Marie-pascale Pomey - Academia.edu (original) (raw)
Papers by Marie-pascale Pomey
Research Square (Research Square), Oct 4, 2019
Research Square (Research Square), May 8, 2023
Objectives Since 2018, four establishments in Quebec have been instrumental in implementing the P... more Objectives Since 2018, four establishments in Quebec have been instrumental in implementing the PAROLE-Onco program, which introduced accompanying patients (APs) in healthcare teams to improve cancer patients' experience. APs are patient advisors who have acquired speci c experiential knowledge related to living with cancer, using services, and interacting with healthcare professionals. They are therefore in a unique and reliable position to be able to provide emotional, informational, cognitive and navigational support to patients dealing with cancer. We aimed to explore APs' perspectives regarding the limiting and facilitating factors in terms of how they are integrated into the clinical oncology teams. Methods A qualitative study based on semi-structured interviews and focus groups was conducted with 20 APs at the beginning of their intervention (T1) and two years afterwards (T2). Limiting and facilitating factors of APs' integration into clinical teams were analyzed in terms of governance, culture, resources and tools. Results The most signi cant limiting factors raised by APs to be integrated into clinical teams were: governance involvement, organizational boundaries, team members' availabilities, and confusion about the speci c roles played by APs. Communication challenges were also raised, leading to inadequate promotion of the program to patients. The lack of time, space and compensation were also mentioned as limiting factors. Creating opportunities for team members to meet APs, building trust and teaching team members how APs' activities are complementary to theirs were enhancing factors. Other facilitators include APs being involved in decision-making committees, being leaders in the PAROLE-Onco program promotion to patients and clinical team members and creating opportunities to communicate with team members to help enhance their work and provide feedback to improve patient services. Awareness of APs' added value for the team and patients is also a key facilitator. Regarding tools, offering accompanying services by telephone allows both patients and APs to bene t from the exibility they need. Conclusion Over time, APs were able to identify the best factors for successful implementation. Recommendations include APs and professionals working in co-construction on organization, leadership, resources, and status factors. This could help catalyze a change in culture within health establishments and allow people dealing with cancer to bene t from the experiential knowledge of other patients within their clinical team. Contributions to the literature Page 4/22 By being among the most signi cantly impacted by the implementation of the PAROLE-Onco program, APs are in a strong position to evaluate the program's implementation and identify facilitating factors to their integration. Misunderstandings about APs' roles can delay a change in culture in healthcare establishments and make APs' accompanying services more challenging to promote. Assigning certain powers to APs, via co-construction and co-decision methods, is conducive to ensuring a successful change in culture within healthcare establishments. Working proactively with APs on organization, leadership, resources, and status factors will allow patients dealing with cancer to bene t from the experiential knowledge of other patients within their clinical team.
PLOS ONE, May 4, 2022
During the COVID-19 pandemic, restrictions were imposed on visits in hospitals in the province of... more During the COVID-19 pandemic, restrictions were imposed on visits in hospitals in the province of Quebec, Canada in an effort to reduce the risk of viral exposure by minimizing faceto-face contact in order to protect patients, visitors and staff. These measures led to social isolation for patients. In order to reduce this isolation, CHUM (the Centre hospitalier de l'Université de Montré al, a teaching hospital) shifted from in-person visits to courtesy telephone calls delivered by volunteers from CHUM's Volunteers, Recreation and Leisure Department. Objectives To study: (1) the contribution made by these calls to reducing isolation and their limitations, (2) how the calls can be improved, and (3) whether they should be maintained, based on the views of patients and volunteers. Methodology This study examined two populations. The first one consisted of 189 adult patients hospitalized at CHUM who received a courtesy phone call from a volunteer and the second one consisted of the 25 CHUM volunteers who made these calls. Quantitative data were collected from patients and volunteers through questionnaires and a Smartsheet. The patient questionnaire evaluated isolation, the courtesy phone calls, the relationship of trust with the volunteer and sociodemographic questions. The volunteer questionnaire evaluated the appropriateness of the technology for the intervention, the support and training received, the
Organizational behaviour in health care, 2019
This chapter presents the way in which citizen and patient participation in Quebec’s health and s... more This chapter presents the way in which citizen and patient participation in Quebec’s health and social services system came about, particularly though the presentation of what is now recognized as the “Montreal Model”, which refers to simultaneous integration of patients in education, research and the health system. Thanks to a structured process and a clear categorization of the different levels of patient engagement, Quebec is on its way been able to progressively change the culture not just for the healthcare system but also among future and current healthcare professionals and researchers. By better meeting the patients’ need and allowing them to take their place in care relationships, healthcare services organization, teaching and research we hope to humanize the healthcare system and contribute to improving the population’s health and well-being.
Background: The COVID-19 pandemic has acted as a catalyst for the development and adoption of a b... more Background: The COVID-19 pandemic has acted as a catalyst for the development and adoption of a broad range of remote monitoring technologies (RMTs) in health care delivery. It is important to demonstrate how these technologies were implemented during the early stages of this pandemic to identify their application and barriers to adoption, particularly among vulnerable populations. Objective: The purpose of this knowledge synthesis was to present the range of RMTs used in delivering care to patients with COVID-19 and to identify perceived benefits of and barriers to their use. The review placed a special emphasis on health equity considerations. Methods: A rapid review of published research was conducted using Embase, MEDLINE, and QxMD for records published from the inception of COVID-19 (December 2019) to July 6, 2020. Synthesis involved content analysis of reported benefits of and barriers to the use of RMTs when delivering health care to patients with COVID-19, in addition to health equity considerations. Results: Of 491 records identified, 48 publications that described 35 distinct RMTs were included in this review. RMTs included use of existing technologies (eg, videoconferencing) and development of new ones that have COVID-19-specific applications. Content analysis of perceived benefits generated 34 distinct codes describing advantages of RMTs, mapped to 10 themes overall. Further, 52 distinct codes describing barriers to use of RMTs were mapped to 18 themes. Prominent themes associated with perceived benefits included a lower burden of care (eg, for hospitals, health care practitioners; 28 records), reduced infection risk (n=33), and support for vulnerable populations (n=14). Prominent themes reflecting barriers to use of RMTs included equity-related barriers (eg, affordability of technology for users, poor internet connectivity, poor health literacy; n=16), the need for quality "best practice" guidelines for use of RMTs in clinical care (n=12), and the need for additional resources to develop and support new technologies (n=11). Overall, 23 of 48 records commented on equity characteristics that stratify health opportunities and outcomes, including general characteristics that vary over time (eg, age, comorbidities; n=17), place of residence (n=11), and socioeconomic status (n=7).
PubMed, Mar 3, 1999
Two reforms of public hospitals have been launched by the French government in 1991 and 1996 aime... more Two reforms of public hospitals have been launched by the French government in 1991 and 1996 aimed at lowering costs and increasing the quality of services and ultimately the safety of patients. As concerns maternity hospitals, several new rules have been imposed upon. For example, those who performed less than 300 births a year should be closed. The basic idea was to concentrate technical resources and human skills in middle-size and important hospitals for saving money, and simultaneously, raising the safety level for mothers and babies. However, negative adverse effects fastly appeared: to avoid closure, some small maternity homes tried to convince future mothers not to go to well-equipped hospitals, even if their cases appeared complex and their health at risk. An experience of partnership between maternity hospitals (care providers), the Sickness Insurance Fund (the financing body) and the Administration was carried out in the Auvergne region. It was based on the observation of a large number of indicators concerning the activity of hospitals, the size and quality of their equipment, the satisfaction of their patients ... etc ... for designing the rights and duties of each partner. Instead of planning from the summit, a process of mutually-agreed contract was established.
International Journal of Innovation Management, Dec 1, 2022
User engagement in innovation processes is crucial for the development of sustainable healthcare.... more User engagement in innovation processes is crucial for the development of sustainable healthcare. One promising user-centred approach used to integrate users’ experiential knowledge in the development of innovations is the Living Lab (LL). However, we lack a systematic understanding of the processes, methods and factors that lead to more effective user engagement. The objective of this scoping review is to map and systematically present current research on user engagement in Healthcare Living Labs (HLLs) to enhance understanding and inspire future research. Our review shows that the level of user engagement is still low given the limited use of methods tailored to support it and that HLL are predominantly used in technology and clinical innovation. We offer a clearer depiction and description of the methods innovation managers could use to foster greater user engagement in HLL.
BMJ Open, Mar 1, 2023
Introduction Attachment to a primary care provider is an important component of primary care as i... more Introduction Attachment to a primary care provider is an important component of primary care as it facilitates access. In Québec, Canada, attachment to a family physician is a concern. To address unattached patients' barriers to accessing primary care, the Ministry of Health and Social Services mandated Québec's 18 administrative regions to implement single points of access for unattached patients (Guichets d'accès première ligne (GAPs)) that aim to better orient patients towards the most appropriate services to meet their needs. The objectives of this study are to (1) analyse the implementation of GAPs, (2) measure the effects of GAPs on performance indicators and (3) assess unattached patients' experiences of navigation, access and service utilisation. Methods and analysis A longitudinal mixed-methods case study design will be conducted. Objective 1. Implementation will be analysed through semistructured interviews with key stakeholders, observations of key meetings and document analysis. Objective 2. GAP effects on indicators will be measured using performance dashboards produced using clinical and administrative data. Objective 3. Unattached patients' experiences will be assessed using a self-administered electronic questionnaire. Findings for each case will be interpreted and presented using a joint display, a visual tool for integrating qualitative and quantitative data. Intercase analyses will be conducted highlighting the similarities and differences across cases. Ethics and dissemination This study is funded by the Canadian Institutes of Health Research (# 475314) and the Fonds de Soutien à l'innovation en santé et en services sociaux (# 5-2-01) and was approved by the CISSS de la Montérégie-Centre Ethics Committee (MP-04-2023-716).
PLOS ONE, Jan 4, 2023
Background Cardiovascular diseases are the leading cause of death and disability worldwide. Littl... more Background Cardiovascular diseases are the leading cause of death and disability worldwide. Little is known about the organizational priorities of patients and clinicians involved in primary cardiovascular care. This study aimed to identify their shared top priorities and explore on which aspects their perspectives differed. Methods A three-round modified online Delphi study was carried out with patients and clinicians in seven academic primary care settings from metropolitan, suburban and small-town areas in Quebec, Canada. Patient partners experienced in the mobilization of their experiential knowledge also participated in the study. Following an "open" round, the items elicited were assessed by a combined rating and ranking approach. Items achieving an initial consensus level �70% were reassessed and then rank-ordered based on their final scores. Levels of consensus achieved among patients and clinicians were compared using Fisher's Exact tests. Results Thirty panelists completed the study (9 clinic patients, 7 patient partners and 14 clinicians). Out of 41 organizational aspects generated, six top priorities were shared by patients and clinicians. These related to listening and tailoring care to each patient, provision of personalized information, rapid response in the event of a problem, keeping professional training upto-date, and relational and informational continuity of care. Statistically significant differences were found between patients' and clinicians' perspectives regarding the importance of offering healthy lifestyle and prevention activities at the clinic (lower for patients), timely access to the treating physician (higher for patients), and effective collaboration with specialist physicians (higher for patients).
BMJ Open, Jul 1, 2022
Patient and family engagement in infection prevention in the context of the COVID-19 pandemic: de... more Patient and family engagement in infection prevention in the context of the COVID-19 pandemic: defining a consensus framework using the Q methodology-NOSO-COVID study protocol. BMJ Open 2022;12:e056172.
The objective was to examine the dynamics of change that operated following accreditation prepara... more The objective was to examine the dynamics of change that operated following accreditation preparations. Through implementation analysis, the present embedded explanatory case study sought to explore the organizational changes brought about in a university hospital centre after the introduction in 1996 of compulsory accreditation in France. To this end: (1) a theoretical framework for analyzing change was developed; (2) semi-structured interviews, focus groups, and questionnaires addressed to the establishment's professionals were used, and documents were collected and (3) qualitative and quantitative analyses were carried out. Analyses were run on four axe.s: nature (extent/rhythm/trajectory), action strategies (accompaniment/resistance), design (deductive/inductive) and issues/challenges (strategic, organizational and environmental). Although preparation involved all areas of the establishment, professionals from clinical and medico-technical services (CMTS) were the ones who most participated, particularly nurses and commission members. The preparation's design, essentially deductive, called for, on the one hand, lectures and an information letter addressed to the professionals, and, on the other, the creation of an internal selfassessment reference system distributed to the CMTS, derived from the accreditation manual, and self-assessment groups to complete the manual. The action strategies did not include any inducements. The main motives for participating were defence of the establishment's interests and the desire to learn. However, the procedure was perceived as bureaucratic. Physician absenteeism at meetings attested to a certain resistance on their part. From an organizational viewpoint, some functions and structures were created. Leadership was exercised by management. The self-asssessment groups provided an opportunity to reflect in a non-hierarchical manner on the treatment of patients and on the establishment's operational modalities, by creating a locus for exchanges and collégial decision-making. Persons lower down in the hierarchy (e.g., women, assistant caregiver, surface agents) or working in less prestigious structures (medium-and long-stay) were the ones for whom the preparation was most a source of change, having to acquire new activities, new intellectual models and new social ties. Otherwise, the greatest changes involved giving greater consideration to results of exit surveys, committing procedures to paper (in all services) and adopting a continuous IV quality improvement (CQI) program. Finally, the establishment set up with its community of establishments a support partnership to deal with quality processes. Accreditation preparation was a key moment for introducing a quality program and change dynamics. The major changes involved the creation of « social capital » and consideration given to the patients' point of view.
International Journal for Quality in Health Care, Sep 1, 2017
European Journal of Oncology Nursing, Feb 1, 2023
Hand surgery and rehabilitation, Jul 1, 2018
Clinical approach to surgical patients has evolved to include previous patients as part of the tr... more Clinical approach to surgical patients has evolved to include previous patients as part of the treating team in the role of ''patient-advisors''. Knowing that compliance to rehabilitation protocols is significant for a successful functional hand replantation, we set out to quantify functional patient-reported outcomes in individuals enrolled in a Patient-Advisor Program (PAP). We performed a prospective cohort pilot study of all patients admitted for a finger replantation between July 2015 to January 2016. All patients were offered to partake in the PAP, or else they would constitute the control group. Primary endpoints were functional outcomes as reported by patients at 6-8 weeks and 4-6 months of follow-up. Secondary endpoints were patient-reported pain and quality of life questionnaires. In total, 62 patients were admitted for finger replantation in the studied period, in which 50 agreed to participate in the study, including 7 in the patient-advisors group and 43 in the control group. Patients from the patient-advisors group fared better on mean scores of the Disabilities of the Arm, Shoulder and Hand than controls (29.6 vs 34.8 respectively at 4-6 months). Improvements in the McGill Pain Questionnaire were also greater in the studied group (19.9 vs 33.3 at 4-6 months). Replantation patients benefiting from the PAP demonstrated superior functional outcomes on self-reported questionnaires, which could be explained by a better understanding of rehabilitation protocols and compliance when previous patients are active members of the treating team.
At their origin, public healthcare systems were designed mainly for the treatment of acute illnes... more At their origin, public healthcare systems were designed mainly for the treatment of acute illnesses. For many years, therefore, public health care focused on services offered in healthcare establishments and primary care was allowed to evolve on the periphery of hospitals, with doctors free to follow their own conception of how best to provide and follow up on care. As hospital costs grew, however, and new challenges regarding the provision of care began to emerge, governments felt increasingly responsible for organizing the front line (Nolte and McKee 2008). How doctors would be called upon to participate in the new configuration of services-particularly in Canada, where physicians function as independent entrepreneurs-is the subject of this article, which investigates the decision to introduce family medicine groups (FMGs) to the province of Quebec.
Jmir mhealth and uhealth, Jun 9, 2021
Provide a structured summary that includes (as applicable): background, objectives, eligibility c... more Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives.
McGill-Queen's University Press eBooks, Oct 24, 2013
forest introduCtion Quebec's health and social services system has been under tremendous pressure... more forest introduCtion Quebec's health and social services system has been under tremendous pressure since the beginning of the 1990s. The manner in which the Quebec governments in the period under study, 1990 to 2003, responded to these pressures was at once similar to and yet different from the way in which other provinces responded. The similarity reflected the common exposure to new realities such as the information technology revolution (with implications both for management of health services and clinical practice), the availability of effective but expensive new breakthrough drugs, the stress on public finances, and the aging of the population. The difference was in part due to history. The growth of the welfare state in Canada (especially from 1963 to 1968, the Pearson years), including health services, coincided with the flowering of Quebec's Quiet Revolution. Where other provinces looked to Ottawa for leadership, Quebec blazed its own trail. As the one jurisdiction in North America with a French-speaking majority, Quebec's situation was unique. The determination to preserve and enhance this uniqueness was shared by most French-speaking Quebecers. Accordingly, francophone Quebecers relied on the Quebec state, the key institution that they controlled, to promote modernity and solidarity. One area of difference between Quebec and other provinces that affected health services was in public administration. By the beginning of the 1990s, Quebec's health system had been regionalized for two decades. Its regional infrastructure thus had deeper roots than elsewhere in Canada. A second was in the role of labour. Where
Presses de l’EHESP eBooks, Mar 1, 2018
Research Square (Research Square), Oct 4, 2019
Research Square (Research Square), May 8, 2023
Objectives Since 2018, four establishments in Quebec have been instrumental in implementing the P... more Objectives Since 2018, four establishments in Quebec have been instrumental in implementing the PAROLE-Onco program, which introduced accompanying patients (APs) in healthcare teams to improve cancer patients' experience. APs are patient advisors who have acquired speci c experiential knowledge related to living with cancer, using services, and interacting with healthcare professionals. They are therefore in a unique and reliable position to be able to provide emotional, informational, cognitive and navigational support to patients dealing with cancer. We aimed to explore APs' perspectives regarding the limiting and facilitating factors in terms of how they are integrated into the clinical oncology teams. Methods A qualitative study based on semi-structured interviews and focus groups was conducted with 20 APs at the beginning of their intervention (T1) and two years afterwards (T2). Limiting and facilitating factors of APs' integration into clinical teams were analyzed in terms of governance, culture, resources and tools. Results The most signi cant limiting factors raised by APs to be integrated into clinical teams were: governance involvement, organizational boundaries, team members' availabilities, and confusion about the speci c roles played by APs. Communication challenges were also raised, leading to inadequate promotion of the program to patients. The lack of time, space and compensation were also mentioned as limiting factors. Creating opportunities for team members to meet APs, building trust and teaching team members how APs' activities are complementary to theirs were enhancing factors. Other facilitators include APs being involved in decision-making committees, being leaders in the PAROLE-Onco program promotion to patients and clinical team members and creating opportunities to communicate with team members to help enhance their work and provide feedback to improve patient services. Awareness of APs' added value for the team and patients is also a key facilitator. Regarding tools, offering accompanying services by telephone allows both patients and APs to bene t from the exibility they need. Conclusion Over time, APs were able to identify the best factors for successful implementation. Recommendations include APs and professionals working in co-construction on organization, leadership, resources, and status factors. This could help catalyze a change in culture within health establishments and allow people dealing with cancer to bene t from the experiential knowledge of other patients within their clinical team. Contributions to the literature Page 4/22 By being among the most signi cantly impacted by the implementation of the PAROLE-Onco program, APs are in a strong position to evaluate the program's implementation and identify facilitating factors to their integration. Misunderstandings about APs' roles can delay a change in culture in healthcare establishments and make APs' accompanying services more challenging to promote. Assigning certain powers to APs, via co-construction and co-decision methods, is conducive to ensuring a successful change in culture within healthcare establishments. Working proactively with APs on organization, leadership, resources, and status factors will allow patients dealing with cancer to bene t from the experiential knowledge of other patients within their clinical team.
PLOS ONE, May 4, 2022
During the COVID-19 pandemic, restrictions were imposed on visits in hospitals in the province of... more During the COVID-19 pandemic, restrictions were imposed on visits in hospitals in the province of Quebec, Canada in an effort to reduce the risk of viral exposure by minimizing faceto-face contact in order to protect patients, visitors and staff. These measures led to social isolation for patients. In order to reduce this isolation, CHUM (the Centre hospitalier de l'Université de Montré al, a teaching hospital) shifted from in-person visits to courtesy telephone calls delivered by volunteers from CHUM's Volunteers, Recreation and Leisure Department. Objectives To study: (1) the contribution made by these calls to reducing isolation and their limitations, (2) how the calls can be improved, and (3) whether they should be maintained, based on the views of patients and volunteers. Methodology This study examined two populations. The first one consisted of 189 adult patients hospitalized at CHUM who received a courtesy phone call from a volunteer and the second one consisted of the 25 CHUM volunteers who made these calls. Quantitative data were collected from patients and volunteers through questionnaires and a Smartsheet. The patient questionnaire evaluated isolation, the courtesy phone calls, the relationship of trust with the volunteer and sociodemographic questions. The volunteer questionnaire evaluated the appropriateness of the technology for the intervention, the support and training received, the
Organizational behaviour in health care, 2019
This chapter presents the way in which citizen and patient participation in Quebec’s health and s... more This chapter presents the way in which citizen and patient participation in Quebec’s health and social services system came about, particularly though the presentation of what is now recognized as the “Montreal Model”, which refers to simultaneous integration of patients in education, research and the health system. Thanks to a structured process and a clear categorization of the different levels of patient engagement, Quebec is on its way been able to progressively change the culture not just for the healthcare system but also among future and current healthcare professionals and researchers. By better meeting the patients’ need and allowing them to take their place in care relationships, healthcare services organization, teaching and research we hope to humanize the healthcare system and contribute to improving the population’s health and well-being.
Background: The COVID-19 pandemic has acted as a catalyst for the development and adoption of a b... more Background: The COVID-19 pandemic has acted as a catalyst for the development and adoption of a broad range of remote monitoring technologies (RMTs) in health care delivery. It is important to demonstrate how these technologies were implemented during the early stages of this pandemic to identify their application and barriers to adoption, particularly among vulnerable populations. Objective: The purpose of this knowledge synthesis was to present the range of RMTs used in delivering care to patients with COVID-19 and to identify perceived benefits of and barriers to their use. The review placed a special emphasis on health equity considerations. Methods: A rapid review of published research was conducted using Embase, MEDLINE, and QxMD for records published from the inception of COVID-19 (December 2019) to July 6, 2020. Synthesis involved content analysis of reported benefits of and barriers to the use of RMTs when delivering health care to patients with COVID-19, in addition to health equity considerations. Results: Of 491 records identified, 48 publications that described 35 distinct RMTs were included in this review. RMTs included use of existing technologies (eg, videoconferencing) and development of new ones that have COVID-19-specific applications. Content analysis of perceived benefits generated 34 distinct codes describing advantages of RMTs, mapped to 10 themes overall. Further, 52 distinct codes describing barriers to use of RMTs were mapped to 18 themes. Prominent themes associated with perceived benefits included a lower burden of care (eg, for hospitals, health care practitioners; 28 records), reduced infection risk (n=33), and support for vulnerable populations (n=14). Prominent themes reflecting barriers to use of RMTs included equity-related barriers (eg, affordability of technology for users, poor internet connectivity, poor health literacy; n=16), the need for quality "best practice" guidelines for use of RMTs in clinical care (n=12), and the need for additional resources to develop and support new technologies (n=11). Overall, 23 of 48 records commented on equity characteristics that stratify health opportunities and outcomes, including general characteristics that vary over time (eg, age, comorbidities; n=17), place of residence (n=11), and socioeconomic status (n=7).
PubMed, Mar 3, 1999
Two reforms of public hospitals have been launched by the French government in 1991 and 1996 aime... more Two reforms of public hospitals have been launched by the French government in 1991 and 1996 aimed at lowering costs and increasing the quality of services and ultimately the safety of patients. As concerns maternity hospitals, several new rules have been imposed upon. For example, those who performed less than 300 births a year should be closed. The basic idea was to concentrate technical resources and human skills in middle-size and important hospitals for saving money, and simultaneously, raising the safety level for mothers and babies. However, negative adverse effects fastly appeared: to avoid closure, some small maternity homes tried to convince future mothers not to go to well-equipped hospitals, even if their cases appeared complex and their health at risk. An experience of partnership between maternity hospitals (care providers), the Sickness Insurance Fund (the financing body) and the Administration was carried out in the Auvergne region. It was based on the observation of a large number of indicators concerning the activity of hospitals, the size and quality of their equipment, the satisfaction of their patients ... etc ... for designing the rights and duties of each partner. Instead of planning from the summit, a process of mutually-agreed contract was established.
International Journal of Innovation Management, Dec 1, 2022
User engagement in innovation processes is crucial for the development of sustainable healthcare.... more User engagement in innovation processes is crucial for the development of sustainable healthcare. One promising user-centred approach used to integrate users’ experiential knowledge in the development of innovations is the Living Lab (LL). However, we lack a systematic understanding of the processes, methods and factors that lead to more effective user engagement. The objective of this scoping review is to map and systematically present current research on user engagement in Healthcare Living Labs (HLLs) to enhance understanding and inspire future research. Our review shows that the level of user engagement is still low given the limited use of methods tailored to support it and that HLL are predominantly used in technology and clinical innovation. We offer a clearer depiction and description of the methods innovation managers could use to foster greater user engagement in HLL.
BMJ Open, Mar 1, 2023
Introduction Attachment to a primary care provider is an important component of primary care as i... more Introduction Attachment to a primary care provider is an important component of primary care as it facilitates access. In Québec, Canada, attachment to a family physician is a concern. To address unattached patients' barriers to accessing primary care, the Ministry of Health and Social Services mandated Québec's 18 administrative regions to implement single points of access for unattached patients (Guichets d'accès première ligne (GAPs)) that aim to better orient patients towards the most appropriate services to meet their needs. The objectives of this study are to (1) analyse the implementation of GAPs, (2) measure the effects of GAPs on performance indicators and (3) assess unattached patients' experiences of navigation, access and service utilisation. Methods and analysis A longitudinal mixed-methods case study design will be conducted. Objective 1. Implementation will be analysed through semistructured interviews with key stakeholders, observations of key meetings and document analysis. Objective 2. GAP effects on indicators will be measured using performance dashboards produced using clinical and administrative data. Objective 3. Unattached patients' experiences will be assessed using a self-administered electronic questionnaire. Findings for each case will be interpreted and presented using a joint display, a visual tool for integrating qualitative and quantitative data. Intercase analyses will be conducted highlighting the similarities and differences across cases. Ethics and dissemination This study is funded by the Canadian Institutes of Health Research (# 475314) and the Fonds de Soutien à l'innovation en santé et en services sociaux (# 5-2-01) and was approved by the CISSS de la Montérégie-Centre Ethics Committee (MP-04-2023-716).
PLOS ONE, Jan 4, 2023
Background Cardiovascular diseases are the leading cause of death and disability worldwide. Littl... more Background Cardiovascular diseases are the leading cause of death and disability worldwide. Little is known about the organizational priorities of patients and clinicians involved in primary cardiovascular care. This study aimed to identify their shared top priorities and explore on which aspects their perspectives differed. Methods A three-round modified online Delphi study was carried out with patients and clinicians in seven academic primary care settings from metropolitan, suburban and small-town areas in Quebec, Canada. Patient partners experienced in the mobilization of their experiential knowledge also participated in the study. Following an "open" round, the items elicited were assessed by a combined rating and ranking approach. Items achieving an initial consensus level �70% were reassessed and then rank-ordered based on their final scores. Levels of consensus achieved among patients and clinicians were compared using Fisher's Exact tests. Results Thirty panelists completed the study (9 clinic patients, 7 patient partners and 14 clinicians). Out of 41 organizational aspects generated, six top priorities were shared by patients and clinicians. These related to listening and tailoring care to each patient, provision of personalized information, rapid response in the event of a problem, keeping professional training upto-date, and relational and informational continuity of care. Statistically significant differences were found between patients' and clinicians' perspectives regarding the importance of offering healthy lifestyle and prevention activities at the clinic (lower for patients), timely access to the treating physician (higher for patients), and effective collaboration with specialist physicians (higher for patients).
BMJ Open, Jul 1, 2022
Patient and family engagement in infection prevention in the context of the COVID-19 pandemic: de... more Patient and family engagement in infection prevention in the context of the COVID-19 pandemic: defining a consensus framework using the Q methodology-NOSO-COVID study protocol. BMJ Open 2022;12:e056172.
The objective was to examine the dynamics of change that operated following accreditation prepara... more The objective was to examine the dynamics of change that operated following accreditation preparations. Through implementation analysis, the present embedded explanatory case study sought to explore the organizational changes brought about in a university hospital centre after the introduction in 1996 of compulsory accreditation in France. To this end: (1) a theoretical framework for analyzing change was developed; (2) semi-structured interviews, focus groups, and questionnaires addressed to the establishment's professionals were used, and documents were collected and (3) qualitative and quantitative analyses were carried out. Analyses were run on four axe.s: nature (extent/rhythm/trajectory), action strategies (accompaniment/resistance), design (deductive/inductive) and issues/challenges (strategic, organizational and environmental). Although preparation involved all areas of the establishment, professionals from clinical and medico-technical services (CMTS) were the ones who most participated, particularly nurses and commission members. The preparation's design, essentially deductive, called for, on the one hand, lectures and an information letter addressed to the professionals, and, on the other, the creation of an internal selfassessment reference system distributed to the CMTS, derived from the accreditation manual, and self-assessment groups to complete the manual. The action strategies did not include any inducements. The main motives for participating were defence of the establishment's interests and the desire to learn. However, the procedure was perceived as bureaucratic. Physician absenteeism at meetings attested to a certain resistance on their part. From an organizational viewpoint, some functions and structures were created. Leadership was exercised by management. The self-asssessment groups provided an opportunity to reflect in a non-hierarchical manner on the treatment of patients and on the establishment's operational modalities, by creating a locus for exchanges and collégial decision-making. Persons lower down in the hierarchy (e.g., women, assistant caregiver, surface agents) or working in less prestigious structures (medium-and long-stay) were the ones for whom the preparation was most a source of change, having to acquire new activities, new intellectual models and new social ties. Otherwise, the greatest changes involved giving greater consideration to results of exit surveys, committing procedures to paper (in all services) and adopting a continuous IV quality improvement (CQI) program. Finally, the establishment set up with its community of establishments a support partnership to deal with quality processes. Accreditation preparation was a key moment for introducing a quality program and change dynamics. The major changes involved the creation of « social capital » and consideration given to the patients' point of view.
International Journal for Quality in Health Care, Sep 1, 2017
European Journal of Oncology Nursing, Feb 1, 2023
Hand surgery and rehabilitation, Jul 1, 2018
Clinical approach to surgical patients has evolved to include previous patients as part of the tr... more Clinical approach to surgical patients has evolved to include previous patients as part of the treating team in the role of ''patient-advisors''. Knowing that compliance to rehabilitation protocols is significant for a successful functional hand replantation, we set out to quantify functional patient-reported outcomes in individuals enrolled in a Patient-Advisor Program (PAP). We performed a prospective cohort pilot study of all patients admitted for a finger replantation between July 2015 to January 2016. All patients were offered to partake in the PAP, or else they would constitute the control group. Primary endpoints were functional outcomes as reported by patients at 6-8 weeks and 4-6 months of follow-up. Secondary endpoints were patient-reported pain and quality of life questionnaires. In total, 62 patients were admitted for finger replantation in the studied period, in which 50 agreed to participate in the study, including 7 in the patient-advisors group and 43 in the control group. Patients from the patient-advisors group fared better on mean scores of the Disabilities of the Arm, Shoulder and Hand than controls (29.6 vs 34.8 respectively at 4-6 months). Improvements in the McGill Pain Questionnaire were also greater in the studied group (19.9 vs 33.3 at 4-6 months). Replantation patients benefiting from the PAP demonstrated superior functional outcomes on self-reported questionnaires, which could be explained by a better understanding of rehabilitation protocols and compliance when previous patients are active members of the treating team.
At their origin, public healthcare systems were designed mainly for the treatment of acute illnes... more At their origin, public healthcare systems were designed mainly for the treatment of acute illnesses. For many years, therefore, public health care focused on services offered in healthcare establishments and primary care was allowed to evolve on the periphery of hospitals, with doctors free to follow their own conception of how best to provide and follow up on care. As hospital costs grew, however, and new challenges regarding the provision of care began to emerge, governments felt increasingly responsible for organizing the front line (Nolte and McKee 2008). How doctors would be called upon to participate in the new configuration of services-particularly in Canada, where physicians function as independent entrepreneurs-is the subject of this article, which investigates the decision to introduce family medicine groups (FMGs) to the province of Quebec.
Jmir mhealth and uhealth, Jun 9, 2021
Provide a structured summary that includes (as applicable): background, objectives, eligibility c... more Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives.
McGill-Queen's University Press eBooks, Oct 24, 2013
forest introduCtion Quebec's health and social services system has been under tremendous pressure... more forest introduCtion Quebec's health and social services system has been under tremendous pressure since the beginning of the 1990s. The manner in which the Quebec governments in the period under study, 1990 to 2003, responded to these pressures was at once similar to and yet different from the way in which other provinces responded. The similarity reflected the common exposure to new realities such as the information technology revolution (with implications both for management of health services and clinical practice), the availability of effective but expensive new breakthrough drugs, the stress on public finances, and the aging of the population. The difference was in part due to history. The growth of the welfare state in Canada (especially from 1963 to 1968, the Pearson years), including health services, coincided with the flowering of Quebec's Quiet Revolution. Where other provinces looked to Ottawa for leadership, Quebec blazed its own trail. As the one jurisdiction in North America with a French-speaking majority, Quebec's situation was unique. The determination to preserve and enhance this uniqueness was shared by most French-speaking Quebecers. Accordingly, francophone Quebecers relied on the Quebec state, the key institution that they controlled, to promote modernity and solidarity. One area of difference between Quebec and other provinces that affected health services was in public administration. By the beginning of the 1990s, Quebec's health system had been regionalized for two decades. Its regional infrastructure thus had deeper roots than elsewhere in Canada. A second was in the role of labour. Where
Presses de l’EHESP eBooks, Mar 1, 2018
Construits entre les années 1940 et 1970, les systèmes de santé se sont structurés autour des soi... more Construits entre les années 1940 et 1970, les systèmes de santé se sont structurés autour des soins aigus et hautement spécialisés, offerts dans des établissements de santé. Or, on constate qu’au cours de ces 30 dernières années, les besoins ont considérablement changé dû à l’augmentation significative de la prévalence des maladies chroniques [1]. Celles-ci sont actuellement la principale cause de morbidité et de mortalité dans les pays occidentaux [2]. Dans le contexte spécifique canadien, 65 % de la population âgée de 12 ans et plus et 90 % pour les plus de 65 ans déclarent souffrir d’au moins une maladie chronique [3]. Cette tendance ne fera que s’accentuer au cours des prochaines années dans l’ensemble des pays de l’OCDE [4]. Lors de son rapport publié en 2010, le Commissaire à la santé et au bien-être du Québec mettait en évidence que ces mutations épidémiologiques entraînaient [5] des changements d’habitudes de vie, un renforcement de l’autogestion par les patients, une accessibilité accrue aux professionnels de la santé, une meilleure continuité et coordination des soins et des services. Aussi, dans le souci d’améliorer la santé de la population et d’améliorer la qualité des soins et des services délivrés, une des voies prometteuses réside dans l’engagement des patients à tous les niveaux du système de santé [6]. Actuellement, des modèles proposent un continuum dans l’engagement des patients, tel celui de Carman et al. [7], qui va de l’information jusqu’à l’implication. Toutefois, aucun ne va aussi loin que celui mis en place par la Faculté de médecine de l’Université de Montréal (UdM) que l’on nommera dans cet article le Montreal model [8].
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Nous présenterons tout d’abord les fondements théoriques du partenariat patient sur lesquels s’appuient les différents secteurs d’application : en milieu de soins, de l’enseignement et de la recherche. Nous déclinerons également comment ce partenariat peut se mettre en œuvre aux niveaux clinique, organisationnel et systémique et quels sont ses facteurs de réussite. Nous conclurons par la présentation des perspectives actuelles et des recherches en cours pour évaluer l’impact de ce nouveau modèle sur la santé de la population.