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Dare LO, Champagne F, Denis JL, Ste-Marie G, Yordanov Y. Web-based comparative study of some national experiences of health care quality management. Int J Health Plann Manage 2023; 38:1706-1720. [PMID: 37507359 DOI: 10.1002/hpm.3696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/27/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Since the publication of study results on adverse events to health care in OECD countries, the importance of the national quality improvement strategies has been recognised. To examine how these strategies have been shaped in different jurisdictions, we carried out this study. We conducted a web-based comparative study of international practices. We first defined seven key health care and services quality management functions. We then drew on the experience of authors to make a reasoned selection of 13 countries or states across the world. We determined the distance that separates each of these functions from a country's Ministry of Health (MoH); and examined whether these functions are concentrated in a single organisation or dispersed across several organisations. Afterwards, we correlated our results with the quality level of these countries based on the OECD's health care indicators. Overall, Netherlands, Québec (Canada), Korea, Germany, England (UK), and the United States had at least 50% of their quality management functions controlled by self-regulated organisations. The Market Concentration Index ranged from 937 for the United States to 6800 for Russia. Graphical representation has shown us two health system models. Our results also clearly showed that countries had a better quality of care most often when they belong to model 1 of our taxonomy. These findings will help countries design and implement large-scale health care and services quality strategies for better and safer health care and services.
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Affiliation(s)
- Labante Outcha Dare
- School of Public Health of Université de Montréal (ESPUM) - Département de gestion, d'évaluation et de politique de santé (DGEPS), Montreal, Québec, Canada
| | - François Champagne
- School of Public Health of Université de Montréal (ESPUM) - Département de gestion, d'évaluation et de politique de santé (DGEPS), Montreal, Québec, Canada
| | - Jean-Louis Denis
- School of Public Health of Université de Montréal (ESPUM) - Département de gestion, d'évaluation et de politique de santé (DGEPS), Montreal, Québec, Canada
- Chaire de recherche du Canada - Design et adaptation des systèmes de santé, Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada
| | | | - Yassen Yordanov
- Healthcare Quality Management, HEXIM Solutions Inc, Montreal, Québec, Canada
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Coulibaly GL, Farand L, Champagne F. [Contextual factors influencing the delegation of tasks to Multi-skilled Community Health Workers in Haiti]. Sante Publique 2023; 35:183-192. [PMID: 37558623 DOI: 10.3917/spub.232.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
INTRODUCTION In Haiti, the delegation of tasks to Multi-skilled Community Health Workers (locally called ASCP) is a strategy implemented by the Ministry of Public Health and Population to improve universal health coverage. PURPOSE OF RESEARCH To contribute to the successful implementation of this strategy, this article reports on a case study of its implementation in the northern health department of Haiti. More specifically, this article provides information on the contextual factors that facilitate or hinder the implementation of task delegation to ASCP. RESULTS The results obtained show notable progress in the implementation of task delegation to ASCP in the northern health department of Haiti. These mainly concern the following activities: selection, training, and deployment of ASCPs, endowment of work materials, supervision, collection and analysis of data on the results obtained. In September 2019, 215 ASCPs were active in the department. This corresponds to 44.3% of the 485 ASCPs planned to cover the department’s needs. Several contextual factors hindering or facilitating the implementation of this intervention were also identified with 35 resource persons during semi-structured interviews. These relate to the planning and monitoring of the implementation of the intervention (cited by 12 out of 35 people), the institutional context (10/35), and political (17/35), structural (30/35) and environmental factors (7/35). CONCLUSIONS This study highlights several contextual factors that need to be considered to ensure the successful implementation of the delegation of tasks to ASCP in Haiti and possibly in other contexts.
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Affiliation(s)
| | - Lambert Farand
- Université de Montréal, École de santé publique – Montréal – Canada
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Wassef J, Champagne F, Farand L. Nutritionists as policy advocates: the case of obesity prevention in Quebec, Canada. Public Health Nutr 2021; 25:1-14. [PMID: 34955107 PMCID: PMC9991765 DOI: 10.1017/s1368980021004997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A core function of the public health nutrition workforce is advocacy. Little is known of the nutritionists' role in policymaking from a policy process theory perspective. The current study analyses the nutritionists' role in advocating for a six-year governmental plan on obesity prevention in Quebec, Canada. DESIGN We conducted qualitative research using Quebec's obesity policy as a case study to understand the role of nutritionists in advocating for obesity prevention policies. A conceptual framework combining the Advocacy Coalition Framework with a political analysis model based on the Theory of the Strategic Actor was developed to analyse the beliefs, interests and strategies of policy actors including nutritionists. Data sources comprised semi-structured open-ended interviews with key policy actors (n 25), including eight nutritionists (32 %) and policy-related documents (n 267). Data analysis involved thematic coding and analysis using NVivo 11 Pro. SETTING Quebec, Canada. PARTICIPANTS Key policy actors including nutritionists. RESULTS Nutritionists formed the core of the dominant public health coalition. They advocated for an inter-sectoral governmental plan to prevent obesity through enabling environments. Their advocacy, developed through an iterative process, comprised creating a think tank and reinforcing partnerships with key policy actors, conducting research and developing evidence, communicating policy positions and advocacy materials, participating in deliberative forums and negotiating an agreement with other coalitions in the policy subsystem. CONCLUSIONS Nutritionists' advocacy influenced agenda setting and policy formulation. This research may contribute to empowering the public health nutrition workforce and strengthening its advocacy practices. It informs practitioners and researchers concerned with obesity policy and workforce development.
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Affiliation(s)
- Jacqueline Wassef
- University of Montreal, School of Public Health, Department of Health Management, Evaluation and Policy, C.P. 6128, Downtown campus, Montreal, QCH3C 3J7, Canada
| | - François Champagne
- University of Montreal, School of Public Health, Department of Health Management, Evaluation and Policy, C.P. 6128, Downtown campus, Montreal, QCH3C 3J7, Canada
| | - Lambert Farand
- University of Montreal, School of Public Health, Department of Health Management, Evaluation and Policy, C.P. 6128, Downtown campus, Montreal, QCH3C 3J7, Canada
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Spagnolo J, Champagne F, Leduc N, Rivard M, Melki W, Piat M, Laporta M, Guesmi I, Bram N, Charfi F. Building capacity in mental health care in low- and middle-income countries by training primary care physicians using the mhGAP: a randomized controlled trial. Health Policy Plan 2020; 35:186-198. [PMID: 31794027 DOI: 10.1093/heapol/czz138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 12/15/2022] Open
Abstract
To address the rise in mental health conditions in Tunisia, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to primary care physicians (PCPs) working in the Greater Tunis area. Non-specialists (such as PCPs)' training is an internationally supported way to target untreated mental health symptoms. We aimed to evaluate the programme's impact on PCPs' mental health knowledge, attitudes, self-efficacy and self-reported practice, immediately following and 18 months after training. We conducted an exploratory trial with a combination of designs: a pretest-posttest control group design and a one-group pretest-posttest design were used to assess the training's short-term impact; and a repeated measures design was used to assess the training's long-term impact. The former relied on a delayed-intervention strategy: participants assigned to the control group (Group 2) received the training after the intervention group (Group 1). The intervention consisted of a weekly mhGAP-based training session (totalling 6 weeks), comprising lectures, discussions, role plays and a support session offered by trainers. Data were collected at baseline, following Group 1's training, following Group 2's training and 18 months after training. Descriptive, bivariate and ANOVA analyses were conducted. Overall, 112 PCPs were randomized to either Group 1 (n = 52) or Group 2 (n = 60). The training had a statistically significant short-term impact on mental health knowledge, attitudes and self-efficacy scores but not on self-reported practice. When comparing pre-training results and results 18 months after training, these changes were maintained. PCPs reported a decrease in referral rates to specialized services 18 months after training in comparison to pre-training. The mhGAP-based training might be useful to increase mental health knowledge and self-efficacy, and decrease reported referral rates and negative mental health attitudes among PCPs in Tunisia and other low- and middle-income countries. Future studies should examine relationships among these outcome variables.
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Affiliation(s)
- Jessica Spagnolo
- School of Public Health, IRSPUM, Université de Montréal, 7101 Park Avenue, Montréal, Québec H3N 1X9, Canada
| | - François Champagne
- School of Public Health, IRSPUM, Université de Montréal, 7101 Park Avenue, Montréal, Québec H3N 1X9, Canada
| | - Nicole Leduc
- School of Public Health, IRSPUM, Université de Montréal, 7101 Park Avenue, Montréal, Québec H3N 1X9, Canada
| | - Michèle Rivard
- School of Public Health, IRSPUM, Université de Montréal, 7101 Park Avenue, Montréal, Québec H3N 1X9, Canada
| | - Wahid Melki
- Hôpital Razi, Manouba, Tunisia.,Faculté de médecine, Université de Tunis El-Manar, Tunis, Tunisia
| | - Myra Piat
- Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Verdun, QC H4H 1R3, Canada.,Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montréal, QC H3A 1A1, Canada
| | - Marc Laporta
- Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montréal, QC H3A 1A1, Canada.,The Montréal WHO-PAHO Collaborating Centre for Research and Training in Mental Health, 6875 Boulevard LaSalle, Verdun, QC H4H 1R3, Canada
| | - Imen Guesmi
- Centre médico-scolaire et universitaire de Manouba, Manouba, Tunisia
| | - Nesrine Bram
- Hôpital Razi, Manouba, Tunisia.,Faculté de médecine, Université de Tunis El-Manar, Tunis, Tunisia
| | - Fatma Charfi
- Faculté de médecine, Université de Tunis El-Manar, Tunis, Tunisia.,Hôpital Mongi-Slim, La Marsa, Tunisia
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Spagnolo J, Vasiliadis HM, Berbiche D, Champagne F, Leduc N, Melki W, Saeed K, Charfi F. The influence of primary care physicians' mental health knowledge, attitudes and self-efficacy on referrals to specialised services: findings from a longitudinal pilot trial. BJPsych Open 2020; 6:e130. [PMID: 33121559 PMCID: PMC7745245 DOI: 10.1192/bjo.2020.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/16/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Training based on the Mental Health Gap Action Programme (mhGAP) is being increasingly adopted by countries to enhance non-specialists' mental health capacities. However, the influence of these enhanced capacities on referral rates to specialised mental health services remains unknown. AIMS We rely on findings from a longitudinal pilot trial to assess the influence of mental health knowledge, attitudes and self-efficacy on self-reported referrals from primary to specialised mental health services before, immediately after and 18 months after primary care physicians (PCPs) participated in an mhGAP-based training in the Greater Tunis area of Tunisia. METHOD Participants included PCPs who completed questionnaires before (n = 112), immediately after (n = 88) and 18 months after (n = 59) training. Multivariable analyses with linear mixed models accounting for the correlation among participants were performed with the SAS version 9.4 PROC MIXED procedure. The significance level was α < 0.05. RESULTS Data show a significant interaction between time and mental health attitudes on referrals to specialised mental health services per week. Higher scores on the attitude scale were associated with more referrals to specialised services before and 18 months after training, compared with immediately after training. CONCLUSION Findings indicate that, in parallel to mental health training, considering structural/organisational supports to bring about a sustainable change in the influence of PCPs' mental health attitudes on referrals is important. Our results will inform the scale-up of an initiative to further integrate mental health into primary care settings across Tunisia, and potentially other countries with similar profiles interested in further developing task-sharing initiatives.
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Affiliation(s)
- Jessica Spagnolo
- School of Public Health, University of Montreal; Department of Community Health Sciences, University of Sherbrooke; and Charles-Le-Moyne - Saguenay-Lac-St-Jean Research Centre on Health Innovations, University of Sherbrooke - Longueuil Campus, Quebec, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, University of Sherbrooke; and Charles-Le-Moyne - Saguenay-Lac-St-Jean Research Centre on Health Innovations, University of Sherbrooke - Longueuil Campus, Quebec, Canada
| | - Djamal Berbiche
- Department of Community Health Sciences, University of Sherbrooke; and Charles-Le-Moyne - Saguenay-Lac-St-Jean Research Centre on Health Innovations, University of Sherbrooke - Longueuil Campus, Quebec, Canada
| | | | - Nicole Leduc
- School of Public Health, University of Montreal, Quebec, Canada
| | - Wahid Melki
- Department of Psychiatry D, Razi Hospital; Faculty of Medicine of Tunis, University of Tunis El-Manar, Tunisia; and Technical Committee for Mental Health Promotion in Ministry of Health, Tunis, Tunisia
| | - Khalid Saeed
- Mental Health and Substance Abuse Unit, Department of Non-Communicable Diseases and Mental Health, World Health Organization Regional Office for the Eastern Mediterranean, Egypt
| | - Fatma Charfi
- Department of Child Psychiatry, Mongi Slim Hospital; and Faculty of Medicine of Tunis, University of Tunis El-Manar, Tunisia
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Spagnolo J, Gautier L, Champagne F, Leduc N, Melki W, N'Guessan K, Charfi F. Reflecting on knowledge translation strategies from global health research projects in Tunisia and the Republic of Côte d'Ivoire. Int J Public Health 2020; 65:1559-1570. [PMID: 33068122 DOI: 10.1007/s00038-020-01502-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/26/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES We describe the knowledge translation strategies in two projects and share lessons learned about knowledge sharing and uptake. METHODS To generate findings for dissemination: (1) the Republic of Côte d'Ivoire (RCI) project relied on a multiple case study design to document barriers and facilitators to implementing a community-led prevention strategy targeting Ebola virus disease; and (2) the Tunisia project used several designs to assess a mental health training's effectiveness, and a case study design to explore contextual factors that may influence anticipated outcomes. RESULTS To share findings with participants, the RCI project relied on workshops and a pamphlet, and the Tunisia project relied on a structured half-day dissemination workshop and research summary. Facilitators that may have encouraged sharing and using findings include involving champions in dissemination activities, ongoing collaboration, and developing/implementing context-specific knowledge sharing strategies. Barriers include omitting to assess strategies, limited consideration of a wider audience, and the exclusion of a knowledge translation training component. CONCLUSIONS Our experiences might be useful to contexts involved in global and public health research that wish to address the "know-do gap."
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Affiliation(s)
- Jessica Spagnolo
- School of Public Health, Université de Montréal, Montreal, Canada.
- Department of Community Health Sciences, Centre de Recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les Innovations en Santé, Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada.
| | - Lara Gautier
- School of Public Health, Université de Montréal, Montreal, Canada
- Department of Sociology, McGill University, Montreal, Canada
| | | | - Nicole Leduc
- School of Public Health, Université de Montréal, Montreal, Canada
| | - Wahid Melki
- Hôpital Razi, Manouba, Tunisia
- Faculty of Medicine, Université de Tunis El-Manar, Tunis, Tunisia
| | - Konan N'Guessan
- Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
- Institut National d'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Fatma Charfi
- Faculty of Medicine, Université de Tunis El-Manar, Tunis, Tunisia
- Hôpital Mongi-Slim, La Marsa, Tunisia
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Danish A, Champagne F, Blais R. Theoretical analysis of policies to improve the recruitment and retention of rural physicians. Aust J Rural Health 2020; 28:427-433. [PMID: 33001509 DOI: 10.1111/ajr.12666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 11/26/2022] Open
Abstract
The lack of success in resolving the shortage of rural physicians in Organisation for Economic Cooperation and Development countries has been attributed to the weakness of implemented policies. This research examines the theoretical plausibility of policies to improve the recruitment and retention of rural physicians, first, by modelling the policies; and then, by describing how they might achieve their intended outcome based on a theoretical analysis. A theory-driven method relying on published research and expert analysis is used. A conceptual model is created to represent the policies and their underlying assumptions. Then, the functional mechanism of the policies is defined. This research demonstrates that financial, educational and tailored interventions might improve rural physician recruitment and retention, but that regulatory interventions are unlikely to do this. The majority of the policies implemented in Organisation for Economic Cooperation and Development countries are therefore theoretically plausible.
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Affiliation(s)
- Alya Danish
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | | | - Régis Blais
- School of Public Health, University of Montreal, Montreal, QC, Canada
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Smits P, Champagne F. Governance of health research funding institutions: an integrated conceptual framework and actionable functions of governance. Health Res Policy Syst 2020; 18:22. [PMID: 32070372 PMCID: PMC7029568 DOI: 10.1186/s12961-020-0525-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health research has scientific, social and political impacts. To achieve such impacts, several institutions need to participate; however, health research funding institutions are seldom nominated in the literature as essential players. The attention they have received has so far focused mainly on their role in knowledge translation, informing policy-making and the need to organise health research systems. In this article, we will focus solely on the governance of national health research funding institutions. Our objectives are to identify the main functions of governance for such institutions and actionable governance functions. This research should be useful in several ways, including in highlighting, tracking and measuring the governance trends in a given funding institution, and to forestall low-level governance. METHODS First, we reviewed existing frameworks in the grey literature, selecting seven relevant documents. Second, we developed an integrated framework for health research funding institution governance and management. Third, we extracted actionable information for governance by selecting a mix of North American, European and Asian institutions that had documentation available in English (e.g. annual report, legal status, strategy). RESULTS The framework contains 13 functions - 5 dedicated to governance (intelligence acquisition, resourcing and instrumentation, relationships management, accountability and performance, and strategy formulation), 3 dedicated to management (priority-setting, financing and knowledge transfer), and 5 dedicated to transversal logics that apply to both governance and management (ethics, transparency, capacity reinforcement, monitoring and evaluation, and public engagement). CONCLUSIONS Herein, we provide a conceptual contribution for scholars in the field of governance and health research as well as a practical contribution, with actionable functions for high-level managers in charge of the governance of health research funding institutions.
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Affiliation(s)
- Pernelle Smits
- Université Laval, Pavillon Palasis Prince, 2325 Rue de la Terrasse, Québec, QC, G1V 0A6, Canada.
| | - François Champagne
- Département d'Administration de la santé, University of Montréal, 7101 Avenue Parc, Montréal, Québec, H3N 1X7, Canada
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Demes JAE, Nickerson N, Farand L, Montekio VB, Torres P, Dube JG, Coq JG, Pomey MP, Champagne F, Jasmin ER. What are the characteristics of the champion that influence the implementation of quality improvement programs? Eval Program Plann 2020; 80:101795. [PMID: 32087525 DOI: 10.1016/j.evalprogplan.2020.101795] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/23/2020] [Accepted: 02/11/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Quality improvement in Healthcare is the new fashion actually. Rich countries and developing countries alike are trying to implement quality improvement initiatives to improve their performance and the quality of care. There is evidence in the scientific literature that the existence of a "champion" can play an important role in the successful implementation of quality improvement strategies. Most of the time, people get stuck at the implementation level: they know what to do but they fail to execute it in the organizational setting. That's where a champion can be useful to facilitate the success of the change. There is a paucity of research on the link between the champion and the implementation of quality improvement programs. The aim of the study was to investigate the perceptions of stakeholders about the characteristics and qualities of the champion that could facilitate the successful implementation of quality improvement programs in health care settings in Haiti. METHODS Twenty semi-structured individual interviews and one small group discussion (n = 4) with providers, administrators, directors, and NGO representatives were conducted during a six months period. The total sample size was twenty-four (n = 24). The methods were informed by grounded theory and the data were analyzed using the constant comparative method and thematic content analysis approach. RESULTS The analysis resulted in eleven themes describing the characteristics and qualities of a successful champion: Communication and persuasion, proactivity, humility, horizontal and collective leadership style, sense of responsibility and accountability, go-ahead type, empathy, dedication and motivation, ability to inspire and motivate people, have a vision, and encourage learning. CONCLUSIONS It is important to support and encourage champions in the health care systems in developing countries to master and exhibit those qualities and characteristics in order to lead a team for the successful implementation of quality improvement initiatives in the health facilities. More research is needed to understand how to better articulate those qualities in the context of the Haitian health care system.
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Affiliation(s)
- Joseph Adrien Emmanuel Demes
- School of Medicine and Pharmacy (UEH), Haiti; School of Public Health, University of Montreal, C.P. 6128, Succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada.
| | | | - Lambert Farand
- School of Public Health, University of Montreal, C.P. 6128, Succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada.
| | - Victor Becerril Montekio
- National Institute of Public Health / Centre for Health Systems Research, Av. Universidad 655, Col. Santa Mara Ahuacatitlan, Cuernavaca, Morelos CP62100, Mexico.
| | - Pilar Torres
- National Institute of Public Health / Centre for Health Systems Research, Av. Universidad 655, Col. Santa Mara Ahuacatitlan, Cuernavaca, Morelos CP62100, Mexico.
| | | | | | - Marie-Pascale Pomey
- School of Public Health, University of Montreal, C.P. 6128, Succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada.
| | - François Champagne
- School of Public Health, University of Montreal, C.P. 6128, Succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada.
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Spagnolo J, Champagne F, Leduc N, Melki W, Bram N, Guesmi I, Rivard M, Bannour S, Bouabid L, Ganzoui SBHH, Mongi BM, Riahi A, Saoud Z, Zine E, Piat M, Laporta M, Charfi F. A program to further integrate mental health into primary care: lessons learned from a pilot trial in Tunisia. Journal of Global Health Reports 2019. [DOI: 10.29392/joghr.3.e2019022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Capo-Chichi V, Ouendo E, Champagne F. [Health Ethics in Benin and HIV-AIDS : What are the stakes]. ACTA ACUST UNITED AC 2019; 28:75-87. [PMID: 29561120 DOI: 10.3917/jib.281.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
As part of the fight against HIV-AIDS, an effort was made at the ethical component, namely that there are legal texts, institutional and ethical. There are ethics committees (three) that give reasoned opinions on study protocols and are endeavoring to raise awareness of the actors. But we note that there is not yet a real ownership and adoption of ethical practice by them. This study targeted research projects on HIV-AIDS and centers supported PLHIV in order to analyze ethical issues : 1) the method of recruitment of participants and beneficiaries ; 2) obtaining informed consent from them ; 2) measures of confidentiality and anonymity ; 3) the integrity of staff of these projects and centers and conflicts of interest. A thematic analysis of data collected, which is done, after semi-structured interviews, helped to highlight the issues related to the recruitment process, obtaining informed consent, confidentiality measures and anonymity, integrity and Conflict of Interest. Let us remember that what is done, not done yet in the forms of art. Constant monitoring is called for, as leaders with ethics committees.They are supposed to play fully their roles.
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Spagnolo J, Champagne F, Leduc N, Melki W, Piat M, Laporta M, Bram N, Guesmi I, Charfi F. "We find what we look for, and we look for what we know": factors interacting with a mental health training program to influence its expected outcomes in Tunisia. BMC Public Health 2018; 18:1398. [PMID: 30572941 PMCID: PMC6302293 DOI: 10.1186/s12889-018-6261-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Primary care physicians (PCPs) working in mental health care in Tunisia often lack knowledge and skills needed to adequately address mental health-related issues. To address these lacunas, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to PCPs working in the Greater Tunis area between February and April 2016. While the mhGAP-IG has been used extensively in low- and middle-income countries (LMICs) to help build non-specialists' mental health capacity, little research has focused on how contextual factors interact with the implemented training program to influence its expected outcomes. This paper's objective is to fill that lack. METHODS We conducted a case study with a purposeful sample of 18 trained PCPs. Data was collected by semi-structured interviews between March and April 2016. Qualitative data was analyzed using thematic analysis. RESULTS Participants identified more barriers than facilitators when describing contextual factors influencing the mhGAP-based training's expected outcomes. Barriers were regrouped into five categories: structural factors (e.g., policies, social context, local workforce development, and physical aspects of the environment), organizational factors (e.g., logistical issues for the provision of care and collaboration within and across healthcare organizations), provider factors (e.g., previous mental health experience and personal characteristics), patient factors (e.g., beliefs about the health system and healthcare professionals, and motivation to seek care), and innovation factors (e.g., training characteristics). These contextual factors interacted with the implemented training to influence knowledge about pharmacological treatments and symptoms of mental illness, confidence in providing treatment, negative beliefs about certain mental health conditions, and the understanding of the role of PCPs in mental health care delivery. In addition, post-training, participants still felt uncomfortable with certain aspects of treatment and the management of some mental health conditions. CONCLUSIONS Findings highlight the complexity of implementing a mhGAP-based training given its interaction with contextual factors to influence the attainment of expected outcomes. Results may be used to tailor structural, organizational, provider, patient, and innovation factors prior to future implementations of the mhGAP-based training in Tunisia. Findings may also be used by decision-makers interested in implementing the mhGAP-IG training in other LMICs.
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Affiliation(s)
- Jessica Spagnolo
- School of Public Health, IRSPUM, Université de Montréal, Montréal, Québec H3N1X9 Canada
| | - François Champagne
- School of Public Health, IRSPUM, Université de Montréal, Montréal, Québec H3N1X9 Canada
| | - Nicole Leduc
- School of Public Health, Université de Montréal, Montréal, Québec Canada
| | - Wahid Melki
- Razi Hospital, University of Tunis El-Manar, Tunis, Tunisia
| | - Myra Piat
- Douglas Mental Health University Institute, McGill University, Montréal, Québec Canada
| | - Marc Laporta
- Montreal WHO-PAHO Collaborating Center for Research and Training in Mental Health, McGill University, Montréal, Québec Canada
| | - Nesrine Bram
- Razi Hospital, University of Tunis El-Manar, Tunis, Tunisia
| | - Imen Guesmi
- Center for School and University Medicine in Manouba, Manouba, Tunisia
| | - Fatma Charfi
- Mongi-Slim Hospital, University of Tunis El-Manar, Tunis, Tunisia
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Spagnolo J, Champagne F, Leduc N, Rivard M, Piat M, Laporta M, Melki W, Charfi F. Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia. Int J Ment Health Syst 2018; 12:63. [PMID: 30386422 PMCID: PMC6203218 DOI: 10.1186/s13033-018-0243-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 10/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-specialists' involvement in mental health care is encouraged in the field of global mental health to address the treatment gap caused by mental illness, especially in low- and middle-income countries. While primary care physicians (PCPs) are involved in mental health care in Tunisia, a lower-middle-income country in North Africa, it is unclear to what extent they are prepared and willing to address mental health problems, substance use disorders, and suicide/self-harm. In this context, we aim (1) to report on mental health knowledge, attitudes, and self-efficacy among a sample of PCPs working in the Greater Tunis area, prior to the implementation of a mental health training program developed by the World Health Organization; and (2) to identify what characteristics are associated with these competencies. METHODS In total, 112 PCPs completed questionnaires related to their socio-demographic and practice characteristics, as well as their mental health knowledge, attitudes, and self-efficacy. Descriptive analyses and regression models were performed. FINDINGS PCPs had more knowledge about depression, symptoms related to psychosis, and best practices after a suicide attempt; had favourable attitudes about distinctions between physical and mental health, learning about mental health, and the acceptance of colleagues with mental health issues; and believed most in their capabilities related to depression and anxiety. However, most PCPs had less knowledge about substance use disorders and myths about suicide attempts; had unfavorable attitudes about the dangerousness of people with mental health problems, personal disclosure of mental illness, non-specialists' role in assessing mental health problems, and personal recovery; and believed the least in their capabilities related to substance use disorders, suicide/self-harm, and psychosis. Participation in previous mental health training, weekly hours (and weekly hours dedicated to mental health), weekly provision of psychoeducation, and certain work locations were associated with better mental health competencies, whereas mental health knowledge was negatively associated with weekly referrals to specialized services. CONCLUSIONS Findings suggest that PCPs in our sample engage in mental health care, but with some gaps in competencies. Mental health training and increased interactions/involvement with people consulting for mental health issues may help further develop non-specialists' mental health competencies, and integrate mental health into primary care settings.
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Affiliation(s)
- Jessica Spagnolo
- School of Public Health, IRSPUM, University of Montreal, Montreal, QC H3N1X9 Canada
| | - François Champagne
- School of Public Health, IRSPUM, University of Montreal, Montreal, QC H3N1X9 Canada
| | - Nicole Leduc
- School of Public Health, University of Montreal, Montreal, QC Canada
| | - Michèle Rivard
- School of Public Health, University of Montreal, Montreal, QC Canada
| | - Myra Piat
- Douglas Mental Health University Institute, McGill University, Montreal, QC Canada
| | - Marc Laporta
- Montreal WHO-PAHO Collaborating Center for Research and Training in Mental Health, McGill University, Montreal, QC Canada
| | - Wahid Melki
- Razi Hospital, University of Tunis El-Manar, Tunis, Tunisia
| | - Fatma Charfi
- Mongi-Slim Hospital, University of Tunis El-Manar, Tunis, Tunisia
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Spagnolo J, Champagne F, Leduc N, Piat M, Guisset AL, Melki W, Charfi F, Guesmi I, Bram N, Laporta M. Factors Affecting the Implementation of a Mental Health Training Program
in Tunisia: Perspectives of Trainers and Tutors. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Spagnolo J, Champagne F, Leduc N, Piat M, Melki W, Charfi F, Laporta M. Building system capacity for the integration of mental health at the level of primary care in Tunisia: a study protocol in global mental health. BMC Health Serv Res 2017; 17:38. [PMID: 28095850 PMCID: PMC5240240 DOI: 10.1186/s12913-017-1992-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 01/06/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In low- and middle-income countries (LMICs), addressing the high prevalence of mental disorders is a challenge given the limited number and unequal distribution of specialists, as well as scarce resources allocated to mental health. The Mental Health Gap Action Programme (mhGAP) and its accompanying Intervention Guide (IG), developed by the World Health Organization (WHO), aim to address this challenge by training non-specialists such as general practitioners (GPs) in mental health care. This trial aims to implement and evaluate an adapted version of the mhGAP-IG (version 1.0) offered to GPs in 2 governorates of Tunisia (i.e., Tunis and Sousse), in order to uncover important information regarding implementation process and study design before country-wide implementation and evaluation. METHODS/DESIGN First, a systematic review will be conducted to explore types and effectiveness of mental health training programs offered to GPs around the world, with a specific focus on programs implemented and evaluated in LMICs. Second, a cluster randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of the implemented training based on the mhGAP-IG (version 1.0). Third, multiple case study design will be used to explore how contextual factors impact the successful implementation of the training and desired outcomes. DISCUSSION In Tunisia, an important need exists to further develop proximity health services and to address the growing mental health treatment gap. One solution is to train GPs in the detection, treatment, and management of mental health problems, given their strategic role in the healthcare system. This trial thus aims to implement and evaluate an adapted version of a training based on the mhGAP-IG (version 1.0) in Tunis and Sousse before country-wide implementation and evaluation. Several contributions are envisioned: adding to the growing evidence on the mhGAP and its accompanying guide, especially in French-speaking nations; building research capacity in Tunisia and more generally in LMICs by employing rigorous designs; evaluating an adapted version of the mhGAP-IG (version 1.0) on a sample of GPs; generating important information regarding implementation process and study design before country-wide implementation; and complimenting the trial results with implementation analysis, a priority in global mental health.
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Affiliation(s)
- Jessica Spagnolo
- School of Public Health, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), University of Montreal, 7101 Parc Avenue, Montreal, Quebec, H3N 1X9, Canada. .,Douglas Mental Health University Institute (CIUSS Ouest-de-l'Île-de-Montréal), 6875 LaSalle boul., Montreal, Québec, H4H 1R3, Canada.
| | - François Champagne
- School of Public Health, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), University of Montreal, 7101 Parc Avenue, Montreal, Quebec, H3N 1X9, Canada
| | - Nicole Leduc
- School of Public Health, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), University of Montreal, 7101 Parc Avenue, Montreal, Quebec, H3N 1X9, Canada
| | - Myra Piat
- Douglas Mental Health University Institute (CIUSS Ouest-de-l'Île-de-Montréal), 6875 LaSalle boul., Montreal, Québec, H4H 1R3, Canada.,McGill University, 845 Sherbrooke Street West Montreal, Quebec, H3A 0G4, Canada
| | - Wahid Melki
- Razi Hospital, Cité des Orangers, Manouba, Tunisia.,Faculty of Medicine, University Tunis El-Manar, 15 rue Djebel Lakhdhar, Tunis, Tunisia
| | - Fatma Charfi
- Faculty of Medicine, University Tunis El-Manar, 15 rue Djebel Lakhdhar, Tunis, Tunisia.,Mongi-Slim Hospital, 2046 Sidi Daoud, La Marsa, Tunisia
| | - Marc Laporta
- Douglas Mental Health University Institute (CIUSS Ouest-de-l'Île-de-Montréal), 6875 LaSalle boul., Montreal, Québec, H4H 1R3, Canada.,McGill University, 845 Sherbrooke Street West Montreal, Quebec, H3A 0G4, Canada
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Denis JL, Lehoux P, Hivon M, Champagne F. Creating a new articulation between research and practice through policy? The views and experiences of researchers and practitioners. J Health Serv Res Policy 2016; 8 Suppl 2:44-50. [PMID: 14596747 DOI: 10.1258/135581903322405162] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES In 1990, the Quebec Social Research Council - a body financing social research in Quebec, Canada - launched a new policy encouraging the development of social research units within health care organizations. Through financial incentives, it encouraged the implementation of long-term collaborations between researchers and practitioners with the purpose of transforming both scientific knowledge production and professional practices. This paper examines the perceptions of researchers and practitioners regarding the attributes and the usefulness of this collaborative research policy. METHODS A self-administered survey was sent to all the researchers (n = 146; response rate 78.1%) and practitioners (n = 204; response rate 44.1%) involved in the 21 collaborative research teams funded in 1998. T-tests were performed in order to assess the difference between the perceptions of researchers and practitioners in five key dimensions of collaborative research. RESULTS The results showed that, contrary to expectations, researchers and practitioners shared fairly similar views regarding the various dimensions of collaborative research. They both agreed that their involvement within collaborative research teams had contributed to the development of new skills and practices but had not facilitated their participation in external activities nor their involvement in networks and organizations that influence environments in which public policies and practices are deployed. They also both encountered some difficulties in putting the dimensions that they highly valued into practice. CONCLUSIONS Collaborative research within health care organizations succeeded in fostering the implementation of new modes of knowledge production and intervention. Nevertheless, special attention needs to be given to the development of strategies to reduce the discrepancies between values and practices.
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Affiliation(s)
- Jean-Louis Denis
- Interdisciplinary Health Research Group, University of Montreal, Quebec, Canada
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Abstract
Quality improvement collaboratives (QICs) are popular vehicles for supporting healthcare improvement; however, the effectiveness of these models and the factors associated with their success are not fully understood. This paper presents a QIC in the Canadian context, where provincial healthcare systems have historically faced difficulty in transcending their structural and political limitations as well as moving from reactive models of care (prioritizing illness treatment in a hospital-reliant system) to more proactive ones (prioritizing population health in a primary care-based system). In March 2012, in a move that has been described as "unprecedented," 17 health regions across four provinces in Atlantic Canada, together with the Canadian Foundation for Healthcare Improvement (CFHI), developed a collaborative to improve chronic disease prevention and management. This paper introduces the Atlantic Healthcare Collaboration for Innovation and Improvement in Chronic Disease (AHC), reflecting on the experience of developing and implementing the model, which involved teams of front-line clinicians and managers working with CFHI faculty, coaches and staff to assess, design, implement, evaluate and share healthcare improvements for people living with chronic diseases. The paper shares key results and lessons learned from the AHC QIC experience, thus far, for improving chronic disease prevention and management in healthcare in Canada.
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Affiliation(s)
- Jennifer Y Verma
- Senior Director, Canadian Foundation for Healthcare Improvement, Ottawa, ON
| | - Jean-Louis Denis
- Professor, Canada Research Chair in Health Systems Governance and Transformation, École nationale d'administration publique, Montréal, QC
| | - Stephen Samis
- Vice-President, Canadian Foundation for Healthcare Improvement, Ottawa, ON
| | | | - Maureen O'Neil
- President, Canadian Foundation for Healthcare Improvement, Ottawa, ON
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Lederer V, Loisel P, Rivard M, Champagne F. Exploring the diversity of conceptualizations of work (dis)ability: a scoping review of published definitions. J Occup Rehabil 2014; 24:242-67. [PMID: 23884716 DOI: 10.1007/s10926-013-9459-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Researchers are confronted to numerous definitions of work ability/disability, influenced by their context of emergence, discipline, purpose, underlying paradigm and relationship to time. This study provides an in-depth analysis of the concept through a systematic scoping review and the development of an integrative concept map of work (dis)ability. The research questions are: How has work (dis)ability been conceptualized from the perspectives of research, practice, policy and industry in the published scientific literature? How has the conceptualization of work (dis)ability evolved over time? METHODS A search strategy was designed with a library scientist to retrieve scientific publications containing explicit definition(s) of work (dis)ability in leading-edge databases. The screening and the extraction of the definitions were achieved by duplicate assessment. The definitions were subject to a comparative analysis based on the grounded theory approach. RESULTS In total, 423 abstracts were retrieved from the bibliographic databases. After removing duplicates, 280 unique records were screened for inclusion. A final set of 115 publications containing unique original conceptual definitions served as basis for analysis. CONCLUSIONS The scientific literature does not reflect a shared, integrated vision of the exact nature and dimensions of work (dis)ability. However, except for a few definitions, there seems to be a consensus that work (dis)ability is a relational concept resulting from the interaction of multiple dimensions that influence each other through different ecological levels. The conceptualization of work (dis)ability also seems to have become more dynamic over time. The way work (dis)ability is defined has important implications for research, compensation and rehabilitation.
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Affiliation(s)
- Valérie Lederer
- University of Montreal Public Health Research Institute, Montreal, QC, Canada,
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Champagne F, Lemieux-Charles L, Duranceau MF, MacKean G, Reay T. Organizational impact of evidence-informed decision making training initiatives: a case study comparison of two approaches. Implement Sci 2014; 9:53. [PMID: 24885800 PMCID: PMC4014624 DOI: 10.1186/1748-5908-9-53] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of efforts by healthcare organizations to enhance the use of evidence to improve organizational processes through training programs has seldom been assessed. We therefore endeavored to assess whether and how the training of mid- and senior-level healthcare managers could lead to organizational change. METHODS We conducted a theory-driven evaluation of the organizational impact of healthcare leaders' participation in two training programs using a logic model based on Nonaka's theory of knowledge conversion. We analyzed six case studies nested within the two programs using three embedded units of analysis (individual, group and organization). Interviews were conducted during intensive one-week data collection site visits. A total of 84 people were interviewed. RESULTS We found that the impact of training could primarily be felt in trainees' immediate work environments. The conversion of attitudes was found to be easier to achieve than the conversion of skills. Our results show that, although socialization and externalization were common in all cases, a lack of combination impeded the conversion of skills. We also identified several individual, organizational and program design factors that facilitated and/or impeded the dissemination of the attitudes and skills gained by trainees to other organizational members. CONCLUSIONS Our theory-driven evaluation showed that factors before, during and after training can influence the extent of skills and knowledge transfer. Our evaluation went further than previous research by revealing the influence--both positive and negative--of specific organizational factors on extending the impact of training programs.
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Affiliation(s)
| | - Louise Lemieux-Charles
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St,, 4th floor, Toronto, ON M5T 3 M6, Canada.
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Lepage M, Renaud L, Champagne F, Rivard M. Évaluation comparative de stratégies visant à augmenter les interventions de courte durée pour le sevrage tabagique auprès du personnel infirmier de milieux hospitaliers : résultats d'une étude expérimentale. Rech Soins Infirm 2014. [DOI: 10.3917/rsi.116.0057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Lepage M, Renaud L, Champagne F, Rivard M. [Strategies to increase the brief interventions in smoking cessation among nurses in hospital settings: experimental study]. Rech Soins Infirm 2014:57-69. [PMID: 24830223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Research results demonstrate a decrease in cigarette smoking when preventive professional interventions are routinely carried out. Literature reports that 30% of hospital nurses assess their patient smoking habits. The objective of the present study is to compare, on medical and surgical units, the effectiveness of three strategies (interactive educational session, recall, and both together) to a control group, on the number of nursing interventions pertaining to cessation of cigarette smoking. Research design is experimental with group randomisation. Pre and post strategy multi-measurements (at 1 and 3 months) are sought from nursing staff (69), patients and patient charts (351). Results show that nursing staff assesses cigarette smoking habits for only 35.7% of the patients, and their intent to stop smoking only of the time. Results show that the educational strategy increases the number of nursing interventions during a short period (1 month), and decreases perception of barriers to tobacco counselling. Impact of recall could not be assessed as it was not introduced as planned. CONCLUSION Considering modest results from the strategies, the interactive educational sessions shows a short- term effect on the nursing staff's interventions.
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Richard L, Chiocchio F, Tremblay MC, Lamy G, Champagne F, Beaudet N. Communities of Practice as a Professional and Organizational Development Strategy in Local Public Health Organizations in Quebec, Canada: An Evaluation Model. Healthc Policy 2014. [DOI: 10.12927/hcpol.2014.23731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Richard L, Chiocchio F, Essiembre H, Tremblay MC, Lamy G, Champagne F, Beaudet N. Communities of practice as a professional and organizational development strategy in local public health organizations in Quebec, Canada: an evaluation model. Healthc Policy 2014; 9:26-39. [PMID: 24726072 PMCID: PMC3999567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Communities of practice (CoPs) are among the professional development strategies most widely used in such fields as management and education. Though the approach has elicited keen interest, knowledge pertaining to its conceptual underpinnings is still limited, thus hindering proper assessment of CoPs' effects and the processes generating the latter. To address this shortcoming, this paper presents a conceptual model that was developed to evaluate an initiative based on a CoP strategy: Health Promotion Laboratories are a professional development intervention that was implemented in local public health organizations in Montreal (Quebec, Canada). The model is based on latest theories on work-group effectiveness and organizational learning and can be usefully adopted by evaluators who are increasingly called upon to illuminate decision-making about CoPs. Ultimately, validation of this conceptual model will help advance knowledge and practice pertaining to CoPs as well as professional and organizational development strategies in public health.
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Affiliation(s)
- Lucie Richard
- Full Professor, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), Faculty of Nursing, Léa-Roback Research Centre on Social Inequalities of Health in Montreal, and Research Centre, Institut universitaire de gériatrie de Montréal, Université de Montréal Montreal, QC
| | - François Chiocchio
- Associate Professor, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM) and Department of Psychology, Université de Montréal, Montreal, QC
| | - Hélène Essiembre
- Research Associate, Department of Psychology, Université de Montréal, Montreal, QC
| | - Marie-Claude Tremblay
- Graduate Student, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM) and School of Public Health Université de Montréal, Montreal Public Health Department, Montreal Health and Social Services Agency, Montreal, QC
| | - Geneviève Lamy
- Research Associate, Montreal Public Health Department, Montreal Health and Social Services Agency, Montreal, QC
| | - François Champagne
- Full Professor, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM) and School of Public Health, Université de Montréal, Montreal, QC
| | - Nicole Beaudet
- Planning, Programming and Research Officer, School of Public Health, Université de Montréal Montreal Public Health Department, Montreal Health and Social Services Agency, Montreal, QC
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Verma JY, Rossiter M, Kirvan K, Denis JL, Samis S, Phillips K, Venu K, Allen D, Ross Baker G, Brosseau M, Champagne F, Gaulton C, Leith E, O'connor P. Going far together: Healthcare collaborations for innovation and improvement in Canada. International Journal of Healthcare Management 2013. [DOI: 10.1179/2047971913y.0000000029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
In recent decades, there has been a growing interest in the design and implementation of systems using public reporting of performance measures to improve performance. In their simplest form, such interventions rest on the market-based logic of consumers using publicly released information to modify their behavior, thereby penalizing poor performers. However, evidence from large-scale efforts to use public reporting of performance measures as an instrumental performance improvement tool suggests that the causal mechanisms involved are much more complex. This article offers a typology of four different plausible causal pathways linking public reporting of performance measures and performance improvement. This typology rests on a variety of conceptual models and a review of available empirical evidence. We then use this typology to discuss the core elements that need to be taken into account in efforts to use public reporting of performance measures as a performance improvement tool.
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Desmeules F, Dionne CE, Belzile ÉL, Bourbonnais R, Champagne F, Frémont P. Determinants of pain, functional limitations and health-related quality of life six months after total knee arthroplasty: results from a prospective cohort study. Sports Med Arthrosc Rehabil Ther Technol 2013; 5:2. [PMID: 23566925 PMCID: PMC3646504 DOI: 10.1186/2052-1847-5-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 02/25/2013] [Indexed: 11/30/2022]
Abstract
Background Total knee arthroplasty (TKA) is an effective procedure. However, for some patients, the outcomes are not satisfactory. Identification of TKA determinants could help manage these patients more efficiently. The purpose of this study was to identify pre- and perioperative determinants of pain, functional limitations and health-related quality of life (HRQoL) 6 months after TKA. Methods 138 participants were recruited from 3 hospitals in Quebec City, Canada and followed up until 6 months after surgery. Data were collected through review of the subjects’ medical files and structured telephone interviews before and 6 months after TKA. Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the SF-36 Health Survey. Independent variables included demographic, socioeconomic, psychosocial, clinical and surgical characteristics of participants as well as data on health services utilization. Stepwise multiple regression analysis was used to assess the strength of the associations between the independent variables and the WOMAC and SF-36 scores. Results Higher preoperative pain, cruciate retaining implants and the number of complications were significantly associated with worse pain 6 months after TKA (p < 0.05) and explained 11% of the variance of the WOMAC pain score. Higher preoperative functional limitations, being single, separated, divorced or widowed, being unemployed or retired and the number of complications were significantly associated (p < 0.05) with worse functional limitations 6 months after TKA and explained 16% of the variance of the WOMAC function score. Lower preoperative HRQoL, contralateral knee pain, higher psychological distress and comorbidities were significantly associated (p < 0.05) with worse HRQoL 6 months after TKA and explained 23% of the variance of the SF-36 physical functioning score. Conclusions Several variables were found to be significantly associated with worse outcomes 6 months after TKA and may help identify patients at risk of poorer outcome. The identification of these determinants could help manage patients more efficiently and may help target patients who may benefit from extensive rehabilitation.
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Affiliation(s)
- François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, CP 6128 Succursale Centre-Ville, H3C 3J7, Montréal, QC, Canada.,URESP du Centre de recherche FRSQ du CHA Universitaire de Québec, Quebec City, QC, Canada.,University of Montreal Public Health Research Institute, Université de Montréal, Montreal, QC, Canada
| | - Clermont E Dionne
- URESP du Centre de recherche FRSQ du CHA Universitaire de Québec, Quebec City, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | | | - Renée Bourbonnais
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.,Community Health Care Centre (CSSS) de la Vieille-Capitale, Quebec City, QC, Canada
| | - François Champagne
- University of Montreal Public Health Research Institute, Université de Montréal, Montreal, QC, Canada
| | - Pierre Frémont
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.,Laval University Hospital Research Center (CRCHUQ), Quebec City, QC, Canada
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Lepage M, Champagne F, Renaud L. Un outil pour évaluer les pratiques cliniques des infirmières auprès des patients fumeurs en cessation tabagique à l'hôpital. Rech Soins Infirm 2013. [DOI: 10.3917/rsi.112.0036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Lepage M, Champagne F, Renaud L. [A tool to evaluate hospital nursing practices toward smoking cessation]. Rech Soins Infirm 2013:36-45. [PMID: 23671985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED Nurses in hospitals are not active in smoking cessation because of certain beliefs and attitudes. Beliefs and attitudes must be measured for changing practice in quitting smoking. The objective is to develop and validate a questionnaire on smoking cessation practices of nurses in hospitals. METHODOLOGY A methodological study was conducted to construct a questionnaire (n = 118) according to the theory of planned behaviour, to validate by four experts, for reliability and validation of instruments constructs (n = 38; n = 29; n = 157). RESULTS An initial questionnaire on practices in smoking cessation was built according to the beliefs of a convenience sample of 118 nurses. Validation of experts was conducted, and the questionnaire obtained an index of content validation (ICV) of 0.94. Subsequently, after two convenience samples (n = 38; n = 29) and a random sample (n = 157), the questionnaire obtained reliability, measured by Cronbach's alpha ranging in 0.697 and 0.93 1. Finally, moderately high correlations (0.406 to 0.569) were obtained between concepts. CONCLUSION A reliable and valid questionnaire in French is available to measure smoking cessation practices.
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Affiliation(s)
- Mario Lepage
- Université du Québec en Outaouais, Département des sciences infirmières, Gatineau, Canada.
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Champagne F, Contandriopoulos A, Denis J, Ducrot S, Fournier M, Lemay A. Dépenses de santé et santé dans les pays de l'OCDE de 1970 à 1990. Med Sci (Paris) 2013. [DOI: 10.4267/10608/2972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Desmeules F, Roy JS, MacDermid JC, Champagne F, Hinse O, Woodhouse LJ. Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review. BMC Musculoskelet Disord 2012; 13:107. [PMID: 22716771 PMCID: PMC3599404 DOI: 10.1186/1471-2474-13-107] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 06/06/2012] [Indexed: 11/25/2022] Open
Abstract
Background The convergence of rising health care costs and physician shortages have made health care transformation a priority in many countries resulting in the emergence of new models of care that often involve the extension of the scope of practice for allied health professionals. Physiotherapists in advanced practice/extended scope roles have emerged as key providers in such new models, especially in settings providing services to patients with musculoskeletal disorders. However, evidence of the systematic evaluation of advance physiotherapy practice (APP) models of care is scarce. A systematic review was done to update the evaluation of physiotherapists in APP roles in the management of patients with musculoskeletal disorders. Methods Structured literature search was conducted in 3 databases (Medline, Cinahl and Embase) for articles published between 1980 and 2011. Included studies needed to present original quantitative data that addressed the impact or the effect of APP care. A total of 16 studies met all inclusion criteria and were included. Pairs of raters used four structured quality appraisal methodological tools depending on design of studies to analyse included studies. Results Included studies varied in designs and objectives and could be categorized in four areas: diagnostic agreement or accuracy compared to medical providers, treatment effectiveness, economic efficiency or patient satisfaction. There was a wide range in the quality of studies (from 25% to 93%), with only 43% of papers reaching or exceeding a score of 70% on the methodological quality rating scales. Their findings are however consistent and suggest that APP care may be as (or more) beneficial than usual care by physicians for patients with musculoskeletal disorders, in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs and patient satisfaction. Conclusions The emerging evidence suggests that physiotherapists in APP roles provide equal or better usual care in comparison to physicians in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs and patient satisfaction. There is a need for more methodologically sound studies to evaluate the effectiveness APP care.
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Affiliation(s)
- François Desmeules
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
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Smits PA, Champagne F, Farand L. Beyond resistance: exploring health managers' propensity for participatory evaluation in a developing country. Eval Program Plann 2012; 35:256-268. [PMID: 22221891 DOI: 10.1016/j.evalprogplan.2011.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 09/21/2011] [Accepted: 10/31/2011] [Indexed: 05/31/2023]
Abstract
The evaluation of interventions is becoming increasing common and now often seeks to involve managers in the process. Such practical participatory evaluation (PPE) aims to increase the use of evaluation results through the participation of stakeholders. This study focuses on the propensity of health managers for PPE, as measured through the components of learning, working in groups, use of judgment and use of systematic methods. We interviewed 16 health managers to determine the meaning they ascribe to these four components in their practice in a developing country, Haïti. We found that learning was often informal and that all managers attached a negative meaning to the use of judgment. Working in groups was favored by all managers, while the health managers viewed the use of systematic methods differently than do evaluators. The administrative health managers generally ranked lower in propensity for PPE than did their clinical colleagues. Implications for the practice of evaluation are discussed in relation to the work styles exhibited by managers in everyday practice, the proactive repetition of actions, the control exercised by formal procedures, and the collective versus "solitary" image of one's environment of action.
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Affiliation(s)
- Pernelle A Smits
- School of Public Health, Faculty of Medicine, University of Montreal, Québec, Canada.
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Abstract
INTRODUCTION In international and national HIV/AIDS policies, free and informed consent is recognized as one of the major components of testing programs. For pregnant women, free and informed consent means that they should get information on prevention of mother-to-child transmission (PMTCT), understand them and make an independent choice after weighing the risks and advantages. However, no PMTCT program looked into the issue of consent. The objective of this paper is to explore the free and informed nature of pregnant women's consent with regard to testing and their rationale for accepting to be tested. METHODS We used data collected within the framework of the analysis of the creation of the PMTCT program in Benin. This analysis is based on multiple case studies that covered six maternity homes selected from 56 operational sites. For the specific analysis of consent, we used both survey data and qualitative research data. FINDINGS Apart from three cases of secret testing, the free nature of the consent to the test is respected on the PMTCT sites. Twenty-nine cases of refusal were recorded. The reasons put forth by most pregnant women include the fear of a positive test and its consequences on family life in 55.2% of cases and the expectation of their husbands' agreement or disagreement in 27.6% of cases. On the whole, the consent was free on all the sites but its informed nature is less respected.
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Affiliation(s)
- N M Kêdoté
- Institut des sciences biomédicales appliquées, 03 BP 3975, Cotonou, Bénin
| | - A Brousselle
- Université de Sherbrooke, centre de recherche HCLM, campus Longueuil, 150, place Charles-LeMoyne, bureau 200, CP 11, Longueuil (Qc) J4K-0A8, Canada
| | - F Champagne
- Université de Montréal, institut de recherche en santé publique (IRSPUM), 1420 Mont-Royal boulevard, room 2392, Outremont (QC) H2V 4P3, Canada
| | - D Laudy
- Université de Montréal, département de chirurgie, pavillon Roger-Gaudry, room S 316, C.P. 6128, succursale Centre-ville, Montréal (QC) H3C 3J7, Canada
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Smits PA, Champagne F, Brodeur JM. A mixed method study of propensity for participatory evaluation. Eval Program Plann 2011; 34:217-227. [PMID: 21555045 DOI: 10.1016/j.evalprogplan.2011.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 02/28/2011] [Accepted: 03/01/2011] [Indexed: 05/30/2023]
Abstract
One way to increase the use of evaluation results is practical participatory evaluation (PPE), which enables non-evaluator participants to join the evaluation process in a participatory mode. We examined the propensity for PPE of health professionals by focusing on four components: learning, working in groups, using judgment and using systematic methods. We interviewed the professionals at a Haitian health institution to determine their positioning on a scale of propensity (low, medium and high) for the four components. The professionals defined each component in relation to the energy puts into them, being more or less proactive. Facilitating elements for all three levels of propensity integration included past positive experiences, external pressure and a desire for better individual and organizational performance. Impeding factors included a lack of available resources perceived responsibilities and commitments toward private patients. The reported advantages included improved organizational performance and idea sharing, and the disadvantages included availability of, difficulty implementing solutions and altered human relationships.
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Affiliation(s)
- Pernelle A Smits
- University of Montréal, C.P. 6128, succ. centre ville, Montréal, Qc, H3 C 3J7, Canada.
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Brousselle A, Champagne F. Program theory evaluation: Logic analysis. Eval Program Plann 2011; 34:69-78. [PMID: 20541262 DOI: 10.1016/j.evalprogplan.2010.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 03/08/2010] [Accepted: 04/24/2010] [Indexed: 05/29/2023]
Abstract
Program theory evaluation, which has grown in use over the past 10 years, assesses whether a program is designed in such a way that it can achieve its intended outcomes. This article describes a particular type of program theory evaluation-logic analysis-that allows us to test the plausibility of a program's theory using scientific knowledge. Logic analysis is useful for improving the intervention or finding alternatives for achieving intended outcomes; it influences the choice of type of evaluation to conduct and strengthens the validity of subsequent evaluations. The objective of this article is to present the methodological principles and the roots of this type of program theory evaluation. We illustrate two types of logic analysis with two actual evaluation cases. There are very few published examples of program theory evaluation. This article will provide evaluators with both theoretical and practical information to help them in conceptualizing their evaluations.
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Affiliation(s)
- Astrid Brousselle
- Department of Community Health Sciences, Charles LeMoyne Hospital Research Center, University of Sherbrooke, Canada.
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Contandriopoulos AP, Rey L, Brousselle A, Champagne F. [Not Available]. Can J Program Eval 2011; 26:1-16. [PMID: 27293310 PMCID: PMC4900871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Theoretically, evaluation should help decision-makers address contemporary health system challenges. Paradoxically, the use of evaluation results by decision-makers remains poor, despite rapid development in the evaluation field. The level of use depends on the evaluator's ability to account for the complexity of health-care systems. The complex nature of an intervention often compels evaluators to adopt unconventional approaches to account for the roles of the players. The evaluation of a complex intervention raises conceptual, methodological, and operational challenges the evaluation has to overcome to increase the level of use of its findings by decision-makers.
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Affiliation(s)
| | - Lynda Rey
- Université de Montréal, Montréal, Québec
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Tanon AA, Champagne F, Contandriopoulos AP, Pomey MP, Vadeboncoeur A, Nguyen H. Patient safety and systematic reviews: finding papers indexed in MEDLINE, EMBASE and CINAHL. Qual Saf Health Care 2010; 19:452-61. [PMID: 20457733 DOI: 10.1136/qshc.2008.031401] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop search strategies for identifying papers on patient safety in MEDLINE, EMBASE and CINAHL. METHODS Six journals were electronically searched for papers on patient safety published between 2000 and 2006. Identified papers were divided into two gold standards: one to build and the other to validate the search strategies. Candidate terms for strategy construction were identified using a word frequency analysis of titles, abstracts and keywords used to index the papers in the databases. Searches were run for each one of the selected terms independently in every database. Sensitivity, precision and specificity were calculated for each candidate term. Terms with sensitivity greater than 10% were combined to form the final strategies. The search strategies developed were run against the validation gold standard to assess their performance. A final step in the validation process was to compare the performance of each strategy to those of other strategies found in the literature. RESULTS We developed strategies for all three databases that were highly sensitive (range 95%-100%), precise (range 40%-60%) and balanced (the product of sensitivity and precision being in the range of 30%-40%). The strategies were very specific and outperformed those found in the literature. CONCLUSION The strategies we developed can meet the needs of users aiming to maximise either sensitivity or precision, or seeking a reasonable compromise between sensitivity and precision, when searching for papers on patient safety in MEDLINE, EMBASE or CINAHL.
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Affiliation(s)
- A A Tanon
- Department of Health Administration, Faculty of Medicine, University of Montreal, PO Box 6128, Succ Centre-ville, Montreal, Quebec, Canada.
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Pomey MP, Lemieux-Charles L, Champagne F, Angus D, Shabah A, Contandriopoulos AP. Does accreditation stimulate change? A study of the impact of the accreditation process on Canadian healthcare organizations. Implement Sci 2010; 5:31. [PMID: 20420685 PMCID: PMC2882897 DOI: 10.1186/1748-5908-5-31] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 04/26/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One way to improve quality and safety in healthcare organizations (HCOs) is through accreditation. Accreditation is a rigorous external evaluation process that comprises self-assessment against a given set of standards, an on-site survey followed by a report with or without recommendations, and the award or refusal of accreditation status. This study evaluates how the accreditation process helps introduce organizational changes that enhance the quality and safety of care. METHODS We used an embedded multiple case study design to explore organizational characteristics and identify changes linked to the accreditation process. We employed a theoretical framework to analyze various elements and for each case, we interviewed top managers, conducted focus groups with staff directly involved in the accreditation process, and analyzed self-assessment reports, accreditation reports and other case-related documents. RESULTS The context in which accreditation took place, including the organizational context, influenced the type of change dynamics that occurred in HCOs. Furthermore, while accreditation itself was not necessarily the element that initiated change, the accreditation process was a highly effective tool for (i) accelerating integration and stimulating a spirit of cooperation in newly merged HCOs; (ii) helping to introduce continuous quality improvement programs to newly accredited or not-yet-accredited organizations; (iii) creating new leadership for quality improvement initiatives; (iv) increasing social capital by giving staff the opportunity to develop relationships; and (v) fostering links between HCOs and other stakeholders. The study also found that HCOs' motivation to introduce accreditation-related changes dwindled over time. CONCLUSIONS We conclude that the accreditation process is an effective leitmotiv for the introduction of change but is nonetheless subject to a learning cycle and a learning curve. Institutions invest greatly to conform to the first accreditation visit and reap the greatest benefits in the next three accreditation cycles (3 to 10 years after initial accreditation). After 10 years, however, institutions begin to find accreditation less challenging. To maximize the benefits of the accreditation process, HCOs and accrediting bodies must seek ways to take full advantage of each stage of the accreditation process over time.
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Affiliation(s)
- Marie-Pascale Pomey
- Department of Health Administration, GRIS, Faculty of Medicine, University of Montreal, CP 6128, Succ. Centre Ville, Montreal, Québec, Canada H3C 3J7
| | | | - François Champagne
- Department of Health Administration, GRIS, Faculty of Medicine, University of Montreal, CP 6128, Succ. Centre Ville, Montreal, Québec, Canada H3C 3J7
| | - Doug Angus
- Telfer School of Management, University of Ottawa, 55 Laurier Avenue East., Ottawa, ON, K1N 6N5, Canada
| | - Abdo Shabah
- Direction de la santé publique de Montréal, 1301 Sherbrooke Est, Montréal (Québec), H2L 1M3
| | - André-Pierre Contandriopoulos
- Department of Health Administration, GRIS, Faculty of Medicine, University of Montreal, CP 6128, Succ. Centre Ville, Montreal, Québec, Canada H3C 3J7
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Lamontagne ME, Swaine BR, Lavoie A, Champagne F, Marcotte AC. Perceptions of traumatic brain injury network participants about network performance. Brain Inj 2010; 24:812-22. [DOI: 10.3109/02699051003789252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gagnon C, Chouinard MC, Lavoie M, Champagne F. [Analysis of the nursing role in the care of patients with neuromuscular disorders]. Can J Neurosci Nurs 2010; 32:22-29. [PMID: 21268911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The nursing role in neuromuscular disorders has been shown as a promising solution in service organization. However, the role of neuromuscular nurses has scarcely been addressed in the literature. The present evaluation process was geared toward defining nursing role in relation to systematic follow-up of neuromuscular disorders and to assess its theoretical background.
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Affiliation(s)
- Cynthia Gagnon
- Faculté de Médecine et des Sciences de la Santé de l'Université de Sherbrooke, Québec, Canada.
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Blais R, Champagne F, Rousseau L. TOCSIN: a proposed dashboard of indicators to control healthcare-associated infections. ACTA ACUST UNITED AC 2009; 12 Spec No Patient:161-7. [PMID: 19667795 DOI: 10.12927/hcq.2009.20985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Healthcare-associated infections (HAIs) constitute a major safety problem. Healthcare managers need complete and valid information to fight against these infections. The purpose of this study was to develop a dashboard of indicators to help healthcare managers monitor HAIs. A pilot testing approach was used that was composed of the following steps: literature review, consultation with infection control experts and healthcare managers, operationalization of selected indicators, data collection from six Quebec hospital complexes to test the feasibility of the selected indicators and results dissemination. The literature review identified 299 possible indicators. After consulting infection control experts and healthcare managers and having collected data in the hospitals, a proposed dashboard was created that includes 97 indicators divided in three categories (structure, process and outcome) and grouped in 22 themes. The proposed indicators are both scientifically valid and administratively feasible. However, many healthcare facilities need additional financial resources and expertise to measure these indicators and manage the information they will generate.
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Affiliation(s)
- Régis Blais
- Department of Health Administration and a researcher in the Groupe de recherche interdisciplinaire en santé (GRIS) of the University of Montreal, Montreal, Quebec, Canada.
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Touati N, Pineault R, Champagne F, Denis JL, Brousselle A, Contandriopoulos AP, Geneau R. Evaluating Service Organization Models: The Relevance and Methodological Challenges of a Configurational Approach. Evaluation (Lond) 2009; 15:375-401. [PMID: 27274682 PMCID: PMC4889425 DOI: 10.1177/1356389009341729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Based on the example of the evaluation of service organization models, this article shows how a configurational approach overcomes the limits of traditional methods which for the most part have studied the individual components of various models considered independently of one another. These traditional methods have led to results (observed effects) that are difficult to interpret. The configurational approach, in contrast, is based on the hypothesis that effects are associated with a set of internally coherent model features that form various configurations. These configurations, like their effects, are context-dependent. We explore the theoretical basis of the configuration approach in order to emphasize its relevance, and discuss the methodological challenges inherent in the application of this approach through an in-depth analysis of the scientific literature. We also propose methodological solutions to these challenges. We illustrate from an example how a configurational approach has been used to evaluate primary care models. Finally, we begin a discussion on the implications of this new evaluation approach for the scientific and decision-making communities.
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Affiliation(s)
- Nassera Touati
- École Nationale d'Administration Publique, Groupe de Recherche Interdisciplinaire en Santé (GRIS), Canada
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Gagnon I, Swaine B, Champagne F, Lefebvre H. Perspectives of adolescents and their parents regarding service needs following a mild traumatic brain injury. Brain Inj 2009; 22:161-73. [DOI: 10.1080/02699050701867381] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Swaine BR, Gagnon I, Champagne F, Lefebvre H, Friedman D, Atkinson J, Feldman D. Identifying the specific needs of adolescents after a mild traumatic brain injury: A service provider perspective. Brain Inj 2009; 22:581-8. [DOI: 10.1080/02699050802189701] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gravel S, Vissandjée B, Lippel K, Brodeur JM, Patry L, Champagne F. Ethics and the Compensation of Immigrant Workers for Work-Related Injuries and Illnesses. J Immigr Minor Health 2009; 12:707-14. [DOI: 10.1007/s10903-008-9208-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 11/03/2008] [Indexed: 10/21/2022]
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Kêdoté MN, Brousselle A, Champagne F. Use of health care services by patients with co-occurring severe mental illness and substance use disorders. ACTA ACUST UNITED AC 2008; 1:216-227. [PMID: 27239226 DOI: 10.1080/17523280802274886] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND To better respond to the health care needs of people with co-occurring mental illness and substance use disorders, it is vital to understand their itinerary through the health care system. AIM To describe the characteristics of service utilization among patients with co-occurring disorders in a large urban area. METHOD We used a sample (n = 5467) constituted from administrative and clinical databases. Those identified as having substance use disorders and psychoses were followed over 12 months with respect to their utilization of medical services. A descriptive analysis of the data and a two-step cluster analysis were undertaken. RESULTS Our analyses revealed a relatively high utilization of emergency services, outpatient clinics, private practices and hospitalization among patients with co-occurring disorders of severe mental illness and substance use. The two-step cluster analysis produced four heterogeneous groups in terms of service utilization. CONCLUSIONS This study demonstrates the need to develop strategies for organizing health care and services that are adapted to various sites of service utilization and to diverse profiles of patients with co-occurring mental illness and substance use disorders.
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Affiliation(s)
| | - Astrid Brousselle
- Groupe de Recherche Interdisciplinaire en Santé (GRIS); Université de Montréal, Department of Health Administration
| | - François Champagne
- Groupe de Recherche Interdisciplinaire en Santé (GRIS); Université de Montréal, Department of Health Administration
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Abstract
PURPOSE The purpose of this paper is to describe and understand the effects of the accreditation process on organizational control and quality management practices in two Quebec primary-care health organizations. DESIGN/METHODOLOGY/APPROACH A multiple-case longitudinal study was conducted taking a mixed qualitative/quantitative approach. An analytical model was developed of the effects of the accreditation process on the type of organizational control exercised and the quality management practices implemented. The data were collected through group interviews, semi-directed interviews of key informers, non-participant observations, a review of the literature, and structured questionnaires distributed to all the employees working in both institutions. FINDINGS The accreditation process has fostered the implementation of consultation mechanisms in self-assessment teams. Improving assessments of client satisfaction was identified as a prime objective but, in terms of the values promoted in organizations, accreditation has little effect on the perceptions of employees not directly involved in the process. As long as not all staff members have integrated the basis for accreditation and its outcomes, the accreditation process appears to remain an external, bureaucratic control instrument. ORIGINALITY/VALUE This study provides a theoretical model for understanding organizational changes brought about by accreditation of primary services. Through self-assessment of professional values and standards, accreditation may foster better quality management practices.
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Affiliation(s)
- André Paccioni
- Centre of Interdisciplinary Research on Rehabilitation of Greater Montreal, Quebec, Canada.
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Minvielle E, Sicotte C, Champagne F, Contandriopoulos AP, Jeantet M, Préaubert N, Bourdil A, Richard C. Hospital performance: Competing or shared values? Health Policy 2008; 87:8-19. [DOI: 10.1016/j.healthpol.2007.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 09/21/2007] [Accepted: 09/23/2007] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE To compare the conceptualization of performance underlying different accreditation manuals. DATA SOURCES Accreditation manuals were selected from the 2003 WHO report titled 'Quality and Accreditation in Healthcare Services'. We used manuals from WHO-listed countries that most influenced the standards: Canada, France, the USA and Australia. The fifth manual is published by the Pan American Health Organization (PAHO). EXTRACTION METHODS Standards from each manual were classified by two independent reviewers. The coding grid, which was based on a Parsonian-based integrative framework on performance, was composed of performance dimensions and their interlinks/alignments. PRINCIPAL FINDINGS The four dimensions of quality, goal-attainment, adaptation to the external environment and values, along with their alignments, were given differing levels of importance in the five manuals. The Australian manual emphasizes all four dimensions and their alignments. The PAHO accreditation focuses mainly on quality. The manuals from Canada, France and the USA fall somewhere between the two accreditation extremes of complete versus one-dimensional. Finally, we present a taxonomy of the conceptualization of performance in accreditation manuals that distinguishes between quality-oriented and alignment-oriented accreditation manuals. CONCLUSIONS Specific conceptualizations of performance underlying accreditation manuals may not be neutral. Perhaps, more normative accreditation manuals are associated with authoritative management styles, or more balanced accreditation manuals with comprehensive management styles. Our comparative analysis is a first step toward better understanding the relationship between the conceptualization of performance and the management style adopted in a particular healthcare organization. This relationship could help explain the variation observed in healthcare organization performance.
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Affiliation(s)
- Pernelle A Smits
- Program in Public Health, University of Montréal, Faculty of Medicine, Montréal, Québec, Canada.
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Grilli L, Feldman DE, Swaine B, Gosselin J, Champagne F, Pineault R. Wait times for paediatric rehabilitation. Healthc Policy 2007; 2:e171-e187. [PMID: 19305712 PMCID: PMC2585457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Early therapy intervention for children with disabilities may improve functional outcomes. Access to paediatric rehabilitation services can sometimes be difficult. OBJECTIVES To describe waiting time to receive physical therapy (PT) and occupational therapy (OT) services at rehabilitation centres for young children with physical disabilities; to examine factors associated with these waiting times. DESIGN Prospective cohort. SUBJECTS Two hundred and six children with physical disabilities, aged 6 to 72 months, referred in 2002-2004 from the Montreal Children's Hospital and Sainte-Justine Hospital to paediatric rehabilitation centres. MEASURES Data on date of referral, age, gender and diagnosis were obtained from the hospital databases. Data on date of first PT or OT appointments at the rehabilitation centre, family socio-demographics and disability severity (WeeFIM) were obtained during parental interviews. RESULTS Half of the sample waited more than 7 and 11 months for PT and OT services, respectively. Shorter waiting time was significantly associated with younger child's age and referral to one particular rehabilitation centre. CONCLUSION Children with physical disabilities experience long waiting times for PT and OT rehabilitation services. Strategies to improve timely service delivery are needed.
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Affiliation(s)
- Lisa Grilli
- Université de Montréal, Ecole de réadaptation, Centre de recherche interdisciplinaire en réadaptation (CRIR), McGill University Health Center: Montreal Children's Hospital, Montreal, QC
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Gravel S, Brodeur JM, Champagne F, Lippel K, Patry L, Boucheron L, Fournier M, Vissandjée B. Critères pour apprécier les difficultés d’accès à l’indemnisation des travailleurs immigrants victimes de lésions professionnelles. pistes 2006. [DOI: 10.4000/pistes.3025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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