the public supports - and under what conditions. From November 2022 to January 2023, Health Data Research Network Canada was funded by the Public Health Agency of Canada to explore whether there was consensus among experienced public and patient advisors on: (i) uses of health data that all members supported or opposed and (ii) what constitutes an essential requirement for a health data use or user to be within social licence. The project was conducted in English and French in collaboration with the Interdisciplinary Research Group in Health Informatics (GRIIS) at the University of Sherbrooke. It involved 20 public/patient advisor "participants" and an additional 13 public/patient advisors who served as peer-reviewers, all of whom had prior experience working in a health-related field and/or with health data. The process followed inclusive design principles in that it captured views held by the majority and minority of participants, including views expressed by only one or two participants. After two 2-hour facilitated sessions, participants agreed that it is within social licence for health data to be used (i) by healthcare practitioners to improve patient care, (ii) by governments and administrators to improve the health system, and (iii) by university-based researchers to understand disease and well-being. There was consensus opposition to (i) an individual or organisation selling someone else's identified health data and (ii) health data being used for a purpose that has no public or societal benefit. There was no consensus about what constitutes an essential requirement for a use or users of health data to be with social licence. The results of the process have been published in a non-peer-reviewed report co-authored with participants. This paper has been co-authored with a subset of the participants and peer-reviewers to present a high-level summary of the findings, methodological details, and templates to enable other groups to adapt the process to their own settings. It also presents the results of an anonymous evaluation of the process using the Public and Patient Engagement Evaluation Tool (PPEET), which were mostly positive and identified some areas for improvement.

Background: Integrated care pathways (ICPs) could improve the organisation and delivery of care for community dwelling older adults. An ICP was developed and implemented in Québec to support home care processes. This study explores the perspectives of home care staff on the use of an ICP to support the organisation and delivery of health and social care to community-dwelling older adults with complex needs. Theory and Methods: A case study based on eleven semi-structured interviews and analysis of documents was carried out in an urban home care unit. The Normalization Process Theory was used for mixed thematic analysis. Results: While its capacity to store data and enhance interprofessional information exchange was appreciated by home care staff, the broad scope, and automated features of the ICP tool were often problematic. Concerns about increased provider workloads, disruption to provider-client relationships during clinical encounters, and difficulties engaging clients in decision-making were main obstacles in the use of the ICP. Conclusion: Given the importance of ICPs in advancing clinical integration, it is critical to continuously adjust their design to align with providers’ realities in order to optimize their potential in real life contexts.

Introduction: Demographic and epidemiological transitions of industralized countries mean health systems have to integrate health and social services to respond to the changing needs of their populations. Efforts to integrate care involve important policy and structural changes. This paper examines whether integration efforts are lost in translation during the bureaucratic appropriation of models, or, in an allegorical way, do they reveal genes of bureaucracy? Description: Since the 1960s, the health system of Québec has undergone four major structural and progressively integrative transformations, characterized as – modernization, shock of reality, explicit integration, and centralization phases. Discussion: Although integration efforts progressively transformed Québec’s health and social services system, embedded bureaucracies impeded the realisation of these projects. Notably, inadequate change management strategies and lack of integrated funding models hindered integration efforts. Furthermore, there was variability in government prioritisation and support of different aspects of the model by making some components happen, helping others happen and letting others happen. Conclusion: Drawing insights from bureaucratic obstacles to integration efforts may improve implementation strategies. This paper highlights important policy and administrative challenges that have to be taken into consideration in improving the implementation of integrated care initiatives in a real-life context.

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.

Abstract Background Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption. Methods We take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis. Results Despite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability. Conclusions Even in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.

Introduction: Integrated care models for older adults are increasingly implemented in modern healthcare systems. They usually involve complex coordination and collaborations between multiple actors operating at different levels of the healthcare system. Several groups of actors such as policymakers (at the strategic level), managers (at the tactical level), providers (at the operational level), patients and caregivers, are simultaneously involved in the implementation of integrated care. Exploring their convergent and divergent perspectives may deepen our understanding of the values prioritised by these respective groups of actors in the successful implementation of integrated care. Aim: To explore the implementation of a province-wide community-based integrated healthcare model for older adults in Quebec by comparing the perspectives of policymakers, managers, providers, patients and caregivers. Theory and methods: A qualitative multiple-case study, consisting of 97 semi-structured interviews with different actors - policymakers (n=11); managers (n=34), health and social care providers (n=29), older adult patients (n=14) and caregivers (n=9) - as well as document analysis. Thematic analysis of the views of these five groups of actors were compared along the lines of the six dimensions of the Rainbow Model of Integrated Care (Valentijn, 2015). Results/discussion: In this centralised province-wide integrated care model, there are strong convergent perspectives of policymakers, managers and providers regarding the professional, organisational, systemic, functional and normative dimensions of integration. Our results showed the limited participation of patients and caregivers in the implementation process, since they had little information on those dimensions. Although policymakers, managers and providers often adhere to the same principles, differences are sometimes observed at the level of implementation. For instance, they all viewed the "continuity" item as a central element where organizational structures must support service trajectories. However, several providers report that the poor harmonization of the operating rules between the organizations and the lack of knowledge of the various programs create a lack of fluidity. Among the six dimensions, the clinical dimension was illuminated by all perspectives, with the most divergence between actors. Providers appeared to mediate between policymakers/managers, and patients/caregivers. For example, patients and caregivers offered insights into the perceived difficulties of meeting their needs. Policymakers and managers viewed the centrality of patient needs as empowering patients/caregivers to receive the services they felt most strongly about. Meanwhile, providers were mostly concerned with the capacity of the healthcare system to balance patient needs with the limited resources available. Conclusion: Centralised province-wide integration appears to have systemic, organizational, functional, and normative effects, but clinical effects are more uncertain as evidenced by the observed divergences in perspectives of actors. Lessons learned: Additional implementation efforts are needed to improve clinical integration in centralised healthcare systems. Limitations: Coordinating data analysis and interpretation was complicated by the high volume of interviews across the different perspectives. Suggestions for future research: Are systemic effects precursors of clinical changes or, on the contrary, does their importance explain the lack of clinical effects?

Introduction: In many countries, integrated care has been implemented to improve the quality, efficiency and patient experience of services. Understanding how integrated care is adopted in different settings may give insights into where, how and why different components of the organisational design work. The aim of this article is to understand how and why integrated care for older people has been implemented in different contexts from the perspective of providers. Theory and methods: The study uses an innovative composite framework for the implementation of integrated care models, which posits that structural, organisational, provider, innovation and patient factors influence implementation along six dimensions of integration. A qualitative multiple case study was done of three cases in Québec using document analysis and semi-structured interviews of 28 providers. Descriptive comparisons and thematic analysis were performed. Results: Providers considered that structural (government policy) and organisational (mergers) factors highly influenced the implementation of organisational and functional dimensions of integration, at the detriment of clinical integration. Provider, innovation and patient factors mildly or moderately influenced the implementation of integration. Conclusion: Structural and organisational factors were necessary conditions for the implementation of administrative components of integration, with great variability in the implementation of some clinical components.

The aim of this paper is to set the foundation for subsequent empirical studies of the “Implementing models of primary care for older adults with complex needs” project, by introducing and presenting a brief descriptive comparison of the nine case studies in Quebec, Ontario and New Zealand. Each case is described based on key dimensions of Rainbow model of Valentijn and al (2013) with a focus on “meso level” integration. Meso level integration is represented by organizational and professional elements of the Rainbow Model, which are of particular interest in our nine case studies. Each of the three cases in Ontario and three in New Zealand are different and described separately. In Quebec, a local health services network model is presented across the three cases studied with variations in the way it is implemented. The three cases selected in the three jurisdictions under study were not chosen to be representative of wider practice within each country, but rather represent interesting and unique models of community-based primary healthcare integration. Similarities and variations in the integrated care models, context and dimension of integration offer insights regarding core component of integration of services, offering a foundational understanding of the cases on which future analysis will be based.

The principle of Aging Well guides the conception of many current political and clinical intervention modalities in the geriatric sphere. In this paper, we will demonstrate that this principle is built around a project of enablement of elderly people and a project of protocolisation of professional action. Using the examples of the case management device and the Healthy Aging approach, we will argue that these two projects, who look paradoxical at first sight, partake of the same matrix whose current form of public action is the New Public Management. In order to clarify how enablement of elderly people and protocolisation of professional action are linked, we will resort to the foucaldian concept of governmentality, which ties together expected forms of subjectivity and social devices.