Rodríguez Charo, Bélanger Emmanuelle
Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Côte-des-Neiges Boulevard, Montreal, Quebec H3S 1Z1, Canada.
BMC Fam Pract. 2014 Mar 4;15:41. doi: 10.1186/1471-2296-15-41.
The Quebec primary health care delivery system has experienced numerous reforms over the last 15 years. In this study, we sought to examine how managers and primary care providers made sense of the creation of successive new primary care organizational forms.
We conducted a longitudinal qualitative case study in a primary care practice group located in Montreal, Quebec, for over 6 years (2002 to 2008). The data sources for the study include 31 semi-structured interviews with key informants, in-situ observations of group meetings, as well as documents and field notes. Textual material was submitted to narrative and metaphor analysis.
The core metaphor of the journey came from a set of stories in which the members of this primary care group depicted the processes undertaken towards developing a multidisciplinary cooperative practice, which include an uneasy departure, uncertainty about the destination, conflict among members who jump ship or stay on board, negotiations about the itinerary, and, finally, enduring challenges in leading the way and being pioneers of change in the organization of primary care in their institutional context. Identification with the initial family medicine unit identity was persistent over time, but successive reforms further enriched its meaning as it became a multidisciplinary primary care practice pioneering organizational change.
In order to support primary care reforms in complex institutional fields, this study proposes that decision-makers undertake a journey in which they recognize both the need to capitalize on existing meaningful and legitimated organizational identities, as well as the necessity for collective leadership in the management of multiple organizational identities over time.
在过去15年里，魁北克的初级卫生保健提供系统经历了多次改革。在本研究中，我们试图探究管理者和初级保健提供者如何理解相继出现的新初级保健组织形式的创建。
我们在魁北克省蒙特利尔市的一个初级保健实践小组中进行了一项为期6年多（2002年至2008年）的纵向定性案例研究。该研究的数据来源包括对关键信息提供者的31次半结构化访谈、小组会议的现场观察以及文件和实地记录。文本材料被提交进行叙事和隐喻分析。
旅程这一核心隐喻源自一组故事，在这些故事中，这个初级保健小组的成员描述了为发展多学科合作实践所采取的过程，其中包括艰难的启程、对目的地的不确定、中途退出或留下的成员之间的冲突、关于行程的谈判，以及最终在引领道路和成为其机构背景下初级保健组织变革的先驱者方面所面临的持续挑战。随着时间的推移，对最初家庭医学单位身份的认同一直存在，但随着它成为开创组织变革的多学科初级保健实践，相继的改革进一步丰富了其内涵。
为了支持复杂机构领域中的初级保健改革，本研究建议决策者踏上一段旅程，在这段旅程中，他们既要认识到利用现有有意义且合法的组织身份的必要性，也要认识到随着时间推移在管理多种组织身份方面进行集体领导的必要性。
