La politique québécoise de desengorgement des urgences

Abstract

Sommaire: Depuis le milieu des années 70, au Québec, l'engorgement des services d'urgence est un problème qui refait surface de facon épisodique. En 1986, le gou‐vernement québécois adopte un vaste plan visant à corriger la situation. En 1990, l'échec relatif de cette politique mène à I'adoption d'une nouvelle politique qui sera elle‐même modifiée en 1993. Dans cet article, nous examinons les processus récur‐rents d'émergence, de formulation et de mise en euvre de la politique québécoise de désengorgement des services d'urgence. Nous recourons, pour ce faire, à une version étendue du modèle proposé par Kingdon pour expliquer la mise à I'ordre du jour de certains problèmes publics par le gouvernement. Nous soutenons que le prolonge‐ment donné au modèle de Kingdon permet de rendre compte des différentes phases de réalisation de la politique. Abstract: In the Province of Quebec, the overcrowding of hospital emergency wards has been a problem since the mid‐seventies. In 1986, the Quebec government adopted a vast plan to correct the situation. The relative failure of the plan led to the adoption of a new policy in 1990, later modified in 1993. In this paper, we study the recurring emergence, formulation and implementation of Quebec policy towards emergency ward overcrowding. This study is based on an extended version of the model put forward by Kingdon to explain how some public problems appear on a government agenda while others are left aside. We contend that Kingdon's extended model is helpful to further our understanding of the policy process towards emergency wards in Quebec.

Policy Implementation in an African State: An Extension of Kingdon's Multiple‐streams Approach

“…Sabatier (2007, p. 327) even affirms, ‘The multiple‐streams framework has no explicit hypothesis'. In Canada, Demers and Lemieux (1998) have shown that this criticism is unfounded and that the framework does apply to implementation. In their study of a public policy on hospital emergency services, coupling of the policy and problem streams occurred as expected.…”

“…A superficial reading of Kingdon's work might lead one to believe it is the juncture of two streams, which can vary depending on the sub‐processes, that explains the public policy process. Kingdon and others (Demers and Lemieux 1998; Zahariadis 1999) insist on the dual nature of this coupling and also on the importance, although of less influence, of the third stream: ‘The probability of an item rising on a decision agenda is dramatically increased if all three elements – problem, proposal, and political receptivity – are coupled in a single package’ (Kingdon 1995, p. 195). In the specific context of the Burkina Faso study, the author believes the third stream is as important as the others; the empirical data show no difference among the three streams in explaining the poor implementation.…”

“…He has been reproached for not having sufficiently amplified or clarified the ‘policy stream’ concept (Exworthy and Powell 2004). Others fault him for being too circumstantial (Howlett and Ramesh 1995), or too tied to the political system of the United States (Demers and Lemieux 1998). The strongest criticisms, however, are from those who think the framework, which has hardly been contested, in fact cannot be contested because of its limited, or even non‐existent, explanatory capacity.…”

“…Although the scientific relevance and theoretical value of this extension have been demonstrated (Lemieux 2002), they have been empirically validated only once in Canada (Demers and Lemieux 1998). The present study goes against the ‘protracted and sterile debate about the two competing analytical paradigms labelled top‐down versus bottom‐up’ (Saetren 2005, p. 572).…”

A case study on methodological pluralism in public health research in Africa

“…Although the scientific relevance and theoretical value of this extension have been demonstrated, 38 they have only been empirically validated once in Canada. 41 At the same time, policy analysis can be undertaken by studying a process and the actors who take part in it. In our examination of the implementation gap of a public policy that was largely imported and then implemented by means of aid development projects, we found the "neo-interactionism" theory from development anthropology to be useful for studying the roles of actors.…”