Publication date (electronic): 30 September 2015
Funding: This paper is based on a study funded by a grant from FERASI Center (2007-2011) and FRQ-S (2008-2011). The views expressed are those of the authors and not necessarily shared by any individual, government or agency. In addition, we have received funding from the IRSPUM (Research Institute of Public Health -University of Montreal) for the editing work of the article.
At the heart of adapting healthcare organizations:
Developing a multilevel governance framework
Lara Maillet is postdoctoral fellow at the National School of Public Administration in Montreal. She holds a Ph.D in Public Health (Health Administration) from the University of Montreal. Her research area is the development of strategies for improved access to care for vulnerable population like migrant populations. Therefore, her scientific interests revolve around also development of conceptual model about the governance, the complexity and the change in the healthcare organizations. Her doctoral thesis allowed to develop and applied the framework of multilevel adaptive governance presented in this paper.
Paul A. Lamarche is professor at the Department of Health Administration, School of Public Health, University of Montreal. He holds a Ph.D. in Health care Organization and Policies from the University of Michigan. His research area is organization of health services and more specifically its influence on users’ appreciation of their health care experience and the health of the population. His theoretical framework borrows heavily on the configuration approach and the complexity perspective.
Bernard Roy is a professor at the Faculty of Nursing, Laval University (2004) and holds a PhD in Anthropology (2002). It is in his nursing course in Aboriginal communities that is initially interested in this important event of iniquity whose health was and still experienced by men and women of First Nations diabetes. His work on this health issue were supported Diabetes Québec and have been the subject of numerous publications and conferences. His book “Sweet sugar, powers coded and bitter medicine” was awarded in 2005 by the Luc-Lacourcière medal which recognizes excellence of a anthropology’s book published in French language in North America. In fact, the heart of the work of this teacher-researcher is the desire to increase the value of the word of these people too often left behind in a world where, increasingly, the evidence are popular.
arc Lemire is an adjunct professor-researcher in the Health Administration Department and a regular researcher at University of Montreal's Public Health Research Institute (IRSPUM). He is also an in-house researcher at the National Public Health Institute of Quebec (INSPQ). His current research interests are innovation, improvement and knowledge in public health. Lemire holds a PhD in political sciences.
Originating from a concern on the linkage between health policies and immigration policies within healthcare organizations, our goal is to understand how and why healthcare organizations adapt their services to the needs and characteristics of migrant populations. In doing so, we used three angles of analysis: (1) interactions between the stakeholders within an organization viewed as a Complex Adaptive System (CAS), especially between an organization’s various levels of governance; (2) the levers of action implemented by the multiple stakeholders; and (3) the factors that influence the stakeholders. We propose a conceptual model of multilevel adaptive governance able to reconcile two paradoxical adaptation mechanisms: (1) multiple autonomous stakeholders are able to self-organize while acting in a heterogeneous manner; (2) governance allows these heterogeneous actions, through levers of action, to converge toward a more homogeneous collective process.
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