Interdisciplinary collaboration within Quebec community health care centres
Introduction
The traditional importance of the hospital in the health care system is increasingly being challenged by primary care organisations. Central to the success of many recent health system reforms put in place in several countries is indeed the conception and implementation of new primary health care delivery models (Cave, 1995; Leatt, Lemieux-Charles, & Leggat, 1996; Robinson, & Casalino, 1996; Saltman & Figueras, 1997; Shortell, Gillies, Anderson, Mitchell, & Morgan, 1996).
The central characteristics common to these new models usually emphasise an increased responsiveness of services to population needs and better service integration and co-ordination. This is done through a coherent organisational structure and financial incentives promoting common goals among various professional groups. The idea of increasing the continuity of care through a vertically integrated model of health care delivery which provides or purchases a comprehensive range of health care services has become a popular concept (Bolland & Wilson, 1994; Cave, 1995; Conrad, 1993; Shortell et al., 1996). This idea of continuity of care has made the issue of co-ordination of services within and between organisations a priority. It has rapidly gained the attention of policymakers and improved co-ordination has become a priority in most health care reforms. It surfaces implicitly in several models of health care reform under various forms such as managed competition, managed care or integrated services. However, while emphasis is placed on the development of models which improves co-ordination of services through interorganisational relations (Alter & Hage, 1993; Shortell, Gillies, Anderson, Mitchell, & Morgan, 1993), co-ordination of services between various groups of professionals is still fundamental and remains difficult to put in place. A substantial portion of the co-ordination of services within and between organisations and their delivery is still in the hands of individual professionals who are each trained differently, bringing with them their own expertise. The division of work and distribution of tasks among professionals in the workplace remains fundamental to the daily provision of health care services (Abbott, 1988).
Using empirical research, this paper studies interdisciplinary collaboration among various groups of professionals within a Canadian primary health care delivery model, the Quebec Centres Locaux de services communautaires (CLSCs) or Community Health Care Centres (CHCCs). The entire population of more than 150 CHCCs have been surveyed. The CHCC is an interdisciplinary primary health care organisation that is community-based. It was implemented throughout the entire province of Quebec, Canada 25 years ago. The CHCCs emphasise the integration and co-ordination of a full range of health and social services. Inside all of these community centres, large efforts have been put into the implementation of a collaborative model of primary care, which take place between several groups of professionals. This large laboratory of interdisciplinary collaboration is important to investigate and comprehend. This is especially true in the present era of health system renewal in which a greater role and importance is given to the primary care system and to improved collaboration between various groups of professionals.
The goals of this study are: (1) to measure the achieved intensity of inter-professional collaboration among the main Quebec CHCC programmes (i.e. the Elderly Home Care Programme, the Youth and Family Care Programme, the Ambulatory Walk-in Clinic Programme, and the Specialised Adult Care Programme); and (2) to identify the organisational and professional factors fostering or limiting interdisciplinary collaboration. Interdisciplinary collaboration is perceived as a process by which individuals from different professions structure a collective action in order to co-ordinate the services they render to individual clients or groups (D’Amour, Sicotte, & Lévy, 1999). Interdisciplinary integration of care is the result of this co-ordination. The data was obtained through a closed questionnaire administered by mail to the head of the four main programmes within each of the Quebec CHCCs. The development and validation of various scales that measure interdisciplinary collaboration and associated factors have been done with care. Confirmatory factor analysis was used to test the validity of these scales. In the next two sections, the Quebec CHCC collaborative model is described briefly and the analytical framework underlying the study is presented.
Section snippets
The Quebec community health care centre interdisciplinary collaborative model
Despite early promotion for interdisciplinary collaboration made in the mid-1970s by the World Health Organisation (WHO Alma Ata, 1981), physician-centred practices emphasising the delivery of primary health care by physicians is still the dominant model of primary health care delivery in the developed world. At the time of its implementation in the mid-1970s, the Quebec model was the only model of its kind in Canada (Schade, 1995). The Quebec CHCC is a model in which services are provided in a
Analytical framework
The interdisciplinary collaborative service delivery model is a model of care that pursues improved co-ordination of care between different groups of professionals. This collaboration aims at going beyond a traditional model in which professionals work in parallel, continuing to pursue their professional goals with little co-ordination or sharing of responsibilities and tasks with other work group members. The interdisciplinary collaborative service delivery model promotes a collaborative work
Sampling strategy
The entire population of all Quebec CHCCs (n=157 in 1995) was targeted in a postal survey. The unit of analysis is the programme. The advantage of this level of analysis is that it takes into account this fundamental characteristic of the CHCC, the programme. It is at the programme level that work group collaboration is organised and promoted. Each programme is a stand-alone organisational subsystem with its own clientele and its own means of intervention: human, financial and material. Four
Results
Table 1 shows the results obtained in response to the first research objective which was to assess the level of interdisciplinary collaboration reached within the Quebec CHCC programmes. The mean scores of the two response variables assessing the intensity of interdisciplinary collaboration are presented for the four types of CHCC programmes studied. The mean scores must be interpreted keeping in mind that intensity was evaluated using a five-degree scale going from a very negative state (1) to
Discussion
Quebec CHCCs have reached modest results in achieving interdisciplinary collaboration. Although the value attained was positive, many will find the intensity of interdisciplinary collaboration disappointing because of the importance attached to it. However, despite these disappointing results, this study highlights important factors that can enable us to improve interdisciplinary collaboration. These lessons are applicable to other primary health care systems that are attempting to implement
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