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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Health Services Research 1/2014

Impact of Québec’s healthcare reforms on the organization of primary healthcare (PHC): a 2003-2010 follow-up

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2014
Autoren:
Raynald Pineault, Roxane Borgès Da Silva, Alexandre Prud’homme, Michel Fournier, Audrey Couture, Sylvie Provost, Jean-Frédéric Levesque
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-14-229) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

RP participated to all the stages of the study and drafted the manuscript. RB and AC coordinated the organizational part of the study and helped to draft the manuscript. JFL and SP participated in the design, the conduct of the study and drafting of the manuscript. MF advised on and supervised the statistical analysis performed by AP. All authors read and approved the final manuscript.

Abstract

Background

Healthcare reforms initiated in the early 2000s in Québec involved the implementation of new modes of primary healthcare (PHC) delivery and the creation of Health and Social Services Centers (HSSCs) to support it. The objective of this article is to assess and explain the degree of PHC organizational change achieved following these reforms.

Methods

We conducted two surveys of PHC organizations, in 2005 and 2010, in two regions of the province of Québec, Canada. From the responses to these surveys, we derived a measure of organizational change based on an index of conformity to an ideal type (ICIT). One set of explanatory variables was contextual, related to coercive, normative and mimetic influences; the other consisted of organizational variables that measured receptivity towards new PHC models. Multilevel analyses were performed to examine the relationships between ICIT change in the post-reform period and the explanatory variables.

Results

Positive results were attained, as expressed by increase in the ICIT score in the post-reform period, mainly due to implementation of new types of PHC organizations (Family Medicine Groups and Network Clinics). Organizational receptivity was the main explanatory variable mediating the effect of coercive and mimetic influences. Normative influence was not a significant factor in explaining changes.

Conclusion

Changes were modest at the system level but important with regard to new forms of PHC organizations. The top-down decreed reform was a determining factor in initiating change whereas local coercive and normative influences did not play a major role. The exemplar role played by certain PHC organizations through mimetic influence was more important. Receptivity of individual organizations was both a necessary condition and a mediating factor in influencing change. This supports the view that a combination of top-down and bottom-up strategy is best suited for achieving substantial changes in PHC local organization.
Zusatzmaterial
Additional file 1: The organizational questionnaire contains all the questions completed by the respondent for every PHC organization. It pertains to various aspects of this organization, such as vision, structure, resources and practices. The last section deals with the reorganization of PHC services. (PDF 632 KB)
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Additional file 2: List of variables* used to construct the index of conformity to an ideal type (ICIT).(PDF 188 KB)
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Additional file 3: List of explanatory variables.(PDF 175 KB)
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Additional file 4: List of control variables.(PDF 296 KB)
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Authors’ original file for figure 1
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Authors’ original file for figure 11
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