Empowerment and health promoting networks in Quebec

Nicole Dedobbeleer, Sc.D.André-Pierre Contandriopoulos, Ph.D.

Louise Rousseau, Ph.D.Hung N’Nguyen, MSc.

Lise Lamothe, Ph.D.Martin Beaumont, Ph.D. candidate

INTRODUCTION

• Historical background:

– In Quebec (Canada), a publicly funded health care system;

– Health and social services integrated under a unified administration;

– A universal heath insurance program;.

INTRODUCTION– In the late fifteen years,

• Major changes were observed in the network organisation, administration of services and health care provision of the Health Care and Social Services System.

• In a context of zero deficit and rapid development in medical technology, the consequences were dramatic.

– Different governmental reports requested changes.

INTRODUCTION

• Bill 25, adopted in December 2003, provided for the latest system reorganization :– the transformation of regional boards into local

health and social network development agencies.

INTRODUCTION

• Mission of these agencies:– Establish integrated services

organizations in their areas of jurisdiction in order to bring services closer to the general public and make it easier for people to move through the health and social services network.

– Each agency had to develop and propose an organizational model based on one or more local services networks.

INTRODUCTION• The local services networks encompass

– a local instance, a health and social services centre (CSSS), merging establishments currently offering the services of local community health centers (CLSC), hospitals and residential and long-term care centres (CHSLD) .

• The networks also include pharmacists, physicians, community groups, and private resources.

• Special agreements have to be concluded with specialized hospitals.

* CHU, CHAU, CHR, Institutes

Quebec Public Network of Health and Social Services

MINISTER

AdvisingCouncils 11

Ministeryof Healthand SocialServices

RegionalAgencies 18

CommunityOrganizations

4000

Child and YouthProtection Centres

19

PrivateEstablishments128

RehabilitationCentres 40

Hospital *Centres 27

Medical ClinicsPrivate Practices

1500

OfficeHandicapped

People

Health Insurance

Health and SocialServices Centres 95

CLSC-CHSLD-CH

CLSC-CHSLD

78

17

INTRODUCTION• Each network

– will provide the people in its territory with access to a broad range of primary social and health services, including prevention, assessment, diagnostic, treatment, rehabilitation and support services.

– will lead all stakeholders within a given territory to become collectively responsible for the health and well-being of their population.

Local Health and Social Services Network

Social EconomyEntreprices Pharmacies

Community

Private

CHSLDCommunityOrganizations

IntermediateResources /

ResourcesFamily Type

Private Resources

Physicians

Child and YouthProtection Centres

RehabilitationCentres

Subsidized

[ GMF ][ Medical Clinics ]

CSSSCLSC - CHSLD - CH

CLSC - CHSLD

OtherSectors :

EducationMunicipality

University /AffiliatedUniversity

HospitalCentres

OBJECTIVES• To examine to what extent the Quebec law

25 and upcoming law 83 will enable CSSS (health and social services centres including hospitals) to become empowered and empowering organizations;

• To examine how quality criteria of the Canadian Council on Health Services Accreditation (CCHSA) may enable CSSS and the health and social services networks to become empowering organizations for patients, staff and citizens.

DEFINITIONS

• Empowerment – Active, participatory process through which

individuals, organizations and communities gain greater control, efficacy and social justice (Rappaport, 1987; Solomon, 1976).

• Organizational empowerment (OE)– Organizational efforts that generate

psychological empowerment among members and organizational effectiveness needed for goal achievement (Zimmerman, 2000).

DEFINITIONS• According to Peterson and Zimmerman

(2004), there is a distinction between:– Empowering organizations are those that

produce psychological empowerment for individual members as part of their organizational process;

– Empowered organizations are those that influence the larger system of which they are a part.

• They presented a theoretical framework for processes and outcomes for intra-organizational, inter-organizational and extra-organizational components of OE.

Processes for the components of OE

• Components– Intra-organizational

– Inter-organizational

– Extra-organizational

• Processes– Incentive management– Subgroup linkages– Opportunity role structure– Leadership– Social support– Group-based belief system.

– Accessing social networks of other organizations;

– Participating in alliance-building activities with other organizations.

– Implementing community actions;

– Disseminating information.

Intra-, Inter- and Extra-organizational Components of OE

• Components– Intra-organizational

• Characteristics that represent the internal structure and functioning of organizations;

– Inter-organizational• Capture linkages and relationships between

organizations; – Extra-organizational

• Actions intended to affect the larger policy or other environments.

Laws 25 and 83 and Intra-organizational Processes

Processes Accomplishments Challenges

Subgroup linkages

Creation of CSSS

Redefinition of roles, sharing of responsibilities, privileges,

feeling of ownership,

collective agreements

Opportunity role structure

Administrative boards

Membership representation on administrative boards, population participation

Incentive management

Sharing of information, decisions

Overworked staff, low morale and motivation, no additional budget

Law 25 and 83 and Intra-organizational Processes

Processes Accomplishments Challenges

Leadership Renewed local leadership

Inter-professional and inter-organizational dynamics, population leadership

Social support Professional development plans

Additional budget

Group-based belief system

Integration of services

Common vision ,values

Laws 25 and 83 and Inter-organizational Processes

Processes Accomplishments Challenges

Accessing social networks of other organizations

Second phase of the reform

Protection of professional, institutional, budgetary silos

Participating in alliance-building activities with other organizations

Second phase of the reform

Negotiation of shared responsibility

Laws 25 and 83 and Extra-organizational Processes

Processes Accomplishments Challenges

Community actions

Public meetings and events

Participation

Dissemina-tion of information

Circulation of information, information technology,

Access of different establishments, common information center

CCHSA STANDARDS : Examples• Patients empowerment

– The team works with clients and families to help them actively participate in service delivery and carry out responsibilities……gives complete and accurate information…provides education (knowledge, skills development)….helping clients understand what they are responsible for…teaching positive behaviour,..

CCHSA STANDARDS: Examples

• Staff empowerment

– ..staff..participate in developing the organization vision, goals, objectives and strategic plans. The organization manages its equipment, supplies.. by…choosing and buying on comments and suggestions from staff.. clients.

CCHSA STANDARDS: Examples

• Community empowerment– The organization forms linkages and

partnerships with other organizations and the community by participating in or leading activities…advocate..changes in public policy (smoking in public places). The governing body.... giving the community the opportunity to participate in decisions about the organization services.…working with other organizations, groups, sectors and governments to promote healthy communities…

CONCLUSION

• Findings indicate empowering processes

– a work in progress;

– networks have been created;

– Bill 25 Law 83 on health services and social services (second phase).

CONCLUSION

• Bill 25 success will be related to the policy understanding or meaning given to this radical restructuring and to the vision proposed.

– It provides the opportunity to consider the critical role that the HPH concept can and could play in the integrated services organizations.

CONCLUSION• Success conditions

– a significant shift in philosophy, values and practices;

– real decentralization;– financial and organizational incentives;– leadership (political,administrative,

clinical);– professionals’ capacity to develop local

intervention projects;– integrated information systems.

CONCLUSION

• Empowerment is incorporated in CCHSA standards.

• Further developments in CCHSA standards are needed to provide a useful tool for the adoption of the HPH concept in Quebec and its extension to a “health promoting network” concept.