Community health care
MEDICAL ADMINISTRATIVE GOVERNANCE : AN OBJECT FOR STUDY AND RESEARCH
April 19, 2012
In 2010, l’Association québécoise d’établissements de santé et de services sociaux (AQESS) organized a think-tank on the implementation of a new medical administrative management structure. It resulted in convening a working group on medical and administrative governance. Its mandate was to diagnose the current situation among health and social services facilities and to propose potential avenues for partnership that would meet career aspirations of doctors while enhancing cooperation toward achieving the objectives set for health facilities.
In order to test these avenues and their power to improve collaboration and decision making, AQESSS established pilot projects in four facilities, CHUS (Centre Hospitalier de l'Université de Sherbrooke), CSSS Gatineau, CSSS Vieille-Capitale and CSSS des Sommets.
In February 2012, the research team turned in the first of three deliverables, a literature review (link) assessing what had been done elsewhere in the field of medical and administrative governance. The authors (*) outlined the context and issues surrounding the relationship between medical officers and health administration. They presented findings from American and European models, and drew a portrait of the medical administrative dynamics. The Group identified two strategic approaches that may foster the development of medical leadership: « the training of physicians in management » and the introduction of « incentives for involving physicians in management. »
In their conclusions, the authors noted that "structural changes provide a basis for the emergence of a strong medical leadership at the organizational level. However, structure in itself does not create commitment nor leadership. Rather it is commitment that energizes structure. Building leadership and the sustained commitment of physicians calls for a consistent use of various complementary levers: mutual and sincere commitment to integrating physicians into management; respective involvement from both physicians and management striving for high standards of quality; intrinsic and extrinsic incentives; as well as capacity building and time. "
The de Gaspé Beaubien Foundation looks forward with great optimism and interest to the results of this research. Among the four pilot projects, CSSS des Sommets is the only one who benefited from the support of a Foundation in the implementation of a co-management model. Members of the de Gaspé Beaubien Foundation closely followed implementation of each step, contributing to dialogue with physicians and covering the fees of a consultant hired for sustained coaching of doctors and administrators working as tandems. Since 2006, the Foundation has been involved as an outside social intervener in the small town of des Sommets. "What is fundamental in this approach is to be working with open-minded people who also happen to believe in the project. It took the commitment of doctors and the efforts on both sides to establish a climate of confidence essential to the success of the co-management project, "said Dominique Monchamp, executive director of the de Gaspé Beaubien Foundation.
Last June, the de Gaspé Beaubien Foundation welcomed to its premises the CSSS des Sommets team to launch the co-management model. Proud to be involved with such a project and firmly believing in its success, the de Gaspé Beaubien Foundation reaffirms its commitment, notably through supporting a further research project : "The de Gaspé Beaubien Foundation commitment at the CSSS des Sommets - The concept of social intervener ", conducted in association with the HEC Montréal’s Pôle santé. The Foundation aims to highlight the various steps and best practices that lead to successful partnerships between a public service organization and a Foundation acting as a social intervener. This model could be put to good use in other organizations within their own communities.
(*) The study’s authors are : Jean-Louis Denis of the École nationale d’administration publique (ENAP) ; Ann Langley and Émilie Gibeau of HEC Montréal ; Marie-Pascale Pomey, Université de Montréal’s Medical Faculty ; and Nicolas Ban Schendel of HEC Montréal and Université de Montréal