Управление в сети: одна из главных задач современного менеджемента

l’Institut de recherche en santé publique de l’Université de Montréal (IRSPUM), CANADA, Département d’administration publique, Université de Moncton, CANADAŢările dezvoltate caută noi forme de organizare a sistemelor lor de sănătate, pentru a le adapta mai bine la presiunile demografi ce, tehnologice şi economice actuale, asigurând totodată populaţia lor cu servicii de calitate. Acest articol îşi propune să identifice provocările actuale privind implementarea unei organizaţii de reţea, în scopul de a identifica metode de îmbogăţire a cunoştinţelor şi abilităţilor managerilor din sistemul de sănătate.Развитые страны ищут пути организации своих систем здравоохранения, чтобы лучше адаптироваться к демографическим, технологическим и экономическим давлениям, обеспечивая при этом население качественными услугами. Эта статья призвана выявить проблемы, связанные с реализацией управления в сети, для того, чтобы обогатить знания и навыки лидеров менеджмента

Canadian Institutes of Health Research (CIHR; 2005-2008)

Abstract Purpose -The aim of this paper is to illustrate and discuss how healthcare organisations can act as institutional entrepreneurs in a context of change. Design/methodology/approach -The authors conducted an in-depth longitudinal case study (2005)(2006)(2007)(2008)) of a healthcare organisation in the province of Quebec, Canada. Data collection consisted of real-time observations of senior managers (n ¼ 87), interviews (n ¼ 24) with decision-makers and secondary data analysis of documents. Findings -The paper reports on the extent to which entrepreneurial healthcare organisations can be a driving force in the creation of a new practice. The authors analyse the development of a diabetes reference centre by a healthcare organisation acting as an institutional entrepreneur that illustrates the conceptualisation of an innovation and the mobilisation of resources to implement it and to influence other actors in the field. The authors discuss the case in reference to three stages of change: emergence, implementation and diffusion. The results illustrate the different strategies used by managers to advance their proposed projects. Research limitations/implications -This study helps to better understand the dynamics of mandated change in a mature field such as healthcare and the roles played by organisations in this process. By adopting a proactive strategy, a healthcare organisation can play an active role and strongly influence the evolution of its field. Originality/value -This paper is one of only a few to analyse strategies used by healthcare organisations in the context of mandated change. Keywords Canada, Healthcare, Management strategy, Organisational theory, Leaders, Change process Paper type Research paper The current issue and full text archive of this journal is available at www. emeraldinsight.com/1477-7266.htm This article benefited from the insightful contributions and comments of Dr Raynald Pineault, Professor Emeritus, University of Montreal. Also, this paper was submitted at the 2011 annual meeting of Administrative Science Association of Canada. The authors thank two anonymous reviewers for their helpful comments. This study was part of the "Governing Change and Changing Governance in Health Care Systems and Organisations" project funded by the Canadian Institutes of Health Research (CIHR; Introduction Institutional theory is one of the most prominent approaches used for understanding organisational phenomena The objective of this paper is to illustrate and discuss how healthcare organisations can act as institutional entrepreneurs in a context of change. First, we present the institutional theory concepts on which our work is based, followed by our methodology and our research setting. We then present a summary of our longitudinal case study. We analyse the process of institutional change advanced by a healthcare organisation through the emergence, implementation and diffusion of an innovation in the organisational field. Based on this empirical case, we discuss how healthcare organisations can act as institutional entrepreneurs and become driving forces in de-institutionalising and re-institutionalising a field's practices. We conclude with a discussion of the implications of our findings for research and practice

Gobernanza y salud: significado y aplicaciones en américa latina

El término gobernanza es cada vez mas utilizado en la formulación, implementación y evaluación de políticas públicas. El propósito de este artículo es de clarificar su significado y de estudiar su utilidad en el estudio de las recientes políticas de salud de la América Latina. Después de discutir de las diferencias existentes entre gobernanza y los conceptos conexos de gestión, gobernabilidad y gobierno, proponemos la noción de la dualidad de la estructura social de Giddens para una mejor comprensión de los procesos de gobernanza. Utilizamos después este marco teórico para discutir de las implicaciones conceptuales y empíricas del grupo de trabajos sobre la gobernanza en salud en América Latina incluidos en el presente número de la Revista de Salud Pública. Reconociendo que el debate sobre gobernanza aun no está cerrado, terminamos nuestro texto subrayando las contribuciones más importantes de los trabajos revisados, a saber la importancia de la equidad en el proceso de toma de decisiones, el reconocimiento de la naturaleza política de la gobernanza, y las ventajas y limitaciones del modelo de clan en la regulación de las interacciones entre los actores implicados en la toma de decisiones políticas en salud

Barriers and facilitators in the integration of oral health into primary care: a scoping review

Objective This scoping study has been conducted to map the literature and provide a descriptive synthesis on the barriers and facilitators of the integration of oral health into primary care. Methods Grounded in the Rainbow conceptual model and using the Levac et al six-stage framework, we performed a systematic search of electronic databases, organisational websites and grey literature from 1978 to April 2016. All publications with a focus on the integration of oral health into primary care were included except commentaries and editorials. Thematic analyses were performed to synthesise the results. Results From a total of 1619 citations, 58 publications were included in the review. Barrier-related themes included: lack of political leadership and healthcare policies; implementation challenges; discipline-oriented education; lack of continuity of care and services and patients’ oral healthcare needs. The facilitators of integration were supportive policies and resources allocation, interdisciplinary education, collaborative practices between dental and other healthcare professionals, presence of local strategic leaders and geographical proximity. Discussion and public health implications This work has advanced the knowledge on the barriers and facilitators at each integration domain and level, which may be helpful if the healthcare organisations decide to integrate oral health and dental services into primary care. The scoping review findings could be useful for both dental and medical workforce and allied primary healthcare providers. They could also guide the development of healthcare policies that support collaborative practices and patient-centred care in the field of primary care

Access to Indigenous and allopathic medicines: A systematic review of barriers and facilitators

Background: Globally, Indigenous peoples are the victims of social inequalities in health. Their state of health is much lower than the health of the general population. Colonialism, living conditions and access to care are the main determinants of observed health conditions. The scientific objective of this systematic literature review is to study the facilitators and barriers to access healthcare for both, traditional and allopathic medicines. Methods: An inclusive search of electronic databases (e.g ProQuest, Ovid, Medline, CINAHL PLUS, Cochrane Library, ApaPsyNet, PsyINFO and Sociological Abstracts databases) of the past 20 years was performed. We retained studies discussing (1) traditional medicine (TM) or allopathic medicine (AM) or both and occurring (2) within Indigenous population worldwide. We made no distinction between research carried out in rural as opposed to urban areas. Results: A total of 45 studies published between 1996 and 2016 met our inclusion criteria and this speaks to the high interest and contemporary pertinence of accessing both systems of healthcare for Indigenous populations worldwide. Our thematic analysis enabled us to group barriers and facilitators into five categories, namely related to personal, relational, cultural, structural and policy components. As far as barriers and facilitators are concerned, the category that encompasses the most themes is the structural category. Conclusions: Mutual respect, trust and understanding of each other’s modalities is essential to offer the best healthcare options from both AM and TM to Indigenous peoples and hence pave the way to reducing health inequities. Wellness and strength-based approaches must also be favoured

Access to Indigenous and allopathic medicines: A systematic review of barriers and facilitators

Background: Globally, Indigenous peoples are the victims of social inequalities in health. Their state of health is much lower than the health of the general population. Colonialism, living conditions and access to care are the main determinants of observed health conditions. The scientific objective of this systematic literature review is to study the facilitators and barriers to access healthcare for both, traditional and allopathic medicines. Methods: An inclusive search of electronic databases (e.g ProQuest, Ovid, Medline, CINAHL PLUS, Cochrane Library, ApaPsyNet, PsyINFO and Sociological Abstracts databases) of the past 20 years was performed. We retained studies discussing (1) traditional medicine (TM) or allopathic medicine (AM) or both and occurring (2) within Indigenous population worldwide. We made no distinction between research carried out in rural as opposed to urban areas. Results: A total of 45 studies published between 1996 and 2016 met our inclusion criteria and this speaks to the high interest and contemporary pertinence of accessing both systems of healthcare for Indigenous populations worldwide. Our thematic analysis enabled us to group barriers and facilitators into five categories, namely related to personal, relational, cultural, structural and policy components. As far as barriers and facilitators are concerned, the category that encompasses the most themes is the structural category. Conclusions: Mutual respect, trust and understanding of each other’s modalities is essential to offer the best healthcare options from both AM and TM to Indigenous peoples and hence pave the way to reducing health inequities. Wellness and strength-based approaches must also be favoured

Agency at the Managerial Interface: Public Sector Reform as Institutional Work

ABSTRACT This article draws on recent developments in institutional theory to better understand the managerial efforts implicated in the implementation of government-led reforms in public sector services. Based on a longitudinal study of a massive reform effort aimed at transforming the province of Quebec's publicly-funded healthcare system, the article applies the notion of institutional work to understand how managers responsible for newly formed healthcare organizations defined and carried out their individual missions while simultaneously clarifying and operationalizing the government's reform mandate. We identify and describe the properties of four types of work implicated in this process and suggest that structural work, conceptual work, and operational work need to be underpinned by relational work to offer chances for successful policy reform. By showing the specific processes whereby top-down reform initiatives are taken up by managers and hybridized with existing institutionalized forms and practices, this article helps us better understand both the importance of managerial agency in enacting reform, and the dynamics that lead to policy slippage in complex reform contexts

Implementation of an electronic medical record in family practice: a case study

Background Electronic medical records (EMRs) have the potential to foster a safer, more effective and more efficient healthcare system. However, their implementation in primary care practice remains a challenge. Objective This study aims at exploring factors that have influenced the successful implementation of an EMR system in a family medicine group (FMG) in the Province of Qu_bec, Canada. Methods A case study approach was selected to get a deep understanding of the phenomenon in its context. The case was chosen on the basis that it was the first FMG in Qu_bec to implement a full EMR used by all clinicians. Fifteen semi-structured interviews were conducted with key informants. Results Factors that have influenced the success of the EMR implementation were classified under three broad themes: a project leader who combined the roles of clinical, technology and knowledge champion; an organisation that was open to and supportive of change; and an evidence-based implementation strategy tailored to the local context and adoption pace. Conclusions This study underscores the importance of a champion for successful EMR implementation. It proposes a set of roles and characteristics that could be found in a champion as well as other elements for a successful EMR implementation strategy

From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care

Background: Despite its importance, the integration of oral health into primary care is still an emerging practice in the field of health care services. This scoping review aims to map the literature and provide a summary on the conceptual frameworks, policies and programs related to this concept. Methods: Using the Levac et al. six-stage framework, we performed a systematic search of electronic databases, organizational websites and grey literature from 1978 to April 2016. All relevant original publications with a focus on the integration of oral health into primary care were retrieved. Content analyses were performed to synthesize the results. Results: From a total of 1619 citations, 67 publications were included in the review. Two conceptual frameworks were identified. Policies regarding oral heath integration into primary care were mostly oriented toward common risk factors approach and care coordination processes. In general, oral health integrated care programs were designed in the public health sector and based on partnerships with various private and public health organizations, governmental bodies and academic institutions. These programmes used various strategies to empower oral health integrated care, including building interdisciplinary networks, training nondental care providers, oral health champion modelling, enabling care linkages and care coordinated process, as well as the use of e-health technologies. The majority of studies on the programs outcomes were descriptive in nature without reporting long-term outcomes. Conclusions: This scoping review provided a comprehensive overview on the concept of integration of oral health in primary care. The findings identified major gaps in reported programs outcomes mainly because of the lack of related research. However, the results could be considered as a first step in the development of health care policies that support collaborative practices and patient-centred care in the field of primary care sector