"> Objectives and short description of the research program – Montfort Research Chair in Organization of Health Services

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Objectives and short description of the research program

© François Chiocchio 2017

The objective of the Research program is to Describe, understand and explain the impact of interaction among individual, group and organizational factors on the ties between collaboration and innovation in health care services in Canada and other countries. It covers three complementary components: (1) the implementation of service optimization changes; (2) a collaborative research approach; (3) improved health services for Francophone minority communities.

By emphasizing collaboration as a human phenomenon whereby the people involved (patients/families, administrators, health professionals and researchers) interact in achieving a shared objective, the program highlights the levers and obstacles of the driving force behind health services. By focussing on the determinants underlying the creation, establishment and appropriation of the innovation required by health services performance, the research program acknowledges the vast complexity of the issue. For that reason, it has gleaned many of its basic precepts from the fields of industrial and organizational psychology, organizational management and health care service organization, in which it will also make its mark.

The figure opposite shows the topics on which the Research Chair program plans to enlist the collaborative efforts of healthcare system stakeholders in order to achieve promising and sustainable innovations.figure-en

Background

The issue of innovation determinants is complex. It is compounded by pressures brought to bear in a context where the health care system must adapt to the increasingly complex needs of patients (Waibel, Henio, Aller, Vargas, & Vázquez, 2012) but also of all the other players involved. The context changes how the causes (such as collaboration) influence effects (such as innovation) (Johns, 2006). Individuals, teams, groups, units and organizations are all intertwined, which demands a multi-level understanding of the phenomena under study (Kozlowski & Klein, 2000). Connecting these components based on the various levels demands a multidisciplinary research approach, with contributions from the fields of industrial and organizational psychology, management and health care services documentation. The Chair’s work will therefore encompass these three areas.

Collaboration

Collaboration is the essence of health care service organization and requires the participation of researchers, administrators, health care professionals, technicians, support staff and, obviously, patients and their family members. Collaboration is an evolving process whereby two or more social entities actively and mutually engage in activities designed to achieve a common goal (Bedwell et al., 2012).

Innovation

Innovation is a process that the healthcare system can use to meet the changing needs of pa-tients. Many determinants must be taken into account (Fleuren, Wiefferink, & Paulussen, 2004). For example, innovation can be gradual or radical, which determines how approaches to managing such change may differ (McDermott & O’Connor, 2002). Moreover, compared to continuous improvement, a project management approach fosters richer collaboration (Chiocchio & Richer, 2015). At an individual level, flexible individuals who are capable of adapting to circumstances generate more new ideas (Howell & Boies, 2004), which is vital for innovation. At the group level, teams with a clear objective innovate more effectively. And teams able to engage in self-examination and adapt to circumstance foster innovation (Schippers, West, & Dawson, 2015). Lastly, organizational culture has an important influence on the innovation process (Hogan & Coote, 2014).

Research Axes

Axis 1. Implementation of the changes involved in optimizing services is an emerging field of research. Changes in health care are frequent and complex (Plsek & Greenhalgh, 2001; Plsek & Wilson, 2001) both inside and among organizations (Bazzoli, Dynan, Burns, & Yap, 2004). For example, in hospitals, structures are changing from compartmentalized operational units to entities focused on patient processes (Brown et al., 2014; Reddeman et al., 2016; van Riet Paap et al., 2015; Vos et al., 2011). Among organizations, the emphasis centres on the effectiveness and efficiency of organizational coordination. In Ontario, patients want clear, easy, fast and practical transitions (Baker & Axler, 2015). The change process represents the biggest of the innovative health care service innovation initiatives (Bazzoli et al., 2004) where “human” issues like leading patient care teams (Lemieux-Charles & McGuire, 2006) or inter-professional distrust and conflicts are major obstacles (D’Amour, Ferrada-Videla, San Martin Rodriguez, & Beaulieu, 2005; D’Amour, Goulet, Ladadie, San Martin-Rodriguez, & Pineault, 2008; San Martin Rodriguez, Beaulieu, D’Amour, & Ferrada-Videla, 2005). Little is known about the relative effectiveness of the two major approaches used to introduce change in the health field: the gradual approach based on continuous improvement, and the radical approach based on pro-ject management. Few people question the paradigm of continuous improvement (Chiocchio, 2015b) and it tends to be applied in all circumstances. Radical change requires a project management approach (Chiocchio, Rabbat, & Lebel, 2015), which is rare in the case of “small” change projects (Chiocchio, 2015a) and problematic in the case of “large” hospital reorganization (Vos et al., 2011), infrastructure (Barlow & Koberle-Gaiser, 2009) and information technology (Heeks, 2006) projects.

Axis 2. The patient-centred care concept has evolved since it first appeared in the 1950s (Uijen, Schers, Schellevis, & van den Bosch, 2012) and is spreading (Morgan & Yoder, 2012). A holistic, bio-logical-psychological-social outlook on patients, responsibility and decision-sharing, and the identification of shared goals have gained recognition since the early 2000s (Flagg, 2015; Mead & Bower, 2002; Uijen et al., 2012), but more progress is needed (Pomey, Ghadiri, Karazivan, Fernandez, & Clavel, 2015). For example, some believe that an even more productive partnership is possible and necessary in terms of the role that patients play in their own care (Karazivan et al., 2015; Pomey, Flora, et al., 2015) and see their interaction with health care services as a learning process (Pomey, Ghadiri, et al., 2015). But two additional steps are necessary: (1) include the patient as a full partner in designing health care services and (2) include the patient in designing and implementing research on the effectiveness of the health care system. These two factors are the main focus of interest under this Component of the Chair program. Collaborative research is an appealing means of taking the needs of patients and their family members into account (Las Nueces, Hacker, DiGirolamo, & Hicks, 2012). However, patient involvement in research varies considerably in quality and quantity (Viswanathan et al., 2004).

Axis 3. Much remains to be learned about improving the health care services delivered to minority communities (Karliner, Napoles-Springer, Schillinger, Bibbins-Domingo, & Pérez-Stable, 2008; Miranda et al., 2003). For example, language support programs can improve access to health care services (Chen, Vargas-Bustamante, & Ortega, 2012). However, the complexity involved demands varied and robust underpinnings. In this respect, the concept of cultural competency – a series of congruent behaviours, attitudes and policies that take shape in a system, agency or among professionals and allows the system, agency or professionals to work effectively in intercultural situations (Cross, 1989) – is key to understanding the effect of patient and health care professional interactions on access to services, but also to understanding organizational and systemic competencies (Truong, Paradies, & Priest, 2014). For example, we know that navigator programs foster patient empowerment and trust in institutions (Na-tale‐Pereira, Enard, Nevarez, & Jones, 2011). These actions must be supported by the organizations that deploy them, culturally adapted to the specific needs of the populations concerned, and carried out by multidisciplinary teams, with simultaneous separate identification of the specific effects of various determinants (Chin et al., 2012). For example, language is a major mental health care obstacle for Fran-co-Ontarians (Tempier, Bouattane, & Hirdes, 2015), but rural accessibility is the main obstacle among Franco-Manitobans (de Rocquigny, 2014).

References

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Chin, M. H., Clarke, A. R., Nocon, R. S., Casey, A. A., Goddu, A. P., Keesecker, N. M., & Cook, S. C. (2012). A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care. Journal of general internal medicine, 27(8), 992-1000.

Chiocchio, F. (2015a, 15-18 May). Change (mis)management: The role of healthcare professionals. Paper presented at the 6th Annual Canadian Winter School for Quality and Safety in Radiation Oncology, Kelowna, BC.

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Hogan, S. J., & Coote, L. V. (2014). Organizational culture, innovation, and performance: A test of Schein’s model. Journal of Business Research, 67(8), 1609-1621.

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