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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

research program 2006 2010
Research Program (2006-2010)
  • 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
Quebec Ministerial Action Plan in Mental Health (June 2005)
  • 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
Research Program (2006-2010)
  • Main components:
    • A contextual survey
    • An organisational assessment of medical

PC models

    • A medical PC user’s survey (anxious and depressive disorders)
methodology overview
Methodology Overview
  • Multiple case study: 15 local networks
  • Regional and local respondents
  • Data from:
    • Documentary sources
    • Individual interviews
    • Focus groups
  • 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
Selected Attributes for Compliance Analysis
  • 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
  • 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
Positive dynamic factors
  • 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
High compliant group attributes
  • 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
Poor Compliance Group Attributes
  • 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
Essential Conditions to Successful Implementation
  • 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
Main Components for Collaboration

Setting the problem

Devising a common direction

Structuring the local services network

main components for collaboration14
Main Components for Collaboration
  • 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
Quebec MHAP Usefulness
  • 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
  • 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