Current challenges and future prospects of health services and policy research: The Québec context

Jean-Louis Denis, MRSC, FCAHSProfessor, École nationale d’administration publique (ENAP), Montréal and Canada

Research Chair in Governance and Transformation of Health Organizations and Systems (GETOSS)

Director Centre de recherche de l’hôpital Charles Lemoyne (CR-HCLM), Université de Sherbrooke

The value of process and practice-based research for the

transformation and improvement of healthcare systems

« …processstudies address questions about how and why

things emerge, develop, grow, or terminate overtime, as distinct from variance questions dealing

with covariation among dependent and independentvariables » (Langley, Smallman, Tsoukas, & Van

de Ven, 2013:1).

« …practice refers both to the situated doings of the individual human beings (micro) and to the

different socially defined practices (macro) that the individuals are drawing upon in these doings”.

(Jarzabkowski, P., J. Balogun & D. Seidl. 2007. ‘Strategizing: The challenges of a practice perspective’. Human Relations, 2007, 60.1: 5-27).

Example of a study on the implementation of healthcare reform (the previous one!!) in

Quebec (CSSS)

Push to the new

Pull of the old

OPERATIONAL WORK

RELATIONAL WORK

Integrative

Specialized

RepetitiveDetached

CONCEPTUAL WORK

Transactional

ContentiousFragmented

Constructing agency

Constructingagency

Precursive

RecursiveDisruptive

STRUCTURAL WORK

Figure 1: A Model of Forms of Institutional Work in the Enactment of Policy Reform (Cloutier, Denis, Langley, Lamothe, JPART, conditional acceptance)

« Our model provides a useful lens to explain how contradictions between novel policy

proposals and pre-existing practices influence each form of work in distinctive ways, diluting its

impact to different degrees while at the same time and paradoxically creating opportunities for

its enactment. “(Cloutier, Denis, Langley, Lamothe, JPART, conditional acceptance)

Prospects

• Full potential of process and practice-based research has not been sufficiently exploited. Some examples:– to characterize the resources (skills, competencies, …)

needed by health actors to contribute effectively to policy making and their strategies to develop, sustain and deploy policy capacity;

– realist evaluation of the introduction of financial incentives for organizations and providers (Greenhalgh & al., 2009)

• Combining process and outcomes research in a balanced way at the policy, organizational and clinical levels of health systems

Back to the Québec context

• Developping more effective model to incorporate research in the development of transformative and improvement capacities within policy, organizational and clinical settings

• Organizing knowledge production resources in hybrid networks that combine researchers and practitioners

• Developing a companion research agenda to current reforms in Quebec

• Working (more!) across institutional boundaries