Analyse des conditions d'implantation des centres de santé et de services sociaux (CSSS) : études de cas de l'intégration verticale de la gouvernance des établissements dans deux régions

Authors: Martin, Elisabeth
Advisor: Reinharz, Daniel
Abstract: Vertical integration of healthcare organizations is one of various solutions put forward to reorient health systems and services around primary care, but such experiments remain limited. We examined the implementation of Health and Social Services Centres (HSSCs), introduced by the 2003-2004 reform and aimed at merging healthcare facilities in the province of Quebec. Our research objective intends to show how and under what conditions the integration of healthcare organisations’ administrative governance was made possible. Rooted in a political economy analytical framework, six case studies were conducted in territories within two regions (Bas-Saint-Laurent and Chaudière-Appalaches), using documentary analysis and 32 semi-structured interviews. Our results unveil the singularity of experiences across the six territories, the implementation dynamic and strategies being highly influenced by local context. Our key findings are organized around four convergent axes. First, territoriality portrays the institutionalized status of the regional county municipality (RCM) as an historical and contemporary scheme around which health care services are organized. Second, from an institutions’ history perspective, the research brings to light that HSSC’s implementation is more broadly part of an evolutionary and sequential process, made of interconnected phases of often conflicting mergers and other more consensual forms of organizational integration put in place since the 1990s. Third, the axis of organisations and missions reveals how the initial opposition between hospital and community services fell short rapidly, but also that the healthcare institutions’ missions showed resilience and therefore integrated at different paces in each territory. Finally, under the actors axis, the research shows how individuals had a greater impact than groups in the implementation processes. The practices described in our research share a common dynamic of constant tension between two logics: resistance and belonging. These logics generate conflicts which are mediated through negotiation and compromise. This leads to conclude to the political nature of the mergers’ implementation process, given that it meets the definition of politics, in both its objects and its actions modes.
Document Type: Thèse de doctorat
Issue Date: 2014
Open Access Date: 20 April 2018
Grantor: Université Laval
Collection:Thèses et mémoires

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