Governance tensions in the healthcare sector: a contrasting case study in France.
Ontology highlight
ABSTRACT: Background
Political and managerial reforms affect the health sector by translating into governance tensions. As identified in the public management literature, these tensions come from the diffusion of management principles and practices from the business world. These tensions manifest at four levels: institutional, organisational, managerial and instrumental. The aim of this research is to understand how these tensions are expressed in healthcare organisations of different status.Methods
We conduct a contrasting case study exploring the cases of two French healthcare organisations, one private for-profit (clinic) and one public not-for-profit (cancer treatment centre). Our analyses are mainly based on the content analysis of 32 semi-structured interviews conducted with staff (nurses, doctors, management and administrative staff) of these two organisations.Results
Our results show that these tensions can be distinguished into three categories (tensions on professional values, standards and practices) which are expressed differently depending on the type of healthcare organisation and its main management characteristics.Conclusions
Unexpectedly, in the for-profit organisation, the most intense tensions concern professional standards, whereas they concern professional practices in the not-for-profit organisation. These analyses can help guide policy makers and healthcare managers to better integrate these tensions into their political and managerial decisions.
SUBMITTER: Meriade L
PROVIDER: S-EPMC8739355 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundMost the Organization for Economic Co-operation and Development (OECD) countries are currently facing the challenges of the health transition, the aging of their populations and the increase in chronic diseases. Effective and comprehensive primary healthcare (PHC) services are considered essential for establishing an equitable, and cost-effective healthcare system. Developing care coordination and, on a broader scale, care integration, is a guarantee of quality healthcare delivery. The development of healthcare systems at the meso-level supports this ambition and results in a process of territorial structuring of PHC. In France, the Health Territorial and Professional Communities (HTPC) constitute meso-level organizations in which healthcare professionals (HCPs) from the same territory gather. We conducted a study to determine, in a qualitative step, the key elements of the territorial structuring of PHC in France and, then, to develop, in a quantitative step, a typology of this structuring.MethodsA sequential-exploratory mixed-method study with a qualitative step using a multiple case approach and a quantitative step as a hierarchical clustering on principal components (HCPC) from a multiple correspondence analysis (MCA).ResultsA total of 7 territories were qualitatively explored. Territorial structuring appears to depend on: past collaborations at the micro-level, meso-level coordination among HCPs and multiprofessional structures, diversity of independent professionals, demographic dynamics attracting young professionals, and public health investment through local health contracts (LHCs). The typology identifies 4 clusters of mainland French territories based on their level of structuring: under or unstructured (38.6%), with potential for structuring (34.7%), in the way for structuring (25.3%) and already structured territories (1.4%).ConclusionInterest in territorial structuring aligns with challenges in meso-level healthcare organization and the need for integrated care. Typologies of territorial structuring should be used to understand its impact on access, care quality, and medical resources.
| S-EPMC11270609 | biostudies-literature
Project description:This article covers comprehensive data on firm-level corporate governance practices as imposed by the Jordan Securities Commission (JSC). The study includes panel data for 95 non-financial Jordanian listed firms (industrial and service sector) in Amman Stock Exchange (ASE). The time frame used for this study is from 2012 to 2017. Data presented were extracted from the annual reports of each firm. The annual reports had been downloaded from the official website of the ASE. The data can be used easily by the researcher to develop and calculate a corporate governance index that involves thirty-two internal governance attributes and is comprised of three equally weighted sub-indices. The first sub-index which is "Disclosure and Transparency" consists of 15 unique attributes. While the second sub-index, "Board Effectiveness and Composition" consists of 9 unique attributes. The last sub-index which is "Shareholders Rights" consists of 8 unique attributes. Thus, the un-weighted corporate governance index has an important feature that is easily replicated and modified, enabling the researcher to rate firms based on an aggregate index score or by using the sub-indices score also.
| S-EPMC7200235 | biostudies-literature
Project description:Gene drives have already challenged governance systems. In this case study, we explore the International Genetically Engineered Machine (iGEM) competition's experiences in gene drive-related research and lessons in developing, revising, and implementing a governance system. iGEM's experiences and lessons are distilled into 6 key insights for future gene drive policy development in the United States: (1) gene drives deserve special attention because of their potential for widescale impact and remaining uncertainty about how to evaluate intergenerational and transboundary risks; (2) an adaptive risk management approach is logical for gene drives because of the rapidly changing technical environment; (3) review by individual technical experts is limited and may fail to incorporate other forms of expertise and, therefore, must be complemented with a range of alternative governance methods; (4) current laboratory biosafety and biosecurity review processes may not capture gene drive research or its components in practice even if they are covered theoretically; (5) risk management for research and development must incorporate discussions of values and broader implications of the work; and (6) a regular technology horizon scanning capacity is needed for the early identification of advances that could pose governance system challenges.
| S-EPMC8892970 | biostudies-literature
Project description:ObjectivesTo analyse preferences around promotion of COVID-19 vaccination among workers in the healthcare and welfare sector in Fance at the start of the vaccination campaign.DesignSingle-profile discrete-choice experiment. Respondents in three random blocks chose between accepting or rejecting eight hypothetical COVID-19 vaccination scenarios.Setting4346 healthcare and welfare sector workers in France, recruited through nation-wide snowball sampling, December 2020 to January 2021.OutcomeThe primary outcomes were the effects of attributes' levels on hypothetical acceptance, expressed as ORs relative to the reference level. The secondary outcome was vaccine eagerness as certainty of decision, ranging from -10 to +10.ResultsAmong all participants, 61.1% made uniform decisions, including 17.2% always refusing vaccination across all scenarios (serial non-demanders). Among 1691 respondents making variable decisions, a strong negative impact on acceptance was observed with 50% vaccine efficacy (compared with 90% efficacy: OR 0.05, 95% CI 0.04 to 0.06) and the mention of a positive benefit-risk balance (compared with absence of severe and frequent side effects: OR 0.40, 0.34 to 0.46). The highest positive impact was the prospect of safely meeting older people and contributing to epidemic control (compared with no indirect protection: OR 4.10, 3.49 to 4.82 and 2.87, 2.34 to 3.50, respectively). Predicted acceptance was 93.8% for optimised communication on messenger RNA vaccines and 16.0% for vector-based vaccines recommended to ≥55-year-old persons. Vaccine eagerness among serial non-demanders slightly but significantly increased with the prospect of safely meeting older people and epidemic control and reduced with lower vaccine efficacy.DiscussionVaccine promotion towards healthcare and welfare sector workers who hesitate or refuse vaccination should avoid the notion of benefit-risk balance, while collective benefit communication with personal utility can lever acceptance. Vaccines with limited efficacy will unlikely achieve high uptake.
| S-EPMC8491005 | biostudies-literature
Project description:ObjectiveTo explain the current delivery of healthcare to residents living in UK care homes.DesignQualitative interview study using a grounded theory approach.Setting6 UK care homes and primary care professionals serving the homes.ParticipantsOf the 32 participants, there were 7 care home managers, 2 care home nurses, 9 care home assistants, 6 general practitioners (GPs), 3 dementia outreach nurses, 2 district nurses, 2 advanced nurse practitioners and 1 occupational therapist.Results5 themes were identified: complex health needs and the intrinsic nature of residents' illness trajectories; a mismatch between healthcare requirements and GP time; reactive or anticipatory healthcare?; a dissonance in healthcare knowledge and ethos; and tensions in the responsibility for the healthcare of residents. Care home managers and staff were pivotal to healthcare delivery for residents despite their perceived role in social care provision. Formal healthcare for residents was primarily provided via one or more GPs, often organised to provide a reactive service that did not meet residents' complex needs. Deficiencies were identified in training required to meet residents' needs for both care home staff as well as GPs. Misunderstandings, ambiguities and boundaries around roles and responsibilities of health and social care staff limited the development of constructive relationships.ConclusionsHealthcare of care home residents is difficult because their needs are complex and unpredictable. Neither GPs nor care home staff have enough time to meet these needs and many lack the prerequisite skills and training. Anticipatory care is generally held to be preferable to reactive care. Attempts to structure care to make it more anticipatory are dependent on effective relationships between GPs and care home staff and their ability to establish common goals. Roles and responsibilities for many aspects of healthcare are not made explicit and this risks poor outcomes for residents.
| S-EPMC3717448 | biostudies-literature
Project description:Successful river basin governance is challenged by actor engagement in the various stages of planning and management. A governance approach for determining priorities for actors for sustainable management was developed, based on a river basin diagnostic framework consisting of four social-institutional and four biophysical indicators. It was applied in river basins in Australia, Brazil, China and France. Actors diagnosed current and target capacity for these indicators, and estimated synergistic influences of interacting indicators. The results reveal different priorities and transformative pathways to achieve basin plan outcomes, specific to each basin and actor groups. Priorities include biodiversity for the Murray-Darling, local water management needs for the São Francisco and Yellow rivers, and improved decision-making for the Adour-Garonne. This novel approach challenges entrenched views about key issues and actor engagement roles in co-implementation of the basin plan under existing prevailing governance models, with implications for engagement and international collaboration on basin governance.
| S-EPMC9200927 | biostudies-literature
Project description:Introduction: Early detection of certain types of cancer significantly increases the likelihood of successful treatment and reduces mortality from these causes. However, the use of screening and the early detection of selected tumors such as colorectal cancer (CRC) are lower than those expected in our country. The objective of this project is to evaluate the effectiveness of a multicomponent strategy that improves the screening and early detection of CRC in the population at risk of Primary Health Care Clinics (PCCs) of the public health system.
Population: people leaving in the catchment area of 10 selected primary care clinics from the public health system in the province of Mendoza, Argentina.
Design and methods: a Randomized clinical study by clusters. 10 PCCs will be included: 5 will be randomly assigned to receive an intervention to increase the CRC screening rates (improvement cycles) and 5 to the control arm (usual care). 150 participants will be included in each PCCs, in total, 1500 participants.
Intervention: An innovative vision is proposed, which combines a participatory and dynamic methodology based on improvement cycles. This approach includes the implementation of participatory learning sessions for health providers, involving the effectors of the design of the intervention. In the intervention branch at least 3 workshops (sessions) will be held with the members of the care system, in order to identify opportunities for improvement oriented to the design and application of an innovative intervention based on best practices. Each one of the sessions will constitute an analysis of the improvement cycle, following the following steps: 1) Selection of participants of the initial workshop; 2) Development of work model based on bibliographic review and initial qualitative phase; 3) Initial workshop with effectors for training in continuous improvement, objectives, interventions and data collection; 4) Learning workshops to discuss results, applicability of interventions and modifications to the work plan; 5) Closing session to evaluate preliminary results and discuss continuity of interventions beyond the project.
Outcomes: 1) Percentage of the population at risk that completes the screening; 2) Percentage of the population classified as at habitual risk or increased by risk factors.
| 2331931 | ecrin-mdr-crc
Project description:BackgroundPatient participation in decision-making has become a hallmark of responsive healthcare systems. Cancer networks in many countries have committed to involving people living with and beyond cancer (PLC) at multiple levels. However, PLC participation in network governance remains highly variable for reasons that are poorly understood. This study aims to share lessons learned regarding mechanisms that enable PLC participation in cancer network governance.MethodsThis multiple case study, using a qualitative approach in a natural setting, was conducted over six years in three local cancer networks within the larger national cancer network in Quebec (Canada), where PLC participation is prescribed by the Cancer Directorate. Data were collected from multiple sources, including individual and focus group interviews (n = 89) with policymakers, managers, clinicians and PLC involved in national and local cancer governance committees. These data were triangulated and iteratively analysed according to a framework based on functions of collaborative governance in the network context.ResultsWe identify three main mechanisms that enable PLC participation in cancer network governance: (1) consistent emphasis on patient-centred care as a network objective; (2) flexibility, time and support to translate mandated PLC representation into meaningful participation; and (3) recognition of the distinct knowledge of PLC in decision-making. The shared vision of person-centred care facilitates PLC participation. The quality of participation improves through changes in how committee meetings are conducted, and through the establishment of a national committee where PLC can pool their experience, develop skills and establish a common voice on priority issues. PLC knowledge is especially valued around particular challenges such as designing integrated care trajectories and overcoming barriers to accessing care. These three mechanisms interact to enable PLC participation in governance and are activated to varying extents in each local network.ConclusionsThis study reveals that mandating PLC representation on governance structures is a powerful context element enabling participation, but that it also delineates which governance functions are open to influence from PLC participation. While the activation of mechanisms is context dependent, the insights from this study in Quebec are transferable to cancer networks in other jurisdictions seeking to embed PLC participation in decision-making.
| S-EPMC8423332 | biostudies-literature
Project description:ObjectivesParticipant-led research (PLR) is a rapidly developing form of citizen science in which individuals can create personal and generalisable knowledge. Although PLR lacks a formal framework for ethical review, participants should not be excused from considering the ethical implications of their work. Therefore, a PLR cohort consisting of 24 self-trackers aimed to: (1) substitute research ethics board procedures with engagement in ethical reflection before and throughout the study and (2) draft principles to encourage further development of the governance and ethical review of PLR.MethodsA qualitative case study method was used to analyse the ethical reflection process. Participants discussed study risks, risk management strategies and benefits pre-project, during a series of weekly webinars, via individual meetings with the participant-organisers, and during semi-structured interviews at project completion. Themes arising from discussions and interviews were used to draft prospective principles to guide PLR.ResultsData control, aggregation and identifiability were the most common risks identified. These were addressed by a commitment to transparency among all participants and by establishing participant control via self-collection and self-management of data. Group discussions and resources (eg, assistance with experimental design and data analysis) were the most commonly referenced benefits of participation. Additional benefits included greater understanding of one's physiology and greater ability to structure an experiment. Nine principles were constructed to encourage further development of ethical PLR practices. All participants expressed interest in participating in future PLR.ConclusionsProjects involving a small number of participants can sustain engagement in ethical reflection among participants and participant-organisers. PLR that prioritises transparency, participant control of data and ongoing risk-to-benefit evaluation is compatible with the principles that underlie traditional ethical review of health research, while being appropriate for a context in which citizen scientists play the central role.
| S-EPMC6500204 | biostudies-literature
Project description:In this paper, I address the case of a corporate society in Central Mexico. After volcanic eruptions triggered population displacements in the southern Basin of Mexico during the first and fourth centuries A.D., Teotihuacan became a multiethnic settlement. Groups from different backgrounds settled primarily on the periphery of the metropolis; nevertheless, around the core, intermediate elites actively fostered the movement of sumptuary goods and the arrival of workers from diverse homelands for a range of specialized tasks. Some of these skilled craftsmen acquired status and perhaps economic power as a result of the dynamic competition among neighborhoods to display the most lavish sumptuary goods, as well as to manufacture specific symbols of identity that distinguished one neighborhood from another, such as elaborate garments and headdresses. Cotton attire worn by the Teotihuacan elite may have been one of the goods that granted economic importance to neighborhood centers such as Teopancazco, a compound that displayed strong ties to the Gulf Coast where cotton cloth was made. The ruling elite controlled raw materials that came from afar whereas the intermediate elite may have been more active in providing other sumptuary goods: pigments, cosmetics, slate, greenstone, travertine, and foreign pottery. The contrast between the corporate organization at the base and top of Teotihuacan society and the exclusionary organization of the neighborhoods headed by the highly competitive intermediate elite introduced tensions that set the stage for Teotihuacan's collapse.
| S-EPMC4522775 | biostudies-other