Reorganization Of Health Care Research Articles

Impact of the COVID-19 pandemic on people with epilepsy: Findings from the Brazilian arm of the COV-E study

The COVID-19 pandemic has had an unprecedented impact on people and healthcare services. The disruption to chronic illnesses, such as epilepsy, may relate to several factors ranging from direct infection to secondary effects from healthcare reorganization and social distancing measures. ObjectivesAs part of the COVID-19 and Epilepsy (COV-E) global study, we ascertained the effects of COVID-19 on people with epilepsy in Brazil, based on their perspectives and those of their caregivers. We also evaluated the impact of COVID-19 on the care delivered to people with epilepsy by healthcare workers. MethodsWe designed separate online surveys for people with epilepsy and their caregivers. A further survey for healthcare workers contained additional assessments of changes to working patterns, productivity, and concerns for those with epilepsy under their care. The Brazilian arm of COV-E initially collected data from May to November 2020 during the country's first wave. We also examined national data to identify the Brazilian states with the highest COVID-19 incidence and related mortality. Lastly, we applied this geographic grouping to our data to explore whether local disease burden played a direct role in difficulties faced by people with epilepsy. ResultsTwo hundred and forty-one people returned the survey, 20% were individuals with epilepsy (n = 48); 22% were caregivers (n = 53), and 58% were healthcare workers (n = 140). Just under half (43%) of people with epilepsy reported health changes during the pandemic, including worsening seizure control, with specific issues related to stress and impaired mental health. Of respondents prescribed antiseizure medication, 11% reported difficulty taking medication on time due to problems acquiring prescriptions and delayed or canceled medical appointments. Only a small proportion of respondents reported discussing significant epilepsy-related risks in the previous 12 months. Analysis of national COVID-19 data showed a higher disease burden in the states of Sao Paulo and Rio de Janeiro compared to Brazil as a whole. There were, however, no geographic differences observed in survey responses despite variability in the incidence of COVID-19. ConclusionOur findings suggest that Brazilians with epilepsy have been adversely affected by COVID-19 by factors beyond infection or mortality. Mental health issues and the importance of optimal communication are critical during these difficult times. Healthcare services need to find nuanced approaches and learn from shared international experiences to provide optimal care for people with epilepsy as the direct burden of COVID-19 improves in some countries. In contrast, others face resurgent waves of the pandemic.

Correct use of telemedicine in gastroenterology, hepatology, and endoscopy during and after the COVID-19 pandemic: Recommendations from the Italian association of hospital gastroenterologists and endoscopists (AIGO)

The purpose of the present document is to provide detailed information on the correct and optimal use of digital media to ensure continuity of care for gastroenterological patients in everyday clinical practice, in health emergencies and/or when the patient cannot reach the hospital for other reasons.During the recent COVID-19 pandemic, telemedicine has allowed many patients with chronic diseases to access remote care worldwide, proving to be the ideal solution to overcome restrictions and carry out non-urgent routine follow-ups on chronic patients. The COVID-19 pandemic has therefore made organizational and cultural renewal essential for the reorganization of healthcare in order to ensure greater continuity of care with a minimum risk of spreading the virus to users, practitioners and their families.These AIGO recommendations are intended to provide Italian gastroenterologists with a tool to use this method appropriately, in compliance with current legislation, in particular the proper approach and procedures for conducting a remote examination using a video conferencing tool, the so-called televisit.In the near future, telemedicine may contribute to a possible reorganization of healthcare systems, through innovative care models focusing on the citizen and facilitating access to services throughout the entire Country.

MODERN INSTITUTIONAL AND LEGAL MECHANISMS OF FISCAL FEDERALISM: A COMPARATIVE ANALYSIS

The article analyzes the tools and mechanisms of the Russian budget system used in the context of the global economic crisis and pandemic. A synchronous comparative analysis applied to the mechanisms and institutions of state-territorial administration in foreign federations was used as a research method. Under normal circumstances, ensuring a high degree of vertical coordination of the budget process implies special attention to its constitutional, legal and administrative aspects. However, in extreme circumstances, the need for quick decisions and urgent measures exacerbates the problems of vertical coordination and can subsequently result in deterioration in the quality of public services provided. Based on the study of actual data and analytical studies, general and special problems of the budget process in the federal states are identified. The necessary institutional and legal changes are identified to address such socio-economic problems as reorganization of health care and overcoming social poverty. The ways of solving these problems in the framework of various models of the budget process federal management are considered. The relevance of a comparative analysis of budget federalism mechanisms is due to the fact that centralized methods of the budget process prevail in the Russian budget system today, with obvious asymmetry in the subjects' economic development. The economic crisis has increased the imbalance between the donor and recipient regions. That is why at present, improving the mechanisms for inter-budgetary alignment, the search for optimal institutions of administrative and economic management, taking into account the lessons of the crisis and the experience of foreign countries, attract the attention of researchers from different countries. By comparing traditional institutions and innovations, it is possible to draw conclusions about the specifics of the budget mechanism in the Russian Federation and the goals of its economic policy. When implementing anti-crisis measures, it is of great importance to establish an optimal balance between vertical and horizontal alignment of regional budgets as a strategy for further development of the federation. The analysis of the advantages and disadvantages of decentralized and centralized management makes it possible to identify the most effective institutional and legal mechanisms for influencing socio-economic relations. For present-day Russian economy, the task of increasing the role of regions in the budget policy of the state, taking into accounts their specifics and opportunities for stimulating the economic growth, remains urgent.

Impacto de los estados de alarma por COVID-19 en la atención a pacientes pediátricos en Atención Primaria de un área sanitaria del norte de España

AimThe SARS-CoV-2 pandemic has meant a global change in the healthcare model, enhancing telematic assistance, specially at the Health Primary Care (PC). There are few studies that relate the attendance of children at the PC to the pandemic of COVID-19. The aim of our study is to describe the impact of the two Spanish states of alarm on the care of children at de PC level. Material and methodsRetrospective observational study. The PC visits corresponding to pediatric patients (<14 years) from a health area in northern Spain during the first and second states of alarm were analyzed, and compared with their equivalent periods in 2019. ResultsDuring the first state of alarm, home lockdown and school closure were established, and a large decrease in pediatric visits to the health centres was observed (758 vs. 1381 in 2019) at the expense of health check-ups and infectious diseases. This decrease was not observed in the second state of alarm (1375 vs. 1233 in 2019). In both states of alarm, the percentage of telephone assistance increased significantly. ConclusionsThe implementation of alarm states has meant a decrease on the demand of medical care, especially during the first state of alarm, may be owing to the fear of the families of going to the health center and the decrease in the transmissibility of viruses due to home lockdown. The increase of the telematic assistance has been on account of the need of reorganization of health care, wich has proven to be effective.

Patient Satisfaction with Oncological Care during the SARS-CoV-2 Virus Pandemic.

Recently, the outbreak of the SARS-CoV-2 virus and the COVID-19 pandemic significantly affected the health situation of the entire society and necessitated reorganization of health care including oncology. The objective of this study was to examine the perception of medical services by cancer patients during the pandemic and to identify the key elements influencing the level of satisfaction with oncological care. Of note, 394 patients diagnosed with cancer treated in inpatient oncology wards participated in the study (Poland). The diagnostic survey method was used. A survey questionnaire developed by the authors was used and validated the EORTC IN-PATSAT32 questionnaire. The calculations were made in Statistica 10.0 (Statsoft; 2011, Dell Inc., Round Rock, TX, USA). The average general level of satisfaction with oncological care in the study group was 80.77 out of a total score of 100, representing the highest level of satisfaction. Levels of satisfaction varied according to time since diagnosis (longer time—greater satisfaction) and were lower where treatment was delayed or perceived as disorganised. Nearly half of the respondents felt the threat of the SARS-CoV-2 infection, despite the fact that most of them believed that the hospital was well prepared to diagnose and treat cancer patients during the COVID-19 pandemic. Convincing patients about the proper preparation of health care for diagnostics and therapy is an important element influencing patient satisfaction with oncological care.

Health reform and Indigenous health policy in Brazil: contexts, actors and discourses.

Given the challenges related to reducing socio-economic and health inequalities, building specific health system approaches for Indigenous peoples is critical. In Brazil, following constitutional reforms that led to the universalization of health care in the late 1980s, a specific health subsystem was created for Indigenous peoples in 1999. In this paper, we use a historical perspective to contextualize the creation of the Indigenous Health Subsystem in Brazil. This study is based on data from interviews with Indigenous and non-Indigenous subjects and document-based analysis. In the 1980s, during the post-dictatorship period in Brazil, the emergence of Indigenous movements in the country and the support for pro-Indigenous organizations helped establish a political agenda that emphasized a broad range of issues, including the right to a specific health policy. Indigenous leaders established alliances with participants of the Brazilian health reform movement, which resulted in broad debates about the specificities of Indigenous peoples, and the need for a specific health subsystem. We highlight three main points in our analysis: (1) the centrality of a holistic health perspective; (2) the emphasis on social participation; (3) the need for the reorganization of health care. These points proved to be convergent with the development of the Brazilian health reform and were expressed in documents of the Indigenist Missionary Council (CIMI) and the Union of Indigenous Nations (UNI). They were also consolidated in the final report of the First National Conference on the Protection of Indigenous Health in 1986, becoming the cornerstone of the national Indigenous health policy declared in 1999. Our analysis reveals that Indigenous people and pro-Indigenous groups were key players in the development of the Indigenous Health Subsystem in Brazil.

The clinical consequences of the COVID-19 lockdown: A report from an Italian referral ENT department.

ObjectivesTo evaluate the clinical effects of health care reorganization because of COVID‐19, in a non‐red zone Italian referral department of Otorhinolaryngology.Materials and MethodsWe retrospectively reviewed the statistics of admissions to the Emergency Department (ED) of the Careggi University Hospital, Florence, from January 1, 2020, to May 17, 2020. Data regarding elective and urgent head and neck disorders were reviewed and the most challenging cases were discussed.ResultsDuring the lockdown period, outpatient otolaryngological consultations and elective procedures decreased by 78% and 75% respectively, while emergency/urgency surgery increased by 128%. The five most emblematic clinical cases were thoroughly analyzed.ConclusionOur analysis shows how the profound rearrangement of clinical and surgical activities, along with the citizens' fear to seek medical care has probably exacerbated the management of many routine head and neck conditions.Level of Evidence4.

Impact psychique de la pandémie de Covid-19 sur les professionnels soignants

À l’instar d’autres pandémies, celle de Covid-19 a eu un retentissement psychique important dans l’ensemble de la population. Néanmoins, cet impact s’est avéré encore plus aigu chez les personnels soignants, en lien avec l’exposition répétée au risque infectieux, la réorganisation des soins et leur positionnement spécifique. Les pharmaciens d’officine, qui ont assuré la continuité des soins dans un climat de télétravail généralisé, n’ont pas été épargnés. Des symptômes psychotraumatiques, anxieux et de dépression ont été observés.

From silos to buckets: a qualitative study of how sexual health clinics address their clients' mental health needs.

To describe the current constraints, facilitators, and future prospects for addressing mental health and substance use (MHSU) concerns within sexual health clinics in two cities in British Columbia, Canada. We conducted in-depth interviews with 22 providers (14 nurses, 3 physicians, 3 administrators, 2 other health professionals) from six sexual health clinics. Providers consistently affirmed that MHSU-related concerns co-occur with sexual health concerns among clients presenting to sexual health clinics. Three factors constrained the providers' abilities to effectively address MHSU service needs: (1) clinic mandates or funding models (specific to sexually transmitted infections (STI)/HIV or reproductive health); (2) "siloing" (i.e., physical and administrative separation) of services; and (3) limited familiarity with MHSU service referral pathways. Mental health stigma was an additional provider-perceived barrier for sexual health clinic clients. The low barrier, "safe" nature of sexual health clinics, however, facilitated the ability of clients to open up about MHSU concerns, while the acquired experiences of sexual health nurses in counselling enabled clinicians to address clients' MHSU needs. In response to this context, participants described actionable solutions, specifically co-location of sexual health and MHSU services. Sexual health clinicians in British Columbia generally affirm the results of previous quantitative and client-focused research showing high rates of MHSU-related needs among sexual health clinic clients. Providers prioritized specific short-term (referral-focused) and long-term (healthcare re-organization, co-location of sexual and MHSU services) solutions for improving access to MHSU services for those using sexual health services.

Kolyma health resort «Talaya» (to its 80th birthday)

The article is devoted to the history of the creation and establishment of the Far Eastern resort «Talaya», located in the Far North of Russia, in the Magadan Region among the hills of the Kolyma Range, in the valley of the Talaya River. A historical essay is presented from 1868 to the present days, including periods of the resort's development at various stages of Russia's formation (pre-revolutionary, post-revolutionary periods, the era of developed socialism, present times). The contribution of resort doctors, geologists, employees of research institutes to the study of the mechanism of action and clinical effectiveness of the use of Tal mineral water is described. The balneological characteristic of nitrogen-siliceous thermal water, the main therapeutic factor of the Talaya resort, is given. Currently, the Talaya sanatorium is providing the treatment of patients with diseases of the skin, musculoskeletal system, gynecological, neurological diseases, diseases of the digestive system, metabolism, upper respiratory tract, cardiovascular system, occupational diseases using balneotherapy, mud therapy and others methods of non-drug therapy. Hundreds of thousands of northerners were healed by the Kolyma health resort, which gained fame as the «Northern Pearl». Today, during the reorganization of health care, the Talaya sanatorium is going through a difficult but interesting period in improving the possibilities of healing the inhabitants of the northern regions of Russia.

The impact of a dedicated contact centre on the clinical outcome of patients with inflammatory bowel disease during the COVID-19 outbreak.

Background:With the interruption of elective activity during the coronavirus disease 2019 (COVID-19) pandemic, a reorganisation of health care for patients with inflammatory bowel disease (IBD) was warranted. We aimed to investigate the effectiveness of a dedicated contact centre service (CCS) on the reorganization of a high-volume IBD centre and on the continuity of care during the COVID-19 outbreak.Methods:We compared the CCS services provided to 3680 IBD patients and clinical outcomes before (January–February 2020) and during (March–April 2020) the COVID-19 period. We further included, as comparator, data from March to April of the previous year (2019).Results:During the outbreak, the CCS received an increase of 10.2% of contacts, from 881, in January–February 2020, to 971 (p = 0.02). An increase of 6% in CCS activities was also reported in comparison with March–April 2019 (from 914 to 971 in March–April 2020, p = 0.71). Before COVID-19, in both periods most contacts (67% in January–February 2020 and 60% in March–April 2019) required information about clinical activity, while fewer (33% in January–February 2020 and 40% in March–April 2019) requested logistic information. During the pandemic, most contacts (65.1%) asked to speak with a physician, 23.7% asked for information, while 11.1% wanted to cancel/postpone their appointments. Among all the information, 66% concerned COVID-19. In March–April 2020, 259 outpatient visits were booked, but were all replaced by phone consultations. No difference was detected in the number of intravenous biological administrations (307 versus 296, p = 0.64), surgeries (10 versus 9, p = 0.82) and urgent hospitalisations (10 versus 12, p = 0.67) before and during the COVID-19.Conclusion:The CCS was an effective tool in the reorganization of the IBD centre. Scheduled visits were replaced by phone calls. The main clinical outcomes were maintained in the COVID-19 period. Virtual follow-up using the CCS could be implemented after the pandemic to optimise the resources of the IBD centre.

The defence of health : the debates on health reform in 1970s Spain

This paper analyses the discourses that addressed healthcare reform projects discussed in Spain during the 1970s, before the death of the dictator General Franco, and up to the declaration of healthcare as a right in the Spanish Constitution of 1978. The Spanish health system, which developed from the Compulsory Sickness Insurance launched in 1944, focused only on disease and made no provision for preventive activities. This shortcoming was one of the main aspects that required reform in the 1970s. We analyse the characteristics of the proposals to replace a treatment-centred health system with a new one based on a more holistic view and the defence of health. To contextualise these proposals, we review the development of the Francoist health system and regulations and plans that attempted to reform it before the death of Franco. The most interesting Spanish health system reform projects were written at the end of Francoism and the beginning of the Democratic Transition and were mainly drafted by medical doctors committed to the illegal left-wing parties. All shared the aim of universal healthcare financed by the State and the goal of placing the protection of health at the core of the health system by integrating preventive medicine and healthcare. Some proposals encouraged the study of social determinants of health and disease and emphasised the role of health education. Others were more concerned with the re-organisation of healthcare through planning and decentralisation, retaining the hospital for the treatment of diseases as the main goal.

Progressive science meets indifferent state? Revisiting mental health care reform in post-war Greece (1950-1980)

After the Second World War, many Western countries implemented mental health care reforms that included legislative changes, measures to modernise psychiatric hospitals, and policies to deinstitutionalise mental health care, shifting its locus from residential hospitalsto community services. In Greece, psychiatric reform began in the late 1970s and was linked to the fall of the military dictatorship in 1974, the general reorganisation of health care, accession to the European Economic Community and international outcry at the inhuman treatment of the Leros psychiatric hospital inmates. The 1950s, 1960s and most of the 1970s had been an ambivalent period in relation to psychiatric reform. On the one hand, a dynamic group of experts, some long established and some newly emergent, including psychiatrists, hygienists, psychologists and social workers, strove to introduce institutional and legislative changes. On the other hand, the state, while officially inviting expert opinion on mental health care more than once, did not initiate any substantial reform until the late 1970s and the early 1980s. Within this framework, we ask whether the story of psychiatric modernisation in Greece before the late 1970s could be summarised as a futile encounter between progressive scientists and indifferent state authorities. By assessing the early attempts to restructure mental health care in Greece, examining both the expert proposals and the state policies between the end of the civil war in 1949 and the fall of the dictatorship in 1974, this paper proposes a more nuanced view, which brings out the tensions between state and expert discourses as well as the discrepancies between the discourses and the implemented programmes.

THE QUALITY OF MEDICAL CARE IN MEDICAL ORGANIZATIONS OF MOSCOW PUBLIC HEALTH CARE SYSTEM IN APPRAISALS OF PATIENTS AND PHYSICIANS

The article presents the analysis of results of complex medical sociological survey of effectiveness and efficiency of medical care as main criteria of its quality and accessibility. The survey comprised 1,737 patients of various social groups of population of Moscow and 203 physicians of polyclinics. At self-rating of health, 13.2% of respondents determined it as unsatisfactory, 45.1% as satisfactory and 31.3% as good. In all population groups, the most called-for proved to be polyclinic institutions. The high level of satisfaction of patients with quality of emergency medical care was established in all groups. The quality of medical care in polyclinics and hospitals was assessed significantly lower. The most negatively assessed criteria turned out transition to fee-for-service forms of medical support and time limits of waiting for all modes of medical care, except emergency medical care and district therapist. The evaluation by physicians of their own activity and present problems is characterized by their unanimity in need of increasing of salary (100%) and increasing of typical sectoral standards of time of reception of a patient (96.5%), decreasing of intensity of work of medical personal (92.3%) and reduction of some forms of record cards with the purpose of releasing of time and attention of physician for a patient (88.4%). The disrespectful attitude of patients to medical personnel was mentioned by 77.3% of physicians which is a new phenomenon testifying loss of confidence in patient-physician relationship. The quality of implemented work was assessed equally and rather high by both young and experienced physicians. The positive and negative aspects of reorganization of health care were analyzed. Two alternatives of problems were established to focus plans of development of system of Moscow health care to support accessible and qualitative medical care of population.

Including health promotion and illness prevention in medical education: a progress report.

In 1988, the World Federation of Medical Education called for reform in medical education, publishing 12 recommendations. The sixth recommendation of this Edinburgh Declaration was to 'complement instruction about the management of patients with increased emphasis on promotion of health and prevention of disease'. Thirty years on, this paper reports an exploration of what has changed since then. Several search strategies were used, including websites of medical standards organisations, and formal searches of PubMed and Google Scholar using key words such as 'medical education standards', 'health promotion', 'illness prevention', 'effectiveness' and 'assessment'. As these searches produced more descriptive than evidence-based papers, the exploration widened to follow evolving discussions about changing emphases in medical education relevant to public health. Health promotion and illness prevention are in the undergraduate medical education standards of the more influential regulators. There is little evidence of the impact of this inclusion on graduate outcomes and later medical practice, although 'differently educated' doctors may have contributed to the success of broader public health strategies achieved through reorganisation of health care, media campaigns and legislation changes. There is greater success in postgraduate specialty training of general practitioners and public health doctors. The discussion about public health interventions and the roles of doctors has moved on to topics such as patient safety, the health of doctors, global health and planetary health. The inclusion of health promotion and illness prevention strategies in undergraduate curricula varied considerably, but was strongest in programmes claiming social accountability and responding to medical education standards of the more influential regulators. However, the contribution of medical education to improvements in health care and the health of populations is difficult to measure. It may be timely to revisit the purpose and practicality of broadening the scope of undergraduate medical curricula in public health medicine.

Multi-level determinants of tele-healthcare innovations: an Italian case study.

The routine deployment of tele-healthcare solutions in healthcare systems and at the system-level is challenging and often problematic. This article reports the results of a case study in Tuscany (Italy), aimed at investigating the factors that may affect these processes. A multi-level and multi-stakeholder sample of 32 informants were interviewed in-depth about topics based on a previous literature analysis. Crucial determinant factors in the management of tele-healthcare services were identified in relation to technological, individual, organisational and contextual aspects. A reorganisation of healthcare in line with more participatory dynamics of teamwork, and more collaborative relationships within and among healthcare organisations, as well as with other stakeholders could contribute to integrate tele-healthcare into practice. Leadership and a strategic vision could also strongly influence the implementation and deployment of tele-healthcare.

Multi-level determinants of tele-healthcare: a case study in Italy

The routine deployment of tele-healthcare solutions in healthcare systems and at the system-level is challenging and often problematic. This article reports the results of a case study in Tuscany (Italy), aimed at investigating the factors that may affect these processes. A multi-level and multi-stakeholder sample of 32 informants were interviewed in-depth about topics based on a previous literature analysis. Crucial determinant factors in the management of tele-healthcare services were identified in relation to technological, individual, organisational and contextual aspects. A reorganisation of healthcare in line with more participatory dynamics of teamwork, and more collaborative relationships within and among healthcare organisations, as well as with other stakeholders could contribute to integrate tele-healthcare into practice. Leadership and a strategic vision could also strongly influence the implementation and deployment of tele-healthcare.

Location and reorganization problems: The Calabrian health care system case

In the last few years, the Italian healthcare system has been coping with radical changes, aimed at guaranteeing more efficiency while containing costs. Starting from the actual service network organization, we discuss the problem faced by the Italian authorities of reorganizing the healthcare service network and we propose some optimization models to support the decision-making process. In the first part of the work, we compare the existing health care service network of the northern area of Calabria (Italy) with the configurations determined by solving well-known facility location models. In the second part, taking into account the healthcare reorganization plans imposed by local governments, we consider the problem of reorganizing the public health care service network of the northern area of Calabria. Indeed, we propose two ad-hoc optimization models that consider national and regional guidelines and constraints. The behavior of the proposed models, in terms of solution quality, is evaluated on the basis of an extensive computational study on real data.

Cardiology Tele-Homecare Monitoring In Older Patients with Congestive Heart Failure Enhances the Quality of Care in Chronic Disease Management- Pilot Project

Background: Several chronic diseases are highly associated with disability, requiring a high level of health-care service. Congestive Heart Failure (CHF) represents one of the most frequent chronic diseases associated with poor quality of life, reduced social activity and patient mobility, especially in old patients. During CHF management, both the patient and caregivers should hold an active role in the type of necessary care need. Considering that the majority of patients (or caregivers) are not completely aware of the necessary care plan, direct medical supervision is crucial. According to the recent national guidelines on tele-homecare, an in-depth reorganization of health care is necessary to identify needs from the hospital setting to homecare management in urban area, which in turn will play an important role on improving personal independency levels and quality of life. Aim of our study: In contemporary literature there is a lack of clinical trials for evaluating the impact of telemedicine on quality of life in elderly population affected by cardiovascular disease. The aim is to identify variables associated with improved quality of life of older people with CHF who lives in urban area of medium sized city, (Ancona, Italy). Methods: Tele-homecare for CHF combined with health education courses, addressed to both the patient and caregiver, followed by weekly tele-monitoring of patient vitals. A web-based patient interface technology using medical devices equipped with a software platform, capable of monitoring, recording and sending to cardiology department. The study started in June 2014 and lasted for 12 months. Results: This is a pilot study with patients undergoing training sessions to recognize acute signs and symptoms of heart failure including feedback on learning and self-management skills of the disease. By using Kansas city Cardiomyopathy questionnaire before and after intervention, we obtain improvement in symptom frequency, stability and symptom burden score, as well as in self efficacy and quality of life score.

Organizational Agility, Project management and Healthcare Reorganization: A case study in organizational change

Canada’s healthcare system, like those of other countries, needs to make organizational changes to keep up with our growing understanding of the environment and needs of an aging population. The number, frequency, pace, and kinds of changes are challenging the capacity of decision-makers to deliver effective solutions in which the reorganization of work plays a critical role. The effectiveness of change hinges largely on its psychological acceptance by the people it targets, acceptance that is furthered by their role in defining said change and by the recognition they are given for their contributions at each stage of its implementation. It is therefore reasonable to assert that change implementation can be facilitated through an agile type project approach insofar as its iterative development, validation, and adjustment process enable stakeholders to systematically consider the required adjustments. The use of an agile project management approach that systematically integrates stakeholder concerns and takes into consideration the inherent complexity of the healthcare system when defining and introducing new solutions appears more likely to result in successful organizational change when the focus is on managing the capacity of actors to change, rather than on managing an imposed change. Unlike traditional top-down approaches to organizational change, this kind of approach can come up against a certain resistance to change strategy by managers themselves. This case study will be of value to project sponsors, project managers as well as change managers by inviting them to clearly identify their various responsibilities, to consider a more inclusive and agile project management approach, and by taking account of the psychological acceptance of change by those it impacts.