The process of implementing a population-based approach to managing local healthcare: The Québec example

Introduction: In 2004, a new reform was launched with the aim to create 95 local health networks across the Québec’s health care system.  At the core of these networks are the Health and Social Services Center (HSSC), which resulted from the structural integration (merger) of all community health clinics, long-term care hospitals in a specific geographical territory as well as the inclusion of acute care hospitals in some cases. The HSSC is responsible for the health of the population living on a specific territory. To implement such a board mandate of improving population health in a well defined territory, managers had to develop innovative practices.
Objectives: The purpose of this communication is to introduce the different components of responsibilities that are emerging and to present different practices put in place in response to population-based responsibility.

Research methodology: We conducted an in-depth longitudinal case study of two HSSC and their respective health networks (2005-2007). The data includes real-time observations of top management at the regional and local level during more than one year and half, as well as interviews (46) conducted at two different times with decision-makers.

Results: Our results suggest that population-based responsibility divided itself into five components: primary health care, specialist care, vulnerable clienteles, social and health promotion. Various actions have been taken with respect to these five components. For example, HSSC have developed partnerships with organizations producing care and services located in their territory. Also, strategic inter-sectorial links have been established.

Conclusion: Over time, the mandate of population-based responsibility was integrated into the management of HSSC. The actions implemented reflected a greater influence of public health logic in healthcare organizations. This experience of influence of public health on healthcare management at the local level can be used by other countries experiencing healthcare reforms.