Démarche de gouvernance collaborative d'appréciation des risques des systèmes essentiels: rapport final

La Politique québécoise de sécurité civile 2014-2024 vise entre autres une meilleure résilience des systèmes essentiels(SE). En raison des conséquences des défaillances des SE sur les activités quotidiennes des communautés, leur résilience est étroitement liée à la résilience urbaine. L’interdépendance de la gestion des risques des systèmes essentiels et des responsabilités municipales, notamment eu égard à la sécurité publique et à l’aménagement du territoire, justifie ainsi une approche collaborative. En 2018, le ministère de la Sécurité publique (MSP) en collaboration avec Ouranos sollicite la communauté scientifique pour réaliser un projet de recherche-action visant à développer une approche de gouvernance collaborative d’appréciation des risques des SE en contexte de changements climatiques. Pour réaliser ce mandat, deux groupes de recherche choisissent d’unir leurs forces. Le Cité-ID LivingLab, rattaché à l’ENAP a pour mission de réaliser des travaux de recherche-intervention sur des problématiques urbaines complexes identifiées par les parties prenantes (acteurs publics, privés, communautaires, citoyens, etc.) afin de coconstruire des pratiques de gouvernance innovantes permettant d’accroître la résilience urbaine. Le Centre risque & performance de Polytechnique Montréal est dédié à l’évaluation de la résilience des infrastructures essentielles et des organisations. Le centre a notamment mis sur pied des communautés stratégiques pour mieux comprendre les interdépendances entre les infrastructures essentielles. Avec la collaboration d’Ouranos pour les aspects liés aux changements climatiques, la nouvelle équipe de recherche possède l’expertise requise pour mettre en relation les deux composantes du mandat, c’est-à-dire la gouvernance collaborative et l’appréciation des risques des SE

Innovation in Physician Remuneration in France: What Lessons for Canada?

During the past decade, France has experienced two major reforms in remuneration models for general practitioners who work outside public healthcare organizations: Remuneration for Public Health Objectives (Rémunération sur Objectifs de Santé Publique—ROSP) and Experiments with New Models of Remuneration (Expérimentations desNouveaux Modes de Rémunération—ENMR). These two initiatives introduced payments based on performance in the areas of quality of care, organization of services and multidisciplinary practice. In the first model, individual physicians receive incentives for preventive practices, use of generics and improvements in work organization. In the second model, incentives are provided to multi-professional practice groups to foster interdisciplinary collaboration and patient involvement. While French general practitioners accustomed to fee-for-service remuneration were at first reluctant to accept a mixed remuneration model, they eventually came to embrace it. The ROSP has significantly improved targeted areas of practice, although it has had less impact on preventive practices than on use of generics and work organization. The ENMR has helped formalize inter-professional relationships in primary care and has thus contributed to team integration. These "experiments" suggest that a deliberate distinction between changes to individual physician payment and changes to how multi-professional practice groups are paid and practice may be a good starting point when introducing financial incentives to enable benefits and avoid negative consequences

La résilience du système de santé publique face à la COVID- 19 : développement des systèmes informationnels par les directions régionales de santé publique au Québec

Ce rapport de recherche a été préparé par Cité-ID Living Lab de l’École nationale d’administration publique (ENAP) et la fonction Délibération de l’Observatoire international sur les impacts sociétaux de l’intelligence artificielle et du numérique (OBVIA) dans le cadre des travaux sur les effets des systèmes d’intelligence artificielle et des outils numériques déployés pour lutter contre la propagation de la COVID-19 sur les sociétés et soutenus par les Fonds de recherche du Québec (FRQ)

Getting evidence to travel inside public systems: what organisational brokering capacities exist for evidence-based policy?

Abstract Background Implementing research findings into healthcare policy is an enduring challenge made even more difficult when policies must be developed and implemented with the help and support of multiple ideas, agendas and actors taking part in determinants of health. Only looking at mechanisms to feed policy-makers with evidence or to interest researchers in the policy process will simply bring partial clues; implementing evidence-based policy also requires organisations to lead and to partner in the production and intake of scientific evidence from academics and practical evidence from one another. Main body This Commentary argues for the need to better understand the capacities required by organisations to foster evidence-based policy in a dispersed environment. It proposes a framework of 11 brokering capacities for organisations involved in evidence-based policy. Eight of these capacities are informed by streams of research related to the roles of knowledge broker, innovation broker and policy broker. Three complementary brokering capacities are informed by our experience studying real-life evidence-based policies; these are capturing boundary knowledge, trending know-how on scientific and practical evidence-based policy, and conveying evidence outward. Conclusions Previous guidelines on brokering capacities focused on the individual level more than on the organisational level. Beyond the individual capacities of managers, designers and implementers of new policies, there is a need to identify and assess the brokering capacities of organisations involved in evidence-based policy. The three specific organisational brokering capacities for evidence-based policy that we present offer a means for policy-makers and policy designers to reflect upon favourable environments for evidence-based policy. These capacities could also help administrators and implementation scholars to think about and develop measurements to assess the quality and readiness of organisations involved in evidence-based policy design

Equilibrium in the governance of cross-sectoral policies: how does it translate into practice?

Abstract Background There is growing interest from health researchers in the governance of Health in All Policies (HiAP). Furthermore, the COVID-19 pandemic has re-ignited managers’ interest in HiAP governance and in health prevention activities that involve actors from outside health ministries. Since the dynamics of these multi-actor, multi-sectoral policies are complex, the use of systems theory is a promising avenue toward understanding and improving HiAP governance. We focus on the concept of equilibrium within systems theory, especially as it points to the need to strike a balance between actors that goes beyond synergies or mimicry—a balance that is essential to HiAP governance. Method We mobilized two sources of data to understand how the concept of equilibrium applies to HiAP governance. First, we reviewed the literature on existing frameworks for collaborative governance, both in general and for HiAP specifically, in order to extract equilibrium-related elements. Second, we conducted an in-depth case study over three years of an HiAP implemented in Quebec, Canada. Results In total, we identified 12 equilibrium-related elements relevant to HiAP governance and related to knowledge, actors, learning, mindsets, sustainability, principles, coordination, funding and roles. The equilibria were both operational and conceptual in nature. Conclusions We conclude that policy makers and policy implementers could benefit from mobilizing these 12 equilibrium-related elements to enhance HiAP governance. Evaluators of HiAP may also want to consider and integrate them into their governance assessments

Innovation in Physician Remuneration in France

During the past decade, France has experienced two major reforms in remuneration models for general practitioners who work outside public healthcare organizations: Remuneration for Public Health Objectives (Rémunération sur Objectifs de Santé Publique—ROSP) and Experiments with New Models of Remuneration (Expérimentations desNouveaux Modes de Rémunération—ENMR). These two initiatives introduced payments based on performance in the areas of quality of care, organization of services and multidisciplinary practice. In the first model, individual physicians receive incentives for preventive practices, use of generics and improvements in work organization. In the second model, incentives are provided to multi-professional practice groups to foster interdisciplinary collaboration and patient involvement. While French general practitioners accustomed to fee-for-service remuneration were at first reluctant to accept a mixed remuneration model, they eventually came to embrace it. The ROSP has significantly improved targeted areas of practice, although it has had less impact on preventive practices than on use of generics and work organization. The ENMR has helped formalize inter-professional relationships in primary care and has thus contributed to team integration.  These "experiments" suggest that a deliberate distinction between changes to individual physician payment and changes to how multi-professional practice groups are paid and practice may be a good starting point when introducing financial incentives to enable benefits and avoid negative consequences. Au cours des dix dernières années, les modes de rémunération des médecins de famille exerçant en dehors des établissements de santé ont évolué. En France, deux réformes majeures ont été introduites : la Rémunération sur Objectifs de Santé Publique (ROSP) et les Expérimentations des Nouveaux Modes de Rémunération (ENMR). Ces deux initiatives ont introduit un paiement à la performance dans les domaines de la qualité des soins, de l'organisation des services et de l'exercice pluridisciplinaire. La première consiste à rémunérer individuellement les médecins qui atteignent des objectifs de santé publique, afin d'encourager les pratiques préventives, une meilleure utilisation des génériques et une meilleure organisation du travail. La deuxième initiative se situe au niveau de l'équipe de première ligne afin de favoriser la collaboration interdisciplinaire et une meilleure implication des patients.Tout d'abord peu enclins à accepter un modèle de rémunération mixte à la place de la seule tarification à l'acte, les médecins de famille français ont appris à l'apprécier. La ROSP a permis d'améliorer significativement les domaines de pratique ciblés, même si l'effet sur les pratiques préventives a été moindre que sur les prescriptions de génériques et l'organisation des soins. Les ENMR ont amené à mieux formaliser les relations interprofessionnelles en soins de première ligne et ont donc contribué à leur intégration. Ces expériences suggèrent que cette distinction entre des changements de rémunération au niveau individuel et au niveau des équipes interdisciplinaires peut-être un bon point de départ pour introduire des incitations financières qui favorisent les effets positifs et limitent les conséquences négatives.