+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Reforming primary healthcare: from public policy to organizational change



Reforming primary healthcare: from public policy to organizational change



Journal of Health Organization and Management 29(1): 92-110



Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of "intermediate change" and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. This research is one of few studies to examine a primary care reform from emergence to implementation using a longitudinal multi-level design.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 058720613

Download citation: RISBibTeXText

PMID: 25735555

DOI: 10.1108/JHOM-12-2012-0237


Related references

Public sector hospitals and organizational change: an agenda for policy analysis. International Journal of Health Planning and Management 14(2): 107-128, 1999

The influence of leadership behavior, organizational commitment, organizational support, subjective career success on organizational readiness for change in healthcare organizations. Leadership in Health Services 31(4): 354-370, 2018

Reforming healthcare systems on a locally integrated basis: is there a potential for increasing collaborations in primary healthcare?. Bmc Health Services Research 13: 262, 2013

Shepherding change: how the market, healthcare providers, and public policy can deliver quality care for the 21st century. Critical Care Medicine 34(3 Suppl): S1-S6, 2006

Are healthcare professionals delivering opportunistic behaviour change interventions? A multi-professional survey of engagement with public health policy. Implementation Science 13(1): 122, 2018

Public policy, policy analysis, policy process--these phrases have become the most popular buzzwords in nursing and healthcare today. Nursing Administration Quarterly 26(4): Vii, 2002

Reforming Refugee Healthcare in Canada: Exploring the Use of Policy Tools. Healthcare Policy 12(4): 46-55, 2018

Public perspectives on health human resources in primary healthcare: context, choices and change. Healthcare Policy 5(3): E162-E172, 2011

Longitudinal associations between organizational change, work-unit social capital, and employee exit from the work unit among public healthcare workers: a mediation analysis. Scandinavian Journal of Work, Environment and Health 2018, 2018

Using Positive Organizational Scholarship in Healthcare and Video Reflexive Ethnography to Examine Positive Deviance to New Public Management in Healthcare. Qualitative Health Research 28(8): 1203-1216, 2018

American College of Healthcare Executives. Public policy statement. Access to healthcare. Healthcare Executive 9(5): 45-46, 1994

Policy windows, policy change, and organizational learning: watersheds in the evolution of watershed management. Environmental Management 38(6): 983-992, 2006

Age discrimination and the healthcare executive. American College of Healthcare Executives Public Policy Statement. Healthcare Executive 7(5): 28-28, 1992

The use of external change agents to promote quality improvement and organizational change in healthcare organizations: a systematic review. Bmc Health Services Research 18(1): 42, 2018

Public policy statement. The challenge of healthcare reform: an American College of Healthcare Executives Perspective. Healthcare Executive 9(2): 37-38, 1994