Governance in times of turbulence: how has management by pathway facilitated the adaptation of the health and social services system in the context of Covid-19?
Notice bibliographique
Résumé
In Quebec, the notion of pathway integrates social and health dimensions, user-centered and is conceived as an intertwining of several episodes of care and services over long periods with an intersectoral perspective. A reform in Quebec's health system 2015 put the implementation of such pathways at the agenda. We conducted a developmental evaluation to study the implementation of integrated care pathways in 3 healthcare organizations and their network in Quebec (2017-2019). And we currently conduct another one to follow up with these 3 organizations (+ 2) in the turbulent context of COVID-19. In parallel, we gathered observational notes during meetings of various crisis cells set up to address the COVID-19 pandemic in its very early days in one of the territories of the study (April-May 2020). We seek to understand how change in governance occurred during the development of the integrated care pathways and its impact of leadership and decision taking inside and outside through healthcare organizations. Ultimately, we try to understand whether these governance practices have effectively facilitated the response to the pandemic crisis. The analysis used a conceptual framework based on the Complex Adaptive Systems (CAS) approach of multi-level governance and the model for robust governance strategies in a turbulent context developed by Ansell, Sorensen and Torfing (2020). Qualitative empirical data were collected through documentation (N=12) and observation (N=80h). Our results show that implementation of health and social pathways is based on a double innovation in terms of governance: based on a strategic community approach and introducing a matrix structure in the organization. Although pathway-based management has not been fully implemented in the healthcare organizations studied, our observations show that the change of vision has taken place and certain reflexes have been adopted. For example, the pandemic crisis cells were based on the perspectives put forward by the field (operational level), and the decision, action and feedback loops were very short. The COVID-19 pandemic showed that the health system is capable of great agility, particularly when it relies on a matrix dynamic for decision- making. Management by care and services pathways provides a systemic vision of the issues faced by the organization, in addition to being a cross-functional management tool between the various departments and between the operational, tactical and strategic levels of governance.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,018 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,006 | 0,011 |
| Communication savante | 0,009 | 0,008 |
| Science ouverte | 0,001 | 0,005 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».