Claude Sicotte

Interdisciplinary collaboration within Quebec community health care centres

Central to the success of many recent health system reforms is the implementation of new primary health care delivery models. The central characteristic common to these new models usually emphasises interdisciplinary collaboration. Using empirical research, this paper studies interdisciplinary collaboration among various groups of professionals within an original Canadian primary health care delivery model, the Quebec Community Health Care Centres (CCHCs). The entire population of more than 150 CHCCs have been surveyed. The goals of this study are (1) to measure the achieved intensity of inter-professional collaboration among Quebec CHCCs, and (2) to identify the organisational and professional factors fostering or limiting interdisciplinary collaboration. The results show that Quebec CHCCs have reached modest results in achieving interdisciplinary collaboration especially since interdisciplinary collaboration is a central objective that has been pursued for more than 25 years. This study demonstrates that the main factors associated with interdisciplinary collaboration are closely linked to work group internal dynamics. Interdisciplinary collaboration is linked to the simultaneous and antagonistic effect of some central intragroup process factors. Conflicting values and beliefs are present that both enhance and limit interdisciplinary collaboration. The presence of conflicting stimuli seriously undermines the strength of the CHCC work groups shared beliefs and strongly limits interdisciplinary collaboration. The results also stress the importance of administrative formalisation initiatives to enhance collaboration among different professions. The efficacy of formalisation in this context is based on its capacity to offer an articulated and operative interdisciplinary framework that can generate a counteractive effect to the traditional professional framework. It offers concrete rules that help align the work group beliefs with interdisciplinary values. The formalisation of functions and processes appears thus to be an interesting means to further interdisciplinary collaboration.

Determinants of Internet use as a preferred source of information on personal health.

OBJECTIVE To understand the personal, social and cultural factors likely to explain recourse to the Internet as a preferred source of personal health information. DESIGN A cross-sectional survey was conducted among a population of 2923 Internet users visiting a firmly established website that offers information on personal health. Multiple regression analysis was performed to identify the determinants of site use. MEASUREMENT The analysis template comprised four classes of determinants likely to explain Internet use: beliefs, intentions, user satisfaction and socio-demographic characteristics. Seven-point Likert scales were used. An analysis of the psychometric qualities of the variables provided compelling evidence of the constructs validity and reliability. A confirmatory factor analysis confirmed the correspondence with the factors predicted by the theoretical model. FINDINGS The regression analysis explained 35% of the variance in Internet use. Use was directly associated with five factors: perceived usefulness, importance given to written media in searches for health information, concern for personal health, importance given to the opinions of physicians and other health professionals, and the trust placed in the information available on the site itself. CONCLUSION This study confirms the importance of the credibility of information on the frequency of Internet use as a preferred source of information on personal health. It also shows the potentially influential role of the Internet in the development of personal knowledge of health issues.

Information technology sophistication in health care: an instrument validation study among Canadian hospitals

Several empirical studies have shown that the use of computer-based information systems could have positive impacts on organizational performance. Many agree to say that health care organizations are no exceptions. But if one wishes to identify the effects of information technology (IT) on the delivery of care, one must be able to characterize IT for operationalization purposes. The primary objective of this research project is to develop and validate a measurement instrument of IT sophistication in the hospital milieu. Such instrument should provide hospital managers with a diagnostic tool capable of indicating the profile of their respective institutions in regard to IT adoption and comparing this profile to those of other similar medical centers. Both qualitative and quantitative data were collected in order to assess the psychometric properties of the measurement instrument. Overall, findings suggest a high-moderate level of functional sophistication, a somewhat low level of technological sophistication, and an even lower level of integration sophistication in all of the sampled medical centers. Hence, future investments shall therefore be directed towards the integration of clinical and administrative applications and the acquisition of more advanced technological devices, more specifically those, which allow direct capture of clinical data at the bedside.

Internet use and the logics of personal empowerment in health

OBJECTIVES The development of personal involvement and responsibility has become a strategic issue in health policy. The main goal of this study is to confirm the coexistence of three logics of personal empowerment through health information found on the Internet. METHODS A theoretical framework was applied to analyze personal empowerment from the users perspective. A well-established Canadian Web site that offers information on personal health was used as a case study. A close-ended questionnaire was completed online by 2275 visitors and members of the Web site. RESULTS The findings confirm that the development of feelings of competence and control through Internet use is structured around three different logics. This implies three types of aptitudes that are fostered when the Internet is used to seek health information: doing what is prescribed (the professional logic), making choices based on personal judgment (the consumer logic), and mutual assistance (the community logic). CONCLUSIONS A recurring issue in three logics is the balance of roles and responsibilities required between the individual and the health provider.

The Computer Based Patient Record: A Strategic Issue in Process Innovation

Reengineering of the workplace through Information Technology is an important strategic issue for todays hospitals. The computer-based patient record (CPR) is one technology that has the potential to profoundly modify the work routines of the care unit. This study investigates a CPR project aimed at allowing physicians and nurses to work in a completely electronic environment. The focus of our analysis was the patient nursing care process. The rationale behind the introduction of this technology was based on its alleged capability to both enhance quality of care and control costs. This is done by better managing the flow of information within the organization and by introducing mechanisms such as the timeless and spaceless organization of the work place, de-localization, and automation of work processes. The present case study analyzed the implementation of a large CPR project (

Feasibility and outcome evaluation of a telemedicine application in speech–language pathology

45 million U.S.) conducted in four hospitals in joint venture with two computer firms. The computerized system had to be withdrawn because of boycotts from both the medical and nursing personnel. User-resistance was not the problem. Despite its failure, this project was a good opportunity to understand better the intricate complexity of introducing technology in professional work where the usefulness of information is short lived and where it is difficult to predetermine the relevancy of information. Profound misconceptions in achieving a tighter fit (synchronization) between care processes and information processes were the main problems.

The Computer-Based Patient Record Challenges Towards Timeless and Spaceless Medical Practice

This evaluative study assessed the feasibility and outcome of delivering speech–language services from a distance to children and adolescents who stutter. All six patients who formed the first cohort seen in the telespeech programme were included in the study. The results demonstrated that interactive videoconferencing can provide a feasible and effective care delivery model. Patient attendance was maintained throughout the intervention. All participants showed improved fluency. Stuttering ranged from 13% to 36% before treatment and 2% to 26% after treatment. All participants maintained at least part of their improved fluency during the six-month follow-up, when stuttering ranged from 4% to 32%. The study demonstrates that full assessment and treatment of stuttering in children and adolescents can be accomplished successfully via telemedicine.

Success in health information exchange projects: solving the implementation puzzle.

Although computerization is increasingly advocated as a means for hospitals to enhance quality of care and control costs, few studies have evaluated its impact on the day-to-day organization of medical work. This study investigated a large Computerized Patient Record (CPR) project (

A review of organizational performance assessment in health care

50 million U.S.) aimed at allowing physicians to work in a completely electronic record environment. The present multiple-case study analyzed the implementation of this project conducted in four hospitals. Our results show the intricate complexity of introducing the CPR in medical work. Profound obstructions to the achievement of a tighter synchronization between the care and information processes were the main problems. The presence of multiple information systems in one (Communication, Decision Support, and Archival record keeping) was overlooked. It introduced several misconceptions in the meaning and codification of clinical information that were then torn apart between information richness to sustain clinical decisions and concision to sustain care coordination.

A Risk Assessment of Two Interorganizational Clinical Information Systems

Interest in health information exchange (HIE), defined as the use of information technology to support the electronic transfer of clinical information across health care organizations, continues to grow among those pursuing greater patient safety and health care accessibility and efficiency. In this paper, we present the results of a longitudinal multiple-case study of two large-scale HIE implementation projects carried out in real time over 3-year and 2-year periods in Québec, Canada. Data were primarily collected through semi-structured interviews (n=52) with key informants, namely implementation team members and targeted users. These were supplemented with non-participants observation of team meetings and by the analysis of organizational documents. The cross-case comparison was particularly relevant given that project circumstances led to contrasting outcomes: while one project failed, the other was a success. A risk management analysis was performed taking a process view in order to capture the complexity of project implementations as evolving phenomena that are affected by interdependent pre-existing and emergent risks that tend to change over time. The longitudinal case analysis clearly demonstrates that the risk factors were closely intertwined. Systematic ripple effects from one risk factor to another were observed. This risk interdependence evolved dynamically over time, with a snowball effect that rendered a change of path progressively more difficult as time passed. The results of the cross-case analysis demonstrate a direct relationship between the quality of an implementation strategy and project outcomes.