Abstract
The PRISMA-France pilot project is aimed at implementing an innovative case management type integration model in the 20th district of Paris. This paper apprehends the emergence of two polarized views regarding the progression of the model's spread in order to analyze the change management enacted during the process and its effects. A qualitative analysis was conducted based on an institutional change model. Our results suggest that, according to one view, the path followed to reach the study's current level of progress was efficient and necessary to lay the foundation of a new health and social services system while according to the other, change management shortcomings were responsible for the lack of progress. While neither of these two views appears entirely justified, analyzing the factors underlying their differences pinpoints some of the challenges involved in managing the spread of an integrated service delivery network. Meticulous preparation for the change management role and communication of the time and effort required for a wholesale institutional change process may be significant factors for a successful integrative endeavor.
Highlights
BackgroundIn recent years, healthcare reforms undertaken by most industrialized countries have been based upon the principle of integration
Without considering the opposing views regarding the study’s progress, it is clear that the PRISMA-France pilot project was not supported by strong leadership from the institutional leaders, or by a consensual recognition of the urgent need to revolutionize the organization of the health and social services system from the bottom
The top seemed to be waiting for the bottom to produce sufficient evidence that the PRISMA model was suitable for the Paris context, while the bottom seemed to be waiting for a clear signal from the top that this initiative was worth investing in, more so than other inconclusive projects
Summary
BackgroundIn recent years, healthcare reforms undertaken by most industrialized countries have been based upon the principle of integration. The PRISMA-France pilot study was carried out in the highly complex environment of the French health and social care system This complexity is inherent to its lengthy evolution and to its financing which is not ensured by a single payer, but rather, by four levels of government: the State, the region, the department and the municipality. The multiplicity of financing sources produces a vast diversity of normative systems, which prescribe access to services, and a highly competitive environment This ‘free-market’ atmosphere is exacerbated by the politicization of public services created by the determination of the four governmental levels to maintain their prerogatives in the health and social care domain. The absence of a pivotal organization responsible for the evaluation of elderly people’s needs and consequent service provision adds to the system’s fragmentation [4, 5]
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