Chaire de recherche du Canada en économie politique internationale et comparée (CRÉPIC)
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CIHR Team in reconfiguration of health care organizations and systems

Période
2008-2013

Noms des chercheurs principaux, titre et affiliations
Denis, JL
Contandriopoulos AP
P. Lehoux,
F. Champagne
A. Langley et al.

Budget total
2 627 171 $

Source de financement
IRSC

Résumé

CIHR Team Grant in Reconfiguration of Health Care Organizations and Systems

Our comprehensive research project pursues the following general and specific objectives:

General Objective: To understand the governance of change within health care networks. Overall, our research is intended to generate a system of knowledge production and exchange that can be used to monitor, inform, and support the initiation, implementation, and sustainability of health care networks.

Specific Objectives:

(1) To identify the factors that contribute to successful change within health care networks.
(2) To understand the role performance management can play in evaluating and improving health care networks. (3) To understand the conditions that favour research-based governance changes within health care networks.

The overarching theme of our research project is the governance of change within health care networks – an organizational innovation at the core of health care reform across Canada. In particular, our work focuses on three interdependent dimensions affecting the governance of change: the management of change and innovation, performance management, and knowledge management. Our general objective is to understand the pivotal factors and processes involved in the initiation, implementation, and institutionalization of health care networks as new organizational forms and practices designed to improve the functioning, adaptation, and long-term sustainability of health care organizations and systems. Our work addresses an issue that is often neglected in health care research and even in the practical design of new health care arrangements: the fact that the process of change is itself critical in determining whether or not the theoretical benefits of new organizational forms can be attained in reality.

Our project is articulated around three main components. The objective of Component 1 is to identify the factors that contribute to successful change within health care networks. Based on recent research on organizational change, we propose to use a longitudinal survey to study the emergence of local health care networks in Quebec and to compare this phenomenon with the emergence of disease-based networks associated with Cancer Care Ontario (CCO). The relationship between network attributes, perceived network effectiveness and effectiveness in terms of client outcomes will be analysed empirically. We then propose to analyze, using in-depth case studies, the transition processes of organizations in the Quebec health care system towards the network form at the strategic and operational/clinical levels. We will compare our findings with network-formation processes in Ontario, Alberta, and the UK.

Component 2 examines the role of performance management as a formal system for evaluating and improving health care networks. Based on an integrative model of performance assessment for health care organizations, we propose to study, using verbal protocol analysis, the ways key actors within networks construct their judgements regarding performance. We then propose to analyze, using in-depth case studies, how performance assessment systems are used in 12 health care networks under the jurisdiction of Quebec’s Montérégie regional health authority. This step will enable us to understand the roles contextual and organizational factors play in performance management. We will then draw on indepth case studies to scrutinize the role collective decision-making processes play in determining network performance.

Component 3 is aimed at understanding the conditions that favour research-based governance changes within health care networks. Based on a theoretical model of organizational receptive capacity, we will first develop and assess the potential of forums to foster deliberation among researchers and practitioners around research findings. We will then develop a systematic review of the types, functioning, and outcomes of knowledge-based networks in order to gain an understanding of the variety of organizational arrangements that can promote the co-production and co-interpretation of research. Finally, using three significant experiments that aim to institutionalize collaboration and exchange among researchers and practitioners, we will conduct in-depth case studies in order to identify challenges facing and promising strategies for supporting the use of research to initiate and implement governance changes within health care networks.