How Mental Health Ministerial Orientations Generate Change in Public Health System:
Download
1 / 17

How Mental Health Ministerial Orientations Generate Change in Public Health System: - PowerPoint PPT Presentation


  • 248 Views
  • Uploaded on

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'How Mental Health Ministerial Orientations Generate Change in Public Health System: ' - DoraAna


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Slide1 l.jpg

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


Research program 2006 2010 l.jpg
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


Quebec ministerial action plan in mental health june 2005 l.jpg
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


Research program 2006 20104 l.jpg
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)


Methodology overview l.jpg
Methodology Overview in Public Health System:

  • Multiple case study: 15 local networks

  • Regional and local respondents

  • Data from:

    • Documentary sources

    • Individual interviews

    • Focus groups


Agenda l.jpg
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?


Selected attributes for compliance analysis l.jpg
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


Results l.jpg
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


Positive dynamic factors l.jpg
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


High compliant group attributes l.jpg
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


Poor compliance group attributes l.jpg
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


Essential conditions to successful implementation l.jpg
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


Main components for collaboration l.jpg
Main Components for Collaboration in Public Health System:

Setting the problem

Devising a common direction

Structuring the local services network


Main components for collaboration14 l.jpg
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


Quebec mhap usefulness l.jpg
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


Comments thank you l.jpg

Comments ? in Public Health System: Thank you


Conclusion l.jpg
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


ad