How a Quebec regional health and social services agency is systematically using evidence to transform its operations

Number 10, June 2007

Health services systems across Canada are being restructured in various ways to improve service organization and delivery. In Quebec, for example, hundreds of community health centres, residential and long-term care centres, hospitals, and related institutions have merged into 95 health and social services centres, led by 18 regional agencies.

This restructuring is part of a fundamental shift in Quebec’s approach to health and social services — from an organization- and service-centric model to a population-centric one. As part of the process, health and social services centres are working with partners such as pharmacists and community organizations to create complete networks of services — preventive, diagnostic, pharmaceutical, rehabilitative, and so on. The goal is better access, continuity, co-ordination, and integration of all health and social services for the population served by each centre.

In Montérégie, a 10,000-square-kilometer region south of Montreal with a population of 1.4 million, about 50 establishments were reorganized into 11 health and social services centres, led by the newly minted Agence de la santé et des services sociaux de la Montérégie (Montérégie Health and Social Services Agency).

“We chose to view this restructuring as an opportunity,” says Luc Boileau, president and CEO of the Montérégie agency. “It was an opportunity to embed an evidence-informed approach that would transform how we organize, manage, and deliver health and social services — with the ultimate goal of improving the health and well-being of the population we serve.”

The agency used research evidence in a systematic way to guide its transformation. “Successful, permanent change is difficult and we believed evidence could help us at many levels,” says Dr. Boileau. “It could help us design a process to carry out the restructuring that would increase our chances of success; it could help us develop and implement the new service delivery systems; and it could help us rework our organizational and management practices to support and embed the new culture.”

The agency reviewed the literature on organizational change, selecting and adapting a six-part change management model as its roadmap. Research evidence also informed actions within each of the six elements of the change model, such as in developing and articulating the vision and building support for change.

Evidence also fed into rethinking service organization and delivery. For example, interdisciplinary teams were created for each of 15 health and social problems (such as the loss of autonomy linked with aging). These teams mapped out evidence-informed service continuums that would help to prevent the problem, treat/cure/solve it, and provide support to susceptible populations.

Several key strategies and resources — including assistance from the Foundation’s Executive Training for Research Application (EXTRA) and other programs — supported the transformation process. A highly successful strategy was the establishment of several teams and committees, including a strategic co-ordination committee drawn from the various health and social services organizations.

This committee managed the overall process and continues to serve as the discussion and decision-making forum and the link between decision makers and researchers. It regularly invites researchers to make presentations on existing research evidence and, through its research linkages with the University of Montreal, funds additional research to fill knowledge gaps.

Another key strategy was the creation of the agency’s Information and Knowledge Management Directorate headed by Denis Roy. “Denis and his team, which includes knowledge brokers, gathered research to support the transformation process, and they continue to help us ensure our decisions are supported by evidence where possible by providing information in a timeframe and format that is useful to policy makers,” confirms Dr. Boileau. “They are also helping to embed the new evidence-informed culture by working with researchers to hardwire the consideration of research evidence into our decision-making processes.”

Cultural change of this magnitude is a long and sometimes frustrating process. “It can seem time-consuming to ensure decisions are informed by evidence,” says Dr. Boileau. “And I know some people are sick of the ‘e-word.’ But we have already seen some positive indications, and as the new patterns become more firmly embedded, we will start to see concrete results.”

For more information, contact Luc Boileau at l.boileau@rrsss16.gouv.qc.ca.