Using clinical governance levers to support change in a cancer care reform

Brault, Isabelle; Denis, Jean‐Louis; Sullivan, Terrence

doi:10.1108/jhom-02-2015-0025

Cited by 7 publications

(7 citation statements)

References 25 publications

(45 reference statements)

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“…In this section, we will discuss one of these levers, clinical governance that appears to be gaining ground in the reform efforts of a number of provinces. Clinical governance involves processes that connect clinical practice more explicitly to the organizational context and are aimed, on one hand, at fostering the creation of an organizational environment that develops professional practices and, on the other, at operating directly on professional practices to ensure better quality of care (29) .…”

Section: Clinical Governance As a Lever To Improve Health Systemsmentioning

confidence: 99%

Health system reforms in mature welfare states: tales from the north

Denis¹,

Usher²,

Préval³

et al. 2018

Rev Bras Promoc Saúde

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Objective: This article has the objective show an essay on emerging themes in health system reforms, based on experience in Canada. Data synthesis: Reforms are the privileged mode of social change used by modern democratic societies. Persistent dysfunction and failure to adapt to emerging health needs and priorities within health systems in Canada provide a strong policy rationale to search for alternative strategies that might produce much-needed reforms. Three persistent challenges and opportunities for reform in Canadian health systems are discussed: the design of effective governance arrangements, the large-scale development and implementation of improvement and transformative capacities, and the leadership and engagement of the medical profession in working toward broad system goals. In exploring these challenges, we identify tensions that seem relevant to better understanding health system reform in mature welfare states. Conclusion: Addressing these tensions will require both a reinforcement of state and government capacities and stronger capacities at all levels of the health system to design and support change.

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Section: Clinical Governance As a Lever To Improve Health Systemsmentioning

confidence: 99%

Health system reforms in mature welfare states: tales from the north

Denis¹,

Usher²,

Préval³

et al. 2018

Rev Bras Promoc Saúde

Self Cite

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“…While these factors provided the context for the change, the general manager developed and drove the 495 Implementing a new governance model implementation of the new governance model which embodied his desire to create a partnership between clinicians and managers premised on notions of clinical governance. A somewhat ambiguous term, clinical governance has had large appeal across the health sector internationally since the 1990s and implemented in various guises in New Zealand DHBs since 2005. Generally, clinical governance is seen as a mechanism through which managers and clinicians can work together cooperatively Brault et al, 2015;O'Connor and Paton, 2008). The process of implementing clinical governance involves transforming an organisation's systems and culture so that clinicians and management take joint responsibility and accountability for the quality of clinical care, the safety of patients and the financial management of the organisation (Brault et al, 2015;Flynn et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Implementing a new governance model

Stanley-Clarke

Sanders

Munford

2016

Journal of Health Organization and Management

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Purpose - The purpose of this paper is to discuss the lessons learnt from the process of implementing a new model of governance within Living Well, a New Zealand statutory mental health agency. Design/methodology/approach - It presents the findings from an organisational case study that involved qualitative interviews, meeting observations and document analysis. Archetype theory provided the analytical framework for the research enabling an analysis of both the formal structures and informal value systems that influenced the implementation of the governance model. Findings - The research found that the move to a new governance model did not proceed as planned. It highlighted the importance of staff commitment, the complexity of adopting a new philosophical approach and the undue influence of key personalities as key determining factors in the implementation process. The findings suggest that planners and managers within statutory mental health agencies need to consider the implications of any proposed governance change on existing roles and relationships, thinking strategically about how to secure professional commitment to change. Practical implications - There are ongoing pressures within statutory mental health agencies to improve the efficiency and effectiveness of organisational structures and systems. This paper has implications for how planners and managers think about the process of implementing new governance models within the statutory mental health environment in order to increase the likelihood of sustaining and embedding new approaches to service delivery. Originality/value - The paper presents insights into the process of implementing new governance models within a statutory mental health agency in New Zealand that has relevance for other jurisdictions.

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“…Converging evidence points to the importance of understanding governance mechanisms as factors influencing the evolution of networks and their effectiveness [41]. Governance is increasingly recognized as the “missing link” for understanding networks and their outcomes [52], particularly in the health sector [11, 41, 53–55]. Governance is a relatively new, multi-dimensional concept, lacking a consensus definition [56].…”

Section: Introductionmentioning

confidence: 99%

“…A thorough understanding of the mechanisms by which networks achieve their outcomes is necessary to improve cancer management and optimize the use of resources invested in networking. In this case, a better consideration of governance dynamics to support the transformation of practices in favour of a high-quality, affordable, and PLC-focused service offer is promising [41, 53, 56, 58, 60, 61].…”

Section: Introductionmentioning

confidence: 99%

Collaborative governance in the Quebec Cancer Network: a realist evaluation of emerging mechanisms of institutionalization, multi-level governance, and value creation using a longitudinal multiple case study design

Tremblay

Touati

Poder

et al. 2019

BMC Health Serv Res

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BackgroundPeople living with and beyond cancer (PLC) receive various forms of specialty care at different locations and many interventions concurrently or over time. They are affected by the operation of professional and organizational silos. This results in undue delays in access, unmet needs, sub-optimal care experiences and clinical outcomes, and human and financial costs for PLCs and healthcare systems.National cancer control programs advocate organizing in a network to coordinate actions, solve fragmentation problems, and thus improve clinical outcomes and care experiences for every dollar invested. The variable outcomes of such networks and factors explaining them have been documented. Governance is the “missing link” for understanding outcomes. Governance refers to the coordination of collective action by a body in a position of authority in pursuit of a common goal. The Quebec Cancer Network (QCN) offers the opportunity to study in a natural environment how, why, by whom, for whom, and under what conditions collaborative governance contributes to practices that produce value-added outcomes for PLCs, healthcare providers, and the healthcare system.Methods/designThe study design consists of a longitudinal case study, with multiple nested cases (4 local networks nested in the QCN), mobilizing qualitative and quantitative data and mixed data from various sources and collected using different methods, using the realist evaluation approach. Qualitative data will be used for a thematic analysis of collaborative governance. Quantitative data from validated questionnaires will be analyzed to measure relational coordination and teamwork, care experience, clinical outcomes, and health-related health-related quality of life, as well as a cost analysis of service utilization. Associations between context, governance mechanisms, and outcomes will be sought. Robust data will be produced to support decision-makers to guide network governance towards optimized clinical outcomes and the reduction of the economic toxicity of cancer for PLCs and health systems.

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Using clinical governance levers to support change in a cancer care reform

Abstract: This study provides a better understanding of clinical governance levers. Clinical governance levers are used to implement an organizational environment that is conducive to developing clinical practice, as well as to act directly on practices to improve quality of care.

Cited by 7 publications

References 25 publications

Health system reforms in mature welfare states: tales from the north

Health system reforms in mature welfare states: tales from the north

Implementing a new governance model

Collaborative governance in the Quebec Cancer Network: a realist evaluation of emerging mechanisms of institutionalization, multi-level governance, and value creation using a longitudinal multiple case study design

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