Empowerment and health promoting networks in Quebec

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Empowerment and health promoting networks in
Quebec

• Nicole Dedobbeleer, Sc.D.
• André-Pierre Contandriopoulos, Ph.D.
• Louise Rousseau, Ph.D.
• Hung NNguyen, MSc.
• Lise Lamothe, Ph.D.
• Martin Beaumont, Ph.D. candidate

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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).

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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.

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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.

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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.

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Laws 25 and 83 and Intra-organizational Processes
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Law 25 and 83 and Intra-organizational Processes
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Laws 25 and 83 and Inter-organizational Processes
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Laws 25 and 83 and Extra-organizational Processes
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CCHSA STANDARDS Examples

• Patients empowerment
• The team works with clients and families to help
  them actively participate in service delivery and
  carry out responsibilitiesgives complete and
  accurate informationprovides education
  (knowledge, skills development).helping clients
  understand what they are responsible forteaching
  positive behaviour,..

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CCHSA STANDARDS Examples

• Staff empowerment
• ..staff..participate in developing the
  organization vision, goals, objectives and
  strategic plans. The organization manages its
  equipment, supplies.. bychoosing and buying on
  comments and suggestions from staff.. clients.

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CCHSA STANDARDS Examples

• Community empowerment
• The organization forms linkages and partnerships
  with other organizations and the community by
  participating in or leading activitiesadvocate..c
  hanges 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

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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).

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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.

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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.

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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.