Reforming primary healthcare: from public policy to organizational change
Purpose – Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a pr...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Gilbert, Frédéric [verfasserIn] |
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| Format: |
Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2015 |
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| Rechteinformationen: |
Nutzungsrecht: © Emerald Group Publishing Limited |
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| Schlagwörter: |
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| Übergeordnetes Werk: |
Enthalten in: Journal of health organization and management - Bingley : Emerald Group Publishing Limited, 2003, 29(2015), 1, Seite 92-110 |
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| Übergeordnetes Werk: |
volume:29 ; year:2015 ; number:1 ; pages:92-110 |
| Links: |
|---|
| DOI / URN: |
10.1108/JHOM-12-2012-0237 |
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| Katalog-ID: |
OLC1957605677 |
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| 520 | |a Purpose – Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. Design/methodology/approach – An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. Findings – The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of “intermediate change” and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. Research limitations/implications – This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. Practical implications – The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. Originality/value – This research is one of few studies to examine a primary care reform from emergence to implementation using a longitudinal multi-level design. | ||
| 540 | |a Nutzungsrecht: © Emerald Group Publishing Limited | ||
| 650 | 4 | |a Health & social care | |
| 650 | 4 | |a Healthcare management | |
| 650 | 4 | |a Primary Health Care - organization & administration | |
| 650 | 4 | |a Health care policy | |
| 650 | 4 | |a Studies | |
| 650 | 4 | |a Physicians | |
| 650 | 4 | |a Primary care | |
| 650 | 4 | |a Public policy | |
| 650 | 4 | |a Public health | |
| 650 | 4 | |a Family physicians | |
| 650 | 4 | |a Information systems | |
| 700 | 1 | |a Denis, Jean-Louis |4 oth | |
| 700 | 1 | |a Lamothe, Lise |4 oth | |
| 700 | 1 | |a Beaulieu, Marie-Dominique |4 oth | |
| 700 | 1 | |a D'amour, Danielle |4 oth | |
| 700 | 1 | |a Goudreau, Johanne |4 oth | |
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10.1108/JHOM-12-2012-0237 doi PQ20160617 (DE-627)OLC1957605677 (DE-599)GBVOLC1957605677 (PRQ)c2117-70dbde21b05190d3d8993343fbda89c2596b21476fa9ece8a84a1eae8fda9b600 (KEY)0157233420150000029000100092reformingprimaryhealthcarefrompublicpolicytoorgani DE-627 ger DE-627 rakwb eng 610 ZDB 44.04 bkl 44.00 bkl Gilbert, Frédéric verfasserin aut Reforming primary healthcare: from public policy to organizational change 2015 Text txt rdacontent ohne Hilfsmittel zu benutzen n rdamedia Band nc rdacarrier Purpose – Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. Design/methodology/approach – An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. Findings – The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of “intermediate change” and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. Research limitations/implications – This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. Practical implications – The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. Originality/value – This research is one of few studies to examine a primary care reform from emergence to implementation using a longitudinal multi-level design. Nutzungsrecht: © Emerald Group Publishing Limited Health & social care Healthcare management Primary Health Care - organization & administration Health care policy Studies Physicians Primary care Public policy Public health Family physicians Information systems Denis, Jean-Louis oth Lamothe, Lise oth Beaulieu, Marie-Dominique oth D'amour, Danielle oth Goudreau, Johanne oth Enthalten in Journal of health organization and management Bingley : Emerald Group Publishing Limited, 2003 29(2015), 1, Seite 92-110 (DE-627)363769676 (DE-600)2108289-3 (DE-576)47789321X 1477-7266 nnns volume:29 year:2015 number:1 pages:92-110 http://dx.doi.org/10.1108/JHOM-12-2012-0237 Volltext http://www.ncbi.nlm.nih.gov/pubmed/25735555 http://search.proquest.com/docview/1655458449 GBV_USEFLAG_A SYSFLAG_A GBV_OLC SSG-OLC-WIW SSG-OLC-PHA SSG-OLC-DE-84 GBV_ILN_26 44.04 AVZ 44.00 AVZ AR 29 2015 1 92-110 |
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10.1108/JHOM-12-2012-0237 doi PQ20160617 (DE-627)OLC1957605677 (DE-599)GBVOLC1957605677 (PRQ)c2117-70dbde21b05190d3d8993343fbda89c2596b21476fa9ece8a84a1eae8fda9b600 (KEY)0157233420150000029000100092reformingprimaryhealthcarefrompublicpolicytoorgani DE-627 ger DE-627 rakwb eng 610 ZDB 44.04 bkl 44.00 bkl Gilbert, Frédéric verfasserin aut Reforming primary healthcare: from public policy to organizational change 2015 Text txt rdacontent ohne Hilfsmittel zu benutzen n rdamedia Band nc rdacarrier Purpose – Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. Design/methodology/approach – An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. Findings – The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of “intermediate change” and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. Research limitations/implications – This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. Practical implications – The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. Originality/value – This research is one of few studies to examine a primary care reform from emergence to implementation using a longitudinal multi-level design. Nutzungsrecht: © Emerald Group Publishing Limited Health & social care Healthcare management Primary Health Care - organization & administration Health care policy Studies Physicians Primary care Public policy Public health Family physicians Information systems Denis, Jean-Louis oth Lamothe, Lise oth Beaulieu, Marie-Dominique oth D'amour, Danielle oth Goudreau, Johanne oth Enthalten in Journal of health organization and management Bingley : Emerald Group Publishing Limited, 2003 29(2015), 1, Seite 92-110 (DE-627)363769676 (DE-600)2108289-3 (DE-576)47789321X 1477-7266 nnns volume:29 year:2015 number:1 pages:92-110 http://dx.doi.org/10.1108/JHOM-12-2012-0237 Volltext http://www.ncbi.nlm.nih.gov/pubmed/25735555 http://search.proquest.com/docview/1655458449 GBV_USEFLAG_A SYSFLAG_A GBV_OLC SSG-OLC-WIW SSG-OLC-PHA SSG-OLC-DE-84 GBV_ILN_26 44.04 AVZ 44.00 AVZ AR 29 2015 1 92-110 |
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10.1108/JHOM-12-2012-0237 doi PQ20160617 (DE-627)OLC1957605677 (DE-599)GBVOLC1957605677 (PRQ)c2117-70dbde21b05190d3d8993343fbda89c2596b21476fa9ece8a84a1eae8fda9b600 (KEY)0157233420150000029000100092reformingprimaryhealthcarefrompublicpolicytoorgani DE-627 ger DE-627 rakwb eng 610 ZDB 44.04 bkl 44.00 bkl Gilbert, Frédéric verfasserin aut Reforming primary healthcare: from public policy to organizational change 2015 Text txt rdacontent ohne Hilfsmittel zu benutzen n rdamedia Band nc rdacarrier Purpose – Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. Design/methodology/approach – An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. Findings – The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of “intermediate change” and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. Research limitations/implications – This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. Practical implications – The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. Originality/value – This research is one of few studies to examine a primary care reform from emergence to implementation using a longitudinal multi-level design. Nutzungsrecht: © Emerald Group Publishing Limited Health & social care Healthcare management Primary Health Care - organization & administration Health care policy Studies Physicians Primary care Public policy Public health Family physicians Information systems Denis, Jean-Louis oth Lamothe, Lise oth Beaulieu, Marie-Dominique oth D'amour, Danielle oth Goudreau, Johanne oth Enthalten in Journal of health organization and management Bingley : Emerald Group Publishing Limited, 2003 29(2015), 1, Seite 92-110 (DE-627)363769676 (DE-600)2108289-3 (DE-576)47789321X 1477-7266 nnns volume:29 year:2015 number:1 pages:92-110 http://dx.doi.org/10.1108/JHOM-12-2012-0237 Volltext http://www.ncbi.nlm.nih.gov/pubmed/25735555 http://search.proquest.com/docview/1655458449 GBV_USEFLAG_A SYSFLAG_A GBV_OLC SSG-OLC-WIW SSG-OLC-PHA SSG-OLC-DE-84 GBV_ILN_26 44.04 AVZ 44.00 AVZ AR 29 2015 1 92-110 |
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However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. Design/methodology/approach – An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. Findings – The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. 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Purpose – Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. Design/methodology/approach – An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. Findings – The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of “intermediate change” and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. Research limitations/implications – This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. Practical implications – The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. Originality/value – This research is one of few studies to examine a primary care reform from emergence to implementation using a longitudinal multi-level design. |
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Purpose – Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. Design/methodology/approach – An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. Findings – The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of “intermediate change” and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. Research limitations/implications – This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. Practical implications – The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. Originality/value – This research is one of few studies to examine a primary care reform from emergence to implementation using a longitudinal multi-level design. |
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Purpose – Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. Design/methodology/approach – An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. Findings – The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of “intermediate change” and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. Research limitations/implications – This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. Practical implications – The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. Originality/value – This research is one of few studies to examine a primary care reform from emergence to implementation using a longitudinal multi-level design. |
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