Université de Sherbrooke - Campus de Longueuil , Longueuil, Canada.
École nationale d'administration publique, Montréal, Canada.
J Health Organ Manag. 2019 Aug 8;33(5):563-587. doi: 10.1108/JHOM-10-2018-0303. Epub 2019 Jun 28.
Centralized waiting lists (CWLs) for patient attachment to a primary care provider have been implemented across Canada, including Quebec. Little is known about the implementation of CWLs and the factors that influence implementation outcomes of such primary care innovations. The purpose of this paper is to explain variations in the outcomes of implementation by analyzing the characteristics of CWLs and contextual factors that influence their implementation.
DESIGN/METHODOLOGY/APPROACH: A multiple qualitative case study was conducted. Four contrasting CWLs were purposefully selected: two relatively high-performing and two relatively low-performing cases with regard to process indicators. Data collected between 2015 and 2016 drew on three sources: 26 semi-structured interviews with key stakeholders, 22 documents and field notes. The Consolidated Framework for Implementation Research was used to identify, through a cross-case comparison of ratings, constructs that distinguish high from low-performing cases.
Five constructs distinguished high from low-performing cases: three related to the inner setting: network and communications; leadership engagement; available resources; one from innovation characteristics: adaptability with regard to registration, evaluation of priority and attachment to a family physician; and, one associated with process domain: engaging. Other constructs exerted influence on implementation (e.g. outer setting, individual characteristics), but did not distinguish high and low-performing cases.
ORIGINALITY/VALUE: This is the first in-depth analysis of CWL implementation. Results suggest important factors that might be useful in efforts to continuously improve implementation performance of CWLs and similar innovations.
集中式候诊名单（CWL）已在加拿大各地实施，包括魁北克省。对于 CWL 的实施以及影响此类初级保健创新实施结果的因素知之甚少。本文的目的是通过分析 CWL 的特征和影响其实施的背景因素来解释实施结果的差异。
设计/方法/方法：进行了多次定性案例研究。有针对性地选择了四个具有代表性的 CWL：两个在过程指标方面表现相对较好的案例和两个表现相对较差的案例。2015 年至 2016 年期间收集的数据来自三个来源：26 次与主要利益相关者的半结构化访谈、22 份文件和现场记录。通过对评分的跨案例比较，使用实施研究综合框架确定了区分高绩效和低绩效案例的结构。
有五个结构区分了高绩效和低绩效案例：三个与内部环境有关：网络和沟通；领导参与；可用资源；一个与创新特点有关：注册的适应性、优先级评估和与家庭医生的联系；一个与过程领域有关：参与。其他结构对实施产生了影响（例如，外部环境、个人特征），但没有区分高绩效和低绩效案例。
原创性/价值：这是对 CWL 实施的首次深入分析。结果表明，对于努力不断提高 CWL 和类似创新的实施绩效，可能有一些重要因素是有用的。
