Santé et Services sociaux Québec.
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Lunch hour conferences 2013

Expedited knowledge synthesis on the implementation of integrated services networks for seniors who have lost autonomy.

January 23, 2013

By: Jean-Frédéric Levesque,
Scientific Director, Direction de l’analyse et de l’évaluation des systèmes de soins et services, INSPQ

Léo-Roch Poirier,
Research Officer, Direction de l’analyse et de l’évaluation des systèmes de soins et services, INSPQ

In the context of the Evidence on Tap (EoT) initiative put forward by the Canadian Institutes of Health Research, INSPQ researchers were given a grant to conduct an expedited knowledge synthesis on the factors facilitating or hindering the implementation of integrated services networks for the elderly.

A literature review, interviews with international experts, case studies and a deliberative forum led to the identification of some solutions likely to help achieve an adequate level of implementation of these networks. The synthesis was completed within a 6-month timeframe by systematically involving the ministerial partners.

This lunch hour talk provides an opportunity to present the key findings and proposed solutions in this area and discuss the strengths and limitations of expedited knowledge synthesis with regard to decision support. It is intended for managers, health professionals and other actors from different sectors concerned by this topic. A presentation of the context leading to the call for projects and an assessment of the exercise by MSSS representatives Manon St-Pierre and Danielle Benoit, will frame this presentation. 

Towards greater equity and better results in mental health in Québec: perspective of the Commissaire à la santé et au bien-être regarding improvements in the performance of the health and social services system.

March 13, 2013

By: Jacques E. Girard,
Deputy Commissioner for Assessment and Analysis

The CSBE’s 2012 Report on the Performance Appraisal of the Health and Social Services System includes 5 major recommendations and 15 specific actions to improve the performance of the health and social services system in this sector, with the aim of consolidating knowledge gained in recent years and better responding to the needs of persons with mental disorders, in particular, with regard to front-line services. Following an outline of the key findings, the presentation will highlight the need to re-examine the allocation of mental health resources for an optimal supply of services, with an emphasis on continuity, collaborative health care and the provision of services in the community. Other subjects will include the added value of better access to psychotherapy and the importance of intersectoral action in supporting recovery. Mental health promotion and prevention of mental disorders, and combating the stigma of mental illness represent other ongoing challenges. Lastly, the presentation will highlight the key role played by the MSSS in terms of responding to these challenges.

An interprofessional approach to shared decision making in primary care.

May 22, 2013

By: France Légaré,
holder of Canada Research Chair in the Implementation of Shared Decision Making in Primary Care, Université Laval

Nathalie Brière,
advisor, University Affairs and Interprofessional Collaboration, Centre de santé et de services sociaux de la Vieille-Capitale

Shared decision-making refers to decisions made jointly by the patient/user and his/her health professional. It involves discussing the risks and benefits of available options and taking into account the values and preferences of the patient/user. Shared decision-making aims at a decision that is based on the best evidence available and that reflects what is important for the patient/user. Decision support tools assist the patient/user and health professional by making the decision explicit, providing information on the options available and their impacts on health, and helping the patient/user clearly communicate his/her own values to the health care provider. It is important to note that these decision support tools are intended to complement rather than replace the advice of a health professional. Compared to usual approaches, including the use of educational material, shared decision-making is associated with better knowledge on the part of patients/users concerning the options available, a higher comfort level with the decision made, less regret about the decision, less hesitation to translate the decision into concrete action, fewer choices of options that do not demonstrate gains/benefits for the majority and fewer legal proceedings when the decision leads to a negative outcome. Consequently, several industrialized countries have promoted shared decision-making and introduced decision support tools for their populations. Lastly, in recent years, there has been an exponential growth in interest in training programs aimed at enabling health professionals to support shared decision-making with their patients/users and thus involve patients/users in a significant way in the provision of care and services.

An interprofessional approach to shared decision making allows a team of health professionals – and not just the physician – to support the patient/user faced with the decision. However, shared decision-making has not yet been widely adopted by health professionals despite surveys among patients/users indicating that a large proportion of respondents wish to play a more active role in decisions concerning them. Health professionals are more interested in participating in shared decision-making when there are several clinical options and when healthcare decisions are more difficult to make. One of the decisions that older people face is whether or not to remain at home.  One of our studies showed that, overall, home care professionals would like to adopt an interprofessional approach to shared decision-making with seniors but that various obstacles prevent them from doing do. We thus developed a multifaceted intervention aimed at implementing this approach, which was then tested among a home care team in Quebec City and another in Edmonton. This lunchtime talk presents an opportunity to discuss these studies and the challenges of involving both patients/users and interprofessional healthcare teams in decisions related to healthcare.

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Personalization, intervention and results measurement in social services: an emerging opportunity.

June 4, 2013

By: Paul Morin,
Professor, School of Social Work, Université de Sherbrooke, Scientific Director, CSSS-IUGS, a University-Affiliated Centre

Sébastien Carrier,
Assistant Professor, School of Social Work, Université de Sherbrooke

The primary mandate of a University-Affiliated Centre (UAC), as the social research infrastructure of a health and social services centre (CSSS), is to contribute to the development of programs and practices aimed at knowledge advancement and support for decision-making. At the Sherbrooke UAC, we chose to explore the following paradox: Despite the significant human, technical and financial resources invested in the field of social services, very little is yet known about the effects of intervention on individuals and their loved ones. In the United Kingdom, this concern has led to an approach known as the personalization of social services. According to the Social Care Institute for Excellence, personalization “means recognizing people as individuals who have strengths and preferences and putting them at the centre of their own care and support. ... [It] is also about making sure there is an integrated, community-based approach for everyone.” In England and Scotland, this approach has been applied through the implementation of interventions and related measurement tools that give priority to interventions requested by the individuals themselves and results regarding them.

At this lunch hour talk, two researchers will present a synthesis of a literature review and their own conclusions regarding the added value of this approach for Québec. This talk is intended for managers, health professionals and other actors from different sectors concerned by this topic.

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Integrating the voice of citizens and target groups into the work of expert groups using research techniques from the social sciences and humanities.

October 9, 2013

By: Claude Giroux,
Research Coordinator, Communication, Direction des communications, MSSS

Sometimes the results of the work of teams that bring together experts, researchers and clinical practitioners are met by a lack of interest, reluctance or a lack of understanding on the part of the citizens or groups initially targeted. The difficulty of implementing some practice guidelines, the low levels at which recommended behaviours are adopted, or the reluctance of health professionals regarding new policies are all examples that come to mind.  This is especially disconcerting given that serious effort has usually been made to integrate the comments and viewpoints of representatives of the targeted groups into these initiatives. What, then, can be done to foster the support, receptiveness and collaboration of the groups targeted by our policies, practice guidelines and communication? The approach and methods used in the field of public communication, a discipline tied to the social sciences and humanities, offers interesting possibilities to help meet this challenge.

In 2008, in a presentation on the merits of an interdisciplinary approach to public health, Kreps and Maibach emphasized the complementarity of approaches to communication, seeing them as making a synergetic contribution. An approach that brings together the communication sciences and the health disciplines makes it possible to round out the work of experts by integrating the “voice” of the people concerned, whether citizens or practitioners. Since few social groups possess the formal structure needed to “delegate representatives,” since it is difficult to distinguish between the personal interests and organizational interests of delegates or designated representatives, since, in some contexts, people may hesitate to express their opinions, and since some people are reluctant to collaborate, the research techniques used in the field of communication prove to be useful in terms of enabling health authorities to hear the voice – and understand or anticipate the reactions – of the groups targeted by their policies, programs or communication. It is from this perspective, as complementary tools, that this talk will address the benefits and pertinence of techniques such as sample surveys, focus groups and qualitative interviews.

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The safety of home care: results of a pan-Canadian study.

October 23, 2013

By: Régis Blais,
Professor, Department of Health Administration, Université de Montréal

Over a million Canadians receive home care services. Given that this number will continue to grow due to population aging, this study on the safety of home care, the first of its kind, based on an examination of administrative databases and client charts, as well as interviews with clients, their caregivers and health professionals, sheds important light on this question. Between 10% and 13% of clients experienced an adverse event (AE) or harmful incident over a period of one year and more than half of these AEs were deemed to be preventable. The most common AEs were falls, medication-related incidents and infections. The main risk factors for clients were co-morbid conditions and the fact of being functionally vulnerable. The organizational causes of AEs included inconsistent planning and inconsistent delivery of care, the absence of an integrated, interdisciplinary healthcare team that could ensure continuity of care delivery and coordinate the care across all sectors of the healthcare system, poor standardization of care processes, inappropriate packaging of medication, a lack of timely access to health-related equipment, and risky decisions made by clients and their caregivers. This talk presents an opportunity to discuss the results of this study and the recommendations generated from it for improving the safety of home care.

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