St-Pierre Michèle, Reinharz Daniel, Gauthier Jacques-Bernard
Faculté des sciences de l'administration, Département de management, Pavillon Palasis-Prince, Université Laval, Québec, G1K 7P4, Canada.
Med Health Care Philos. 2006;9(1):97-106. doi: 10.1007/s11019-005-3602-8.
This article addresses the issue of the interface between public health and clinical health within the context of the search for networking approaches geared to a more integrated delivery of health services. The articulation of an operative interface is complicated by the fact that the definition of networking modalities involves complex intra- and interdisciplinary and intra- and interorganizational systems across which a new transversal dynamics of intervention practices and exchanges between service structures must be established. A better understanding of the situation is reached by shedding light on the rationale underlying the organizational methods that form the bases of the interface between these two sectors of activity. The Quebec experience demonstrates that neither the structural-functionalist approach, which emphasizes remodelling establishment structures and functions as determinants of integration, nor the structural-constructivist approach, which prioritizes distinct fields of practice in public health and clinical health, adequately serves the purpose of networking and integration. Consequently, a theoretical reframing is imperative. In this regard, structuration theory, which fosters the simultaneous study of methods of inter-structure coordination and inter-actor cooperation, paves the way for a better understanding of the situation and, in turn, to the emergence of new integration possibilities.
本文探讨了在寻求旨在更综合地提供卫生服务的网络方法的背景下，公共卫生与临床卫生之间的接口问题。操作接口的衔接因以下事实而变得复杂：网络模式的定义涉及复杂的内部和跨学科以及内部和组织间系统，必须在这些系统中建立服务结构之间干预实践和交流的新横向动态。通过阐明构成这两个活动部门之间接口基础的组织方法背后的基本原理，可以更好地理解这种情况。魁北克的经验表明，强调重塑机构结构和功能作为整合决定因素的结构功能主义方法，以及优先考虑公共卫生和临床卫生不同实践领域的结构建构主义方法，都不足以实现网络建设和整合的目的。因此，必须进行理论重构。在这方面，结构化理论促进了对结构间协调方法和行动者间合作方法的同时研究，为更好地理解这种情况铺平了道路，进而催生了新的整合可能性。
