Academic journal article Canadian Journal of Public Health

The Role of Community Organizations in the Transformation of the Health Services Delivery System in the Montreal Metropolitan Area

Academic journal article Canadian Journal of Public Health

The Role of Community Organizations in the Transformation of the Health Services Delivery System in the Montreal Metropolitan Area

Article excerpt

ABSTRACT

In 1995 the Montreal Regional Health and Social Services Board began a major process of change to its health care system. This transformation places particular emphasis on primary health care and increases the role of local community services centres (CLSCs) and community organizations (COs). In order to understand this process as experienced by COs, the present exploratory study was conducted during the summer and fall of 1996. We targeted 12 COs, 4 CLSCs, the Quebec Federation of CLSCs, and the Montreal CLSC Working Group. Semistructured group interviews and CO documents were used as sources of information. Most participants believe in the need for change but feel that the strategies and implementation have been mismanaged. COs are feeling the pressure to professionalize and specialize current and future services. The "social economy" appears to be gaining momentum in the health sector.

ABREGE

En 1995, la Regie regionale de la Sante et des Services sociaux de Montreal-Centre amorcait une demarche de changement majeur du systeme de soins. Cette transformation met l'accent sur la premiere ligne et souligne l'importance des centres locaux des services communautaires (CLSC) et des organismes communautaires (OC). Une etude exploratoire a ete developpee, afin de comprendre ce processus de transformation tel qu'il est percu par les OC. Douze OC, quatre CLSC, la Federation de CLSC du Quebec et le Regroupement de CLSC de Montreal ont ete rencontres. Les sources d'information ont ete des entrevues semistructurees de groupe et des documents des organismes interviewes. La plupart des participants sont de l'avis que la transformation etait necessaire mais que le processus d'implantation n'est pas adequat. Les OC se sentent sous pression pour professionaliser et specialiser leurs services. L' <> semble prendre la place dans le secteur de la sante.

In its 1995 report Un juste prix pour les services de sante, the Quebec Council on Health and Well-Being recommended that "the money saved by health care organizations, due to rationalization of bed usage, must be invested in family support services, in the financing of community organizations, in the coordination of continuous services, and in the organization of primary health care services available around the clock."1 Also in 1995, the Montreal Regional Health and Social Services Board began a major process of change to its health care system known as the virage ambulatoire (ambulatory shift). As part of this transformation the importance of community organizations will increase through an allocation, over three years, of $14.9 million.2

Given that this decision follows the recommendations of both the Council on Health and Well-Being4 and the Inquiry on Health and Social Services,3 there appears to be recognition of the contribution of community organizations to the health care system. Despite this support, many issues regarding the transformation remain unclear and there is a general sense of confusion among community organizations. The general goal of the present study is to better understand the transformation process of the health care system in the Montreal area as experienced by community organizations. More specifically, this study attempts to (a) understand the attitudes and opinions of members of community organizations and CLSCs towards the virage ambulatoire, and (b) understand the role of community organizations in this virage.

METHODS

This study does not base itself on any existing theory and does not attempt to test any precise hypotheses. We therefore decided to use an exploratory research strategy using information gathering and inductive reasoning. A phenomenological approach was chosen given that we sought not to explain but to understand the ambulatory shift from the perspective of COs.4

Two sources of information were employed in our data collection: semistructured group interviews5,6 (Table I), and documents obtained from community organizations concerning the transformation of the health care delivery system in the Montreal area. …

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