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How Mental Health Ministerial Orientations Generate Change in Public Health System: Lessons from The Quebec Experience with Regard to New Practices Implementation. Denise Aubé , Community Medecine Physician, Researcher

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How Mental Health Ministerial Orientations Generate Change in Public Health System: Lessons from The Quebec Experience with Regard to New Practices Implementation

Denise Aubé , Community Medecine Physician, Researcher

Quebec National Institute of Public Health / Research Group on Social Inclusion, Service Organization and Evaluation in Mental Health

2009 12th World Congress on Public Health,

Session#24, April 28, Istanbul, TURKEY

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Research Program (2006-2010) in Public Health System:

  • Aim:

    • To support Mental Health Primary Care transformation in Quebec following introduction of Quebec Action Plan in MH

  • Funding:

    • From Canada: Canadian Health Services Research Foundation

    • From Québec: FRSQ, INSPQ, MSSS, GIRU

    • From 15 participating organizations

  • Main team members:

    • Vallée C., Poirier LR, Fournier L., Roberge P., Lessard L.

    • Total of 14 researchers and 16 decision makers

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Quebec Ministerial Action Plan in Mental Health (June 2005) in Public Health System:

  • Mechanisms:

    • Creation or consolidation of primary mental health care teams

    • Development of unique access for all referral needs when additional mental health services are required

    • Mentorship to support mental health professional and enhance mental health expertise development

  • Aims:

    • To upgrade service quality

    • To optimize existing resource utilization

    • To reinforce service coordination by fostering dialogue between main mental health actors

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Research Program (2006-2010) in Public Health System:

  • Main components:

    • A contextual survey

    • An organisational assessment of medical

      PC models

    • A medical PC user’s survey (anxious and depressive disorders)

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Methodology Overview in Public Health System:

  • Multiple case study: 15 local networks

  • Regional and local respondents

  • Data from:

    • Documentary sources

    • Individual interviews

    • Focus groups

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Agenda in Public Health System:

  • What do we learn from compliance analysis for desired changes?

  • Could we link results with collaborative process analysis to add meaning?

  • How ministerial input sustain changes implementation?

  • What’s next to deepen change understanding in 2009 data survey?

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Selected Attributes for Compliance Analysis in Public Health System:

  • Capacity of CSSS MH teams to act on various MH disorders and to provide multidisciplinary service supply optimizing local network potential

  • Availability of medical back-up from family physicians as well as from psychiatrists

  • Access to clinical advisors when needed

  • Presence of flowing MH services pathways for users

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Results in Public Health System:

  • Three groups with

    • Good / Moderate / or Poor compliance

  • But … differences between and within each group cannot be explained by :

    • Rural, urban or semi-urban area

    • Population socio-economic status

    • Development level of psychiatric services

    • Family physician shortage

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Positive dynamic factors in Public Health System:

  • Previous successful changes in the last 10 years with trends similar to those recently introduced

  • Well established collaborative mechanisms with various partners

  • Successful organization merging

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High compliant group attributes in Public Health System:

  • Successful dialog mechanisms with formal mutual agreement

  • Commitment from territory FP

  • Presence of fluidity and coordination

  • Relatively low turn-over of key personal members, with functional stability

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Poor Compliance Group Attributes in Public Health System:

  • Cohabitation of mixed pitfalls:

    • Non assumed cultural clash from relatively recent merging (with CHC or CH)

    • History of conflicts between some partners

    • Staff shortage, lack of support or solutions

    • High human resources turn-over

    • Uneasy negotiation with psychiatric leaders or hospital managers

    • Various access problems for regular or specific MH clienteles

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Essential Conditions to Successful Implementation in Public Health System:

  • Realistic timeline to build a positive background to their implementation including development and consolidation of various collaborative processes

  • Favourable human factors characterized by stability, dynamism and constructive leadership as well as management skills for continuous adjustment

  • Space for innovation to cope with special needs

  • And, sometimes, required investments to address complexity or resource shortage

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Main Components for Collaboration in Public Health System:

Setting the problem

Devising a common direction

Structuring the local services network

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Main Components for Collaboration in Public Health System:

  • Setting the problem:

    • Continuous process involving all partners

    • Interdependence

    • Quality and frequency of contacts, or connectivity

    • Credible and competent leaders

    • Positive expectations

  • Devising a common direction

    • Development of a common perspective

    • Sharing of relevant information

  • Structuring the local services network:

    • Power redistribution

    • Implementation of mechanisms or strategies to support collaboration and integration at clinical and functional levels

    • A large sense of affiliation

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Quebec MHAP Usefulness in Public Health System:

  • Strong population-based analysis, with PRIMARY CARE as services anchorage

  • Cohesiveness recognized by all main health system actors:

    • Same orientations for all

    • Same structural measures for all

  • Legitimacy, a strong control lever for managers to introduce changes

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Comments ? in Public Health System: Thank you

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Conclusion in Public Health System:

  • Changes: dynamic and slow to implement

  • No recipe: historical background, uniqueness, critical human factors, physician investment

  • Sustained dialog: imperative, time-consuming and sometimes challenging = need forformal and informal meetings, need to enhance personalized relationships and foster linkage

  • Collaboration as a baseline: interdependence, connectivity, information sharing, power redistribution etc.

  • Extensive resources are not a key success

    and scarce resources are not a deterrent

  • Public policies: a must for overall vision, cohesiveness, legitimacy