Trajectories and Matrix Management
ANALYZE GOVERNANCE INNOVATIONS AND PROPOSE ADAPTIVE SCALING
Like several Canadian provinces, the Government of Quebec undertook a major reorganization of its health and social services network in 2015 by establishing Integrated University Health and Social Services Centers offering health care and social services (CISSS and CIUSSS). Since 2016, several of these institutions have taken the reform further by developing management by care and service trajectories (GTSS).
The care and service trajectory is "an interweaving of several episodes of care and services over long periods in an intersectoral perspective in a territory. It is user-centered and brings together users with a similar clinical condition or profile."
Management by care and service trajectories (GTSS) is "a governance innovation based on a transversal, non-hierarchical approach to the functioning of health organizations and where collaboration with external partners and users is central to ensuring the integration of services aimed at improving the health status of the population in a territory".
© Maillet, et al. 2021
Depuis 2017, l'équipe de recherche suit l’implantation de la GTSS dans un, puis dans trois CIUSSS du Québec (Projet #01, 2017-2019). Ce sont des CIUSSS « développeurs », c’est-à-dire que ces trois établissements ont développé à leur manière la GTSS dépendamment de leur contexte géographique, socioéconomique, populationnel et épidémiologique propre. L'équipe adopte depuis le début une approche d'évaluation développementale. Cette démarche vise à guider les organisations et les acteur·trice s dans l'adaptation et le développement d'innovations dans des environnements complexes et turbulents.
En 2018, le ministère de la Santé et des Services Sociaux (MSSS) a mobilisé ces 3 CIUSSS afin de constituer, avec eux, un comité provincial de conceptualisation et d’implantation d’un modèle intégré de GTSS alimenté par les expériences de chacun des trois établissements (Projet #02, 2018-2020). C'est dans ce contexte que l'équipe a développé le Modèle d'analyse de la performance (MAP), avec le soutien de l'IUPLSSS. Il s'agit d'un outillage pour analyser et mesurer la performance des trajectoires et identifier les zones critiques, ainsi que les actions pour les améliorer.
L'objectif principal du Projet #03 (2020-2025) est d’identifier, de manière processuelle, les facteurs d’implantation de la GTSS dans quatre établissements (les 3 CIUSSS développeurs et 1 CISSS "expérimentateur"), et ce notamment dans le contexte mouvementé de la pandémie de COVID-19.
En 2023, un nouveau pan de recherche de comparaison internationale (Québec-France) débute (Projet #04, 2023-2025). L'objectif est de mieux comprendre comment la gestion par trajectoires et parcours de santé (GT-PS) contribuerait à une réponse postpandémique à travers une gouvernance et une organisation robuste et adaptable, notamment pour les groupes marginalisés ou ayant plus difficilement accès au système de santé.
Un projet connexe est actuellement en démarrage (Projet #05, 2023-2024). Celui-ci vise à comprendre comment les structures et les processus de gouvernance pilotés par le CIUSSS impliquant différents secteurs (affaires municipales, sécurité civile, éducation, communautaire, etc.) ont contribué à la capacité d’adaptation face à la situation de crise sanitaire liée à la COVID-19 en vue de protéger la santé des populations.
Le Modèle d'analyse de la performance (MAP)
In order to implement and continuously improve these trajectories, the Ministry of Health and Social Services and several CIUSSSs of Quebec have joined forces to design a trajectory management guide. The MAP is the result of this work. The objective of this tool is to support the decision-making of stakeholders, managers, partners and users responsible for trajectory management, in order to improve performance .
This tool is based on a multidimensional and interrelated model of performance where each dimension that makes it up is related to others. This promotes a systematic analysis to identify the main levers on which to act to improve performance.
Project #01
“Implementation and animation process of the CIUSSS de l’Estrie-CHUS trajectories: developmental evaluation”
Goals
Analyze, in real time, the implementation of the structure and the process of animation of the trajectories of the CIUSSS de l'Estrie-CHUS as well as the effects of this on the functioning and the degree of integration of the trajectories within the organization.
Team
Co-principal investigators: Lara Maillet and Georges-Charles Thiebaut
Co-researchers: Mylaine Breton, Marie-France Duranceau, Nassera Touati, Pernelle Smits, Jean-Louis Denis, Paul Lamarche
Funding
2017-2019
CIUSSS of Estrie-CHUS
Frontline university institute in health and social services
Charles LeMoyne Hospital Research Center.
Project #02
"Innovating in governance: evaluation of the implementation of management by care and service trajectories in the territorial health and social services networks of Quebec"
Goals
Team
Co-principal investigators: Lara Maillet and Georges-Charles Thiebaut
Co-researchers:
Funding
Project #03 (in progress)
"Evaluation of the implementation of management by care and service trajectory and the variation of effects in 4 CI(U)SSS in Quebec"
Goals
Identify, in a procedural manner, the different factors of implementation and variation of the effects of the GTSS in different contexts (CI(U)SSS), then in a potential provincial scaling-up process (MSSS).
Team
Principal Investigator: Lara Maillet
Co-principal investigators: Georges-Charles Thiebaut and Nassera Touati
Co-researchers: Mylaine Breton, Sabina Abou-Malham, Yves Couturier, Frédéric Gilbert, Pernelle Smits, Arnaud Duhoux, Géraldine Layani, Jean-Sébastien Marchand, Jean-Louis Denis
Funding
2020-2025
Canadian Institutes of Health Research (CIHR)
Project #04 (in progress)
“Working on the boundaries of trajectories: towards robust governance modes for adaptable health systems?”
Goals
Better understand how management by health trajectories and pathways (GT-PS) would contribute to a post-pandemic response through robust and adaptable governance and organization, particularly for marginalized groups or those with more difficulty accessing the health system.
Team
Principal Investigator: Lara Maillet
Co-researchers: Nassera Touati , Mylaine Breton, Isabelle Aubert, Frédéric Kletz, Jean-Claude Sardas
Funding
2023-2025
New Frontiers
Quebec-France
Project #05 (starting)
"Governance and turbulence: analyzing the experience of Estrie in the COVID-19 pandemic and post-pandemic recovery situation to draw collective lessons for the regions of Quebec"
Goals
1) Understand how the governance structures and processes led by the CIUSSS and involving different sectors contributed to the capacity to adapt to the health crisis situation linked to COVID-19 in order to protect the health of populations, and 2) Understand how this type of adaptation can be sustained in the daily resumption of management and governance activities of the CIUSSS and its network of partners.
Équipe
Principal Investigator: Lara Maillet
Co-researchers: Paul Morin , Serigne Touba Mbacké Gueye, Nassera Touati, Sébastien Carrier , Nancy Desautels
Collaborators: Robin-Marie Coleman, Georges-Charles Thiebaut
Funding
2023-2024
RISUQ