Implementation of integrated services networks in Quebec and nursing practice transformation: convergence or divergence?

Caroline Longpré,Carl-Ardy Dubois

doi:10.1186/s12913-015-0720-8

Abstract

BackgroundEven though nurses are expected to play a key role in implementing integrated services networks, up to now their practice in this regard has received very little research attention. The aim of this study is to describe the extent to which the evolution of nursing practice in Quebec in recent years has converged with the requirements and efforts involved in services integration.MethodsThis descriptive study was carried out with 107 nurses working an integrated network of healthcare services in Quebec in four different care pathways: chronic obstructive pulmonary disease, autonomy support for the elderly, palliative oncology care, and mental health. Development model for integrated care (DMIC) was used, first, to examine the prevalence in each pathway of integrative activities, grouped into nine practice dimensions, and then to position each pathway in relation to the four phases of development for any integration process, as defined by the DMIC.ResultsOnly one pathway had reached Phase 3, which involves expansion and monitoring of integration, whereas the others were still in the preliminary Phases 1 and 2 characterized by initiative and experimentation. Only two dimensions out of nine (‘quality of care’ and ‘interprofessional teamwork’) were prevalent in all the pathways; two others (‘transparent entrepreneurship’ and ‘performance management’) were in none of the pathways, and the remaining five (‘patient–family centered care’, ‘result-focused learning’, ‘delivery system’, ‘commitment’, ‘roles and tasks’) were present to varying degrees.ConclusionsThese results suggest that particular efforts should be made to bridge the significant gap between the pace of nursing practice transformation and the objectives of service integration. These efforts should focus, among other things, on the deployment of organizational, clinical, human, and material resources to support practice renewal and continuing education for nurses to prepare them for the requirements of integration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0720-8) contains supplementary material, which is available to authorized users.

Highlights

Even though nurses are expected to play a key role in implementing integrated services networks, up to now their practice in this regard has received very little research attention
Each service program is subdivided into different pathways dealing with particular clinical situations and covers services provided by different establishments within the health and social services center (HSSC) or the local health network (CH, Local community services center (CLSC), Residential and long-term care center (CHSLD), family medicine groups (FMG))
Even with the above-mentioned limitations, this study revealed a gap between the evolution of nursing practice and the introduction of changes aimed at increasing service integration

Summary

Introduction

Even though nurses are expected to play a key role in implementing integrated services networks, up to now their practice in this regard has received very little research attention. To deal with numerous challenges related, among other things, to population aging and the rising prevalence of chronic illnesses and mental health disorders, many jurisdictions are investing in strengthening the integration of health care and services. This is seen as a lever to Longpré and Dubois BMC Health Services Research (2015) 15:84 in turn are made up of different care and service trajectories or clinical pathways to address the needs of specific patient groups. 16% of Quebec respondents did not have access to a family physician for primary care, as opposed to 9% in the rest of Canada; only 39% of hospitalized patients reported good coordination of care at discharge; and only 35% of respondents with a chronic illness reported that one person was responsible for all care related to their condition [9]

Objectives

Methods

Results

Discussion

Conclusion