1. Empowerment and health promoting networks in Quebec Nicole Dedobbeleer, Sc.D. André-Pierre Contandriopoulos, Ph.D. Louise Rousseau, Ph.D. Hung N’Nguyen, MSc. Lise Lamothe, Ph.D. Martin Beaumont, Ph.D. candidate

2. INTRODUCTION Historical background: –In Quebec (Canada), a publicly funded health care system; –Health and social services integrated under a unified administration; –A universal heath insurance program;.

3. INTRODUCTION –In the late fifteen years, Major changes were observed in the network organisation, administration of services and health care provision of the Health Care and Social Services System. In a context of zero deficit and rapid development in medical technology, the consequences were dramatic. –Different governmental reports requested changes.

4. INTRODUCTION Bill 25, adopted in December 2003, provided for the latest system reorganization : –the transformation of regional boards into local health and social network development agencies.

5. INTRODUCTION Mission of these agencies: –Establish integrated services organizations in their areas of jurisdiction in order to bring services closer to the general public and make it easier for people to move through the health and social services network. –Each agency had to develop and propose an organizational model based on one or more local services networks.

6. INTRODUCTION The local services networks encompass –a local instance, a health and social services centre (CSSS), merging establishments currently offering the services of local community health centers (CLSC), hospitals and residential and long-term care centres (CHSLD). The networks also include pharmacists, physicians, community groups, and private resources. Special agreements have to be concluded with specialized hospitals.

8. INTRODUCTION Each network –will provide the people in its territory with access to a broad range of primary social and health services, including prevention, assessment, diagnostic, treatment, rehabilitation and support services. –will lead all stakeholders within a given territory to become collectively responsible for the health and well- being of their population.

10. OBJECTIVES To examine to what extent the Quebec law 25 and upcoming law 83 will enable CSSS (health and social services centres including hospitals) to become empowered and empowering organizations; To examine how quality criteria of the Canadian Council on Health Services Accreditation (CCHSA) may enable CSSS and the health and social services networks to become empowering organizations for patients, staff and citizens.

11. DEFINITIONS Empowerment –Active, participatory process through which individuals, organizations and communities gain greater control, efficacy and social justice (Rappaport, 1987; Solomon, 1976). Organizational empowerment (OE) –Organizational efforts that generate psychological empowerment among members and organizational effectiveness needed for goal achievement (Zimmerman, 2000).

12. DEFINITIONS According to Peterson and Zimmerman (2004), there is a distinction between: –Empowering organizations are those that produce psychological empowerment for individual members as part of their organizational process; –Empowered organizations are those that influence the larger system of which they are a part. They presented a theoretical framework for processes and outcomes for intra- organizational, inter-organizational and extra-organizational components of OE.

13. Processes for the components of OE Components –Intra-organizational –Inter-organizational –Extra- organizational Processes –Incentive management –Subgroup linkages –Opportunity role structure –Leadership –Social support –Group-based belief system. –Accessing social networks of other organizations; –Participating in alliance- building activities with other organizations. –Implementing community actions; –Disseminating information.

14. Intra-, Inter- and Extra-organizational Components of OE Components –Intra-organizational Characteristics that represent the internal structure and functioning of organizations; –Inter-organizational Capture linkages and relationships between organizations; –Extra-organizational Actions intended to affect the larger policy or other environments.

15. Laws 25 and 83 and Intra-organizational Processes Processes Accomplishments Challenges Subgroup linkages Creation of CSSS Redefinition of roles, sharing of responsibilities, privileges, feeling of ownership, collective agreements Opportunity role structure Administrative boards Membership representation on administrative boards, population participation Incentive management Sharing of information, decisions Overworked staff, low morale and motivation, no additional budget

16. Law 25 and 83 and Intra- organizational Processes Processes Accomplishments Challenges Leadership Renewed local leadership Inter-professional and inter- organizational dynamics, population leadership Social support Professional development plans Additional budget Group-based belief system Integration of services Common vision, values

17. Laws 25 and 83 and Inter- organizational Processes Processes Accomplishments Challenges Accessing social networks of other organizations Second phase of the reform Protection of professional, institutional, budgetary silos Participating in alliance-building activities with other organizations Second phase of the reform Negotiation of shared responsibility

18. Laws 25 and 83 and Extra- organizational Processes Processes AccomplishmentsChallenges Community actions Public meetings and events Participation Dissemina- tion of information Circulation of information, information technology, Access of different establishments, common information center

19. CCHSA STANDARDS : Examples Patients empowerment –The team works with clients and families to help them actively participate in service delivery and carry out responsibilities……gives complete and accurate information…provides education (knowledge, skills development)….helping clients understand what they are responsible for…teaching positive behaviour,..

20. CCHSA STANDARDS : Examples Staff empowerment –..staff..participate in developing the organization vision, goals, objectives and strategic plans. The organization manages its equipment, supplies.. by…choosing and buying on comments and suggestions from staff.. clients.

21. CCHSA STANDARDS : Examples Community empowerment –The organization forms linkages and partnerships with other organizations and the community by participating in or leading activities…advocate..changes in public policy (smoking in public places). The governing body.... giving the community the opportunity to participate in decisions about the organization services.…working with other organizations, groups, sectors and governments to promote healthy communities…

22. CONCLUSION Findings indicate empowering processes –a work in progress; –networks have been created; –Bill 25 Law 83 on health services and social services (second phase).

23. CONCLUSION Bill 25 success will be related to the policy understanding or meaning given to this radical restructuring and to the vision proposed. –It provides the opportunity to consider the critical role that the HPH concept can and could play in the integrated services organizations.

24. CONCLUSION Success conditions –a significant shift in philosophy, values and practices; –real decentralization; –financial and organizational incentives; –leadership (political,administrative, clinical); –professionals’ capacity to develop local intervention projects; –integrated information systems.

25. CONCLUSION Empowerment is incorporated in CCHSA standards. Further developments in CCHSA standards are needed to provide a useful tool for the adoption of the HPH concept in Quebec and its extension to a “health promoting network” concept.