The role of collaborative governance in translating national cancer programs into network-based practices: A longitudinal case study in Canada
Notice bibliographique
Résumé
OBJECTIVES: Networks (multiple organizations or actors coordinating their activities towards a common goal) have been promoted in the cancer programs of a number of countries. But there is little empirical evidence on whether and how they overcome the siloed functioning endemic in specialized domains. This study examines how collaborative governance takes shape to support integrated network-based practices within a prescribed national cancer program. METHODS: = 45) generated at national and regional level. Abductive thematic analysis during and post-field work was based on Emerson's collaborative governance framework. It aimed to identify how collaborative governance mechanisms (principled engagement, shared motivation and capacity for joint action) were activated in the network, and their contribution to translating a national cancer program into network-based practices at the point of care. RESULTS: Principled engagement was driven through interdisciplinary committees at national and regional level, communities of practice and trajectory-development efforts. These mandated structures supported knowledge exchange and contributed to the recognition of interdependencies, distribution of leadership and development of mutual understanding and trust. Shared motivation benefitted from a vision of patient-centred care but was hindered by top-down communication vehicles that did not allow regional priorities to filter upwards to central level. Between care providers in different settings, trust and candidacy were identified as mechanisms important to shared motivation, though network actions did not sufficiently support trust across care settings, or even between members of the same profession. Candidacy issues hindered family physician participation in cancer network structures that mirrored ongoing difficulties to including them in cancer care practice. Institutional arrangements were important drivers of capacity for joint action in the network. Common indicators were recognized as important to generating efforts towards common goals; however, questions around their validity reduced their contribution to capacities for joint action. CONCLUSIONS: Despite favorable starting conditions from the national cancer program and its central leadership promoting collaborative governance, tensions that emerge through the pursuit of network integration limit the transition to a more collaborative practice. Taking the time to work out these tensions as integration proceeds in waves appears essential to arrive at a governance model that is appropriate and acceptable for all network members.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
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 | 0,007 | 0,016 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,002 | 0,004 |
| Études des sciences et des technologies | 0,028 | 0,006 |
| Communication savante | 0,005 | 0,002 |
| Science ouverte | 0,003 | 0,006 |
| Intégrité de la recherche | 0,002 | 0,003 |
| 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 ».