Reforming primary healthcare: from public policy to organizational change

Journal of Health Organization and Management
Frédéric GilbertJohanne Goudreau

Abstract

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. 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. 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 dist...Continue Reading

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Citations

Oct 16, 2015·BMC Family Practice·Carol CooleAvril Drummond
Mar 24, 2017·The International Journal of Health Planning and Management·Sara JavanparastDavid Sanders
May 18, 2019·Sociology of Health & Illness·Lorelei JonesEllen Stewart
Apr 3, 2020·Journal of Health Organization and Management·Abdelhakim AltabaibehMargaret A Volante
Dec 20, 2019·Journal of Health Organization and Management·Martha L P MacLeodCathy Ulrich
Oct 17, 2020·Journal of Health Organization and Management·Anne BerghöferMartin Gersch

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