Health Sciences Research, Faculty of Medicine and Health Sciences, University of Sherbrooke, Fonds de recherche du Québec, Santé, Canada.
Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Charles-Le Moyne Hospital Research Center, University of Sherbrooke, Canada.
Health Policy. 2021 Jun;125(6):768-776. doi: 10.1016/j.healthpol.2021.04.007. Epub 2021 Apr 20.
As part of reforms in 2015, the Ministry of Health and Social Services in Quebec, Canada mandated the national implementation of control rooms, making health system actors accountable for implementing value-based performance management.
To explore how do organizational actors appropriate control rooms as managerial tools to influence value-based performance in health systems.
Multi-site organizational ethnographic case studies (N = 2) and narrative process analysis of triangulated qualitative data collected through non-participatory observations (179.5 h), individual semi-structured interviews (N = 34), and document review (N = 143).
The process of appropriating control rooms plays a crucial role in achieving value-based performance management. Appropriating unfolds along three paths (cognitive, structural, technical) over three phases (implementing, testing, adapting). Implementing control rooms both produces and emerges from improvement capacities within healthcare organizations. Testing tools reveals that incompatibilities between tools, structures and values give rise to value-driven distributed clinical leadership. Adapting tools relies on the adaptability of organizations towards the value system driving the tools, rather than on the adaptability of tools to organizational design.
There is no "one-size-fits-all" framework to design and support the successful appropriation of control rooms towards achieving value-based performance. However, we believe that consideration for the three distinct phases of appropriation and leveraging the right mechanism to support each phase is a first important step in reviving value in healthcare governance.
2015 年改革的一部分，加拿大魁北克省卫生和社会服务部要求全国实施控制中心，使卫生系统行为者负责实施基于价值的绩效管理。
探索组织行为者如何将控制中心作为管理工具来影响卫生系统的基于价值的绩效。
多地点组织民族志案例研究（N=2）和三角定性数据的叙述过程分析，通过非参与式观察（179.5 小时）、个人半结构化访谈（N=34）和文件审查（N=143）收集。
控制中心的采用过程在实现基于价值的绩效管理方面起着至关重要的作用。采用沿着三条路径（认知、结构、技术）在三个阶段（实施、测试、适应）展开。控制中心的实施既产生又源于医疗机构内部的改进能力。测试工具表明，工具、结构和价值观之间的不兼容性会导致以价值为导向的分布式临床领导。工具的调整依赖于组织对驱动工具的价值体系的适应性，而不是工具对组织设计的适应性。
没有“一刀切”的框架来设计和支持控制中心的成功采用，以实现基于价值的绩效。然而，我们认为，考虑采用的三个不同阶段，并利用正确的机制来支持每个阶段，是恢复医疗保健治理中价值的第一步。
