The purpose of this paper is to describe and understand the effects of the accreditation process on organizational control and quality management practices in two Quebec primary-care health organizations.
A multiple-case longitudinal study was conducted taking a mixed qualitative/quantitative approach. An analytical model was developed of the effects of the accreditation process on the type of organizational control exercised and the quality management practices implemented. The data were collected through group interviews, semi-directed interviews of key informers, non-participant observations, a review of the literature, and structured questionnaires distributed to all the employees working in both institutions.
The accreditation process has fostered the implementation of consultation mechanisms in self-assessment teams. Improving assessments of client satisfaction was identified as a prime objective but, in terms of the values promoted in organizations, accreditation has little effect on the perceptions of employees not directly involved in the process. As long as not all staff members have integrated the basis for accreditation and its outcomes, the accreditation process appears to remain an external, bureaucratic control instrument.
This study provides a theoretical model for understanding organizational changes brought about by accreditation of primary services. Through self-assessment of professional values and standards, accreditation may foster better quality management practices.
The nursing role in neuromuscular disorders has been shown as a promising solution in service organization. However, the role of neuromuscular nurses has scarcely been addressed in the literature. The present evaluation process was geared toward defining nursing role in relation to systematic follow-up of neuromuscular disorders and to assess its theoretical background.
Nurses in hospitals are not active in smoking cessation because of certain beliefs and attitudes. Beliefs and attitudes must be measured for changing practice in quitting smoking. The objective is to develop and validate a questionnaire on smoking cessation practices of nurses in hospitals.
A methodological study was conducted to construct a questionnaire (n = 118) according to the theory of planned behaviour, to validate by four experts, for reliability and validation of instruments constructs (n = 38; n = 29; n = 157).
An initial questionnaire on practices in smoking cessation was built according to the beliefs of a convenience sample of 118 nurses. Validation of experts was conducted, and the questionnaire obtained an index of content validation (ICV) of 0.94. Subsequently, after two convenience samples (n = 38; n = 29) and a random sample (n = 157), the questionnaire obtained reliability, measured by Cronbach's alpha ranging in 0.697 and 0.93 1. Finally, moderately high correlations (0.406 to 0.569) were obtained between concepts.
A reliable and valid questionnaire in French is available to measure smoking cessation practices.
In 1990, the Quebec Social Research Council - a body financing social research in Quebec, Canada - launched a new policy encouraging the development of social research units within health care organizations. Through financial incentives, it encouraged the implementation of long-term collaborations between researchers and practitioners with the purpose of transforming both scientific knowledge production and professional practices. This paper examines the perceptions of researchers and practitioners regarding the attributes and the usefulness of this collaborative research policy.
A self-administered survey was sent to all the researchers (n = 146; response rate 78.1%) and practitioners (n = 204; response rate 44.1%) involved in the 21 collaborative research teams funded in 1998. T-tests were performed in order to assess the difference between the perceptions of researchers and practitioners in five key dimensions of collaborative research.
The results showed that, contrary to expectations, researchers and practitioners shared fairly similar views regarding the various dimensions of collaborative research. They both agreed that their involvement within collaborative research teams had contributed to the development of new skills and practices but had not facilitated their participation in external activities nor their involvement in networks and organizations that influence environments in which public policies and practices are deployed. They also both encountered some difficulties in putting the dimensions that they highly valued into practice.
Collaborative research within health care organizations succeeded in fostering the implementation of new modes of knowledge production and intervention. Nevertheless, special attention needs to be given to the development of strategies to reduce the discrepancies between values and practices.
Department of Management, Business School, Quebec University at Montreal, Interuniversity Research Center on integration and immigration Metropolis, succursale Downtown, Montreal, QC, Canada. gravel.s@uqam.qc.ca
This paper examines the compensation process for work-related injuries and illnesses by assessing the trajectories of a sample of immigrant and non-immigrant workers (n = 104) in Montreal. Workers were interviewed to analyze the complexity associated with the compensation process. Experts specialized in compensation issues assessed the difficulty of the interviewees' compensation process. Immigrant workers faced greater difficulties with medical, legal, and administrative issues than non-immigrants did. While immigrant workers' claim forms tended to be written more often by employers or friends (58% vs. 8%), the claims were still more often contested by employers (64% vs. 24%). Immigrant workers were less likely to obtain a precise diagnosis (64% vs. 42%) and upon returning to work were more likely to face sub-optimal conditions. Such results throw into relief issues of ethics and equity in host societies that are building their economy with migrant workers.
Unité de traumatologie - urgence - soins intensifs, Centre de recherche FRSQ du CHA universitaire de Québec, Québec, Canada. marieeve.lamontagne@umontreal.ca
Networks have been implemented within trauma systems to overcome problems of fragmentation and lack of coordination. Such networks regroup many types of organizations that could have different perceptions of network performance. No study has explored the perceptions of traumatic brain injury (TBI) network participants regarding network performance.
To document the perceptions of TBI network participants concerning the importance of different dimensions of performance and to explore whether these perceptions vary according to organization types.
Participants of network organizations were surveyed using a questionnaire based on a conceptual framework of performance (the EGIPSS framework).
Network organizations reported dimensions related to goal attainment to be more important than dimensions related to process. Differences existed between the perceptions of various types of network organizations for some but not all domains and dimensions of performance.
Network performance appears different from the performance of an individual organization and the consideration of the various organizations' perceptions in clarifying this concept should improve its comprehensiveness and its acceptability by all stakeholders.
Quality-of-work-life (QWL) includes broad aspects of the work environment that affect employee learning and health. Canadian health care organizations (HCOs) are being encouraged to monitor QWL, expanding existing occupational health surveillance capacities.
To investigate the understanding, collection, diffusion and use of QWL indicators in Canadian HCOs.
We obtained cooperation from six diverse public HCOs managing 41 sites. We reviewed documentation relevant to QWL and conducted 58 focus groups/team interviews with strategic, support and programme teams. Group interviews were taped, reviewed and analysed for themes using qualitative data techniques. Indicators were classified by purpose and HCO level.
QWL indicators, as such, were relatively new to most HCOs yet the data managed by human resource and occupational health and safety support teams were highly relevant to monitoring of employee well-being (119 of 209 mentioned indicators), e.g. sickness absence. Monitoring of working conditions (62/209) was also important, e.g. indicators of employee workload. Uncommon were indicators of biomechanical and psychosocial hazards at work, despite their being important causes of morbidity among HCO employees. Although imprecision in the definition of QWL indicators, limited links with other HCO performance measures and inadequate HCO resources for implementation were common, most HCOs cited ways in which QWL indicators had influenced planning and evaluation of prevention efforts.
Increase in targeted HCO resources, inclusion of other QWL indicators and greater integration with HCO management systems could all improve HCO decision-makers' access to information relevant to employee health.
Research results demonstrate a decrease in cigarette smoking when preventive professional interventions are routinely carried out. Literature reports that 30% of hospital nurses assess their patient smoking habits. The objective of the present study is to compare, on medical and surgical units, the effectiveness of three strategies (interactive educational session, recall, and both together) to a control group, on the number of nursing interventions pertaining to cessation of cigarette smoking. Research design is experimental with group randomisation. Pre and post strategy multi-measurements (at 1 and 3 months) are sought from nursing staff (69), patients and patient charts (351). Results show that nursing staff assesses cigarette smoking habits for only 35.7% of the patients, and their intent to stop smoking only of the time. Results show that the educational strategy increases the number of nursing interventions during a short period (1 month), and decreases perception of barriers to tobacco counselling. Impact of recall could not be assessed as it was not introduced as planned.
Considering modest results from the strategies, the interactive educational sessions shows a short- term effect on the nursing staff's interventions.
