The Challenges of a Complex and Innovative Telehealth Project: A Qualitative Evaluation of the Eastern Quebec Telepathology Network

Abstract Background: The Eastern Quebec Telepathology Network (EQTN) has been implemented in the province of Quebec (Canada) to support pathology and surgery practices in hospitals that are lack of pathologists, especially in rural and remote areas. This network includes 22 hospitals and serves a population of 1.7 million inhabitants spread over a vast territory. An evaluation of this network was conducted in order to identify and analyze the factors and issues associated with its implementation and deployment, as well as those related to its sustainability and expansion. Methods: Qualitative evaluative research based on a case study using: (1) historical analysis of the project documentation (newsletters, minutes of meetings, articles, ministerial documents, etc); (2) participation in meetings of the committee in charge of telehealth programs and the project; and (3) interviews, focus groups, and discussions with different stakeholders, including decision-makers, clinical and administrative project managers, clinicians (pathologists and surgeons), and technologists. Data from all these sources were cross-checked and synthesized through an integrative and interpretative process. Results: The evaluation revealed numerous socio-political, regulatory, organizational, governance, clinical, professional, economic, legal and technological challenges related to the emergence and implementation of the project. In addition to technical considerations, the development of this network was associated with major changes and transformations of production procedures, delivery and organization of services, clinical practices, working methods, and clinicaladministrative processes and cultures (professional/organizational). Conclusion: The EQTN reflects the complex, structuring, and innovative projects that organizations and health systems are required to implement today. Future works should be more sensitive to the complexity associated with the emergence of telehealth networks and no longer reduce them to technological considerations

Supporting work practices through telehealth: impact on nurses in peripheral regions

<p>Abstract</p> <p>Background</p> <p>In Canada, workforce shortages in the health care sector constrain the ability of the health care system to meet the needs of its population and of its health care professionals. This issue is of particular importance in peripheral regions of Quebec, where significant inequalities in workforce distribution between regions has lead to acute nursing shortages and increased workloads. Information and communication technologies (ICTs) are innovative solutions that can be used to develop strategies to optimise the use of available resources and to design new nursing work practices. However, current knowledge is still limited about the real impact of ICTs on nursing recruitment and retention. Our aim is to better understand how work practice reorganization, supported by ICTs, and particularly by telehealth, may influence professional, educational, and organizational factors relating to Quebec nurses, notably those working in peripheral regions.</p> <p>Methods/Design</p> <p>First, we will conduct a descriptive study on the issue of nursing recruitment. Stratified sampling will be used to select approximately twenty innovative projects relating to the reorganization of work practices based upon ICTs. Semi-structured interviews with key informants will determine professional, educational, and organizational recruitment factors. The results will be used to create a questionnaire which, using a convenience sampling method, will be mailed to 600 third year students and recent graduates of two Quebec university nursing faculties. Descriptive, correlation, and hierarchical regression analyses will be performed to identify factors influencing nursing graduates' intentions to practice in peripheral regions. Secondly, we will conduct five case studies pertaining to the issue of nursing retention. Five ICT projects in semi-urban, rural, and isolated regions have been identified. Qualitative data will be collected through field observation and approximately fifty semi-structured interviews with key stakeholders.</p> <p>Discussion</p> <p>Data from both parts of this research project will be jointly analysed using triangulation of researchers, theoretical approaches, methods, and results. Continuous exchanges with decision makers and periodic knowledge transfer activities are planned to facilitate the dissemination and utilization of research results in policies regarding the nursing recruitment and retention.</p

Évaluation de la pérennité du programme de l'ONG SUCO au Mali : étude de cas d'une association de développement villageois

De 1998 à 2008, l'ONG canadienne Solidarité, union et coopération (SUCO) a appuyé, au Mali, un ensemble de 26 villages composant la commune rurale de Soye. Chacun de ces villages a pu se doter d'une association de développement villageois (ADV) responsable du développement global de la communauté. Ainsi, plusieurs villages ont su améliorer de façon notable leurs conditions de vie en agissant positivement sur leurs déterminants sociaux de la santé. En 2008 l'ONG SUCO met un terme à son programme. Une question s'impose : ce dernier sera-t-il pérenne? Cette recherche evaluative, menée de février à avril 2009, avait deux objectifs : 1) évaluer la pérennité de l'ADV du village à l'étude, et 2) comprendre quels ont pu être les éléments qui ont contribués à l'édification de cette pérennité. Optant pour un devis qualitatif de nature exploratoire, nous sommes demeuré inductif dans notre démarche. L'étude de cas a été l'approche méthodologique privilégiée. Notre collecte de données s'est accomplie en faisant appel à une revue documentaire, en tenant sept focus groups, en réalisant quatre entretiens individuels semi-directifs et cinq entretiens semi-directifs avec des informateurs clés. L'analyse des résultats nous permet de statuer que l'ADV du village de Sare est bien engagée dans la pérennité. Cette pérennité a été possible grâce à un certain nombre d'éléments déjà présents dans les façons de faire du programme de l'ONG SUCO. Mais, les résultats nous signalent que cette pérennité demeure fragile. À titre d'exemple, l'ADV de Sare semble ne pas posséder ni former de relève en mesure de succéder aux membres actuels de l'exécutif de l'ADV

Les facteurs contributifs à l’optimisation de la pratique de l’infirmière praticienne spécialisée en soins de première ligne. Enjeux de collaboration interprofessionnelle, d’intégration du rôle et de sens du travail

Fondation CSSS de la Vieille-CapitaleAgence de la CapitaleNationale, aujourd’hui dissolues, le MSSS et l’OII