Institute of Health and Society (IRSS), Université catholique de Louvain, Clos Chapelle-aux-Champs, 30, 1200, Brussels, Belgium.
Health Res Policy Syst. 2024 Feb 20;22(1):28. doi: 10.1186/s12961-024-01112-y.
The assessment of primary care organizations is considered to be essential for improving care. However, the assessments' acceptability to professionals poses a challenge. Developing assessment programmes in collaboration with the end-users is a strategy that is widely encouraged to make interventions better targeted. By doing so, it can help to prevent resistance and encourage adherence to the assessment. This process, however, is rarely reported. This paper aims to fill this gap by describing the process of the co-production of an assessment programme for community health centres (CHCs) affiliated to the Federation of Community Health Centres (FCHC) in French-speaking Belgium.
We conducted a documentary study on the co-production of the assessment programme before carrying out semi-structured interviews with the stakeholders involved in its development.
CHCs in French-speaking Belgium are increasing in number and are becoming more diverse. For the FCHC, this growth and diversification pose challenges for the meaning of CHC (an identity challenge) and what beneficiaries can expect in terms of the quality of organizations declaring themselves CHC (a quality challenge). Faced with this double challenge, the FCHC decided to develop an assessment programme, initially called Label, using participatory action research. During the co-production process, this initial programme version was abandoned in favour of a new name "DEQuaP". This new name embodies new objectives and new design regarding the assessment programme. When studying the co-production process, we attributed these changes to two controversies. The first concerns how much and which type of variety is desired among CHCs part of the FCHC. The second concerns the organization of the FCHC in its capacity as a federation. It shed light on tensions between two professional segments that, in this paper, we called "political professionalism" and "pragmatic professionalism".
These controversies show the importance of underlying challenges behind the development of an assessment programme for CHCs. This provided information about the evolution of the identity of multidisciplinary organizations in primary care. Issues raised in the development of this assessment programme also show the importance of considering assessment methods that reflect and embody the current realities of these organizations and the way of developing these assessment methods.
评估基层医疗组织被认为对于改善医疗服务至关重要。然而，评估对专业人员的可接受性是一个挑战。与最终用户合作制定评估计划是一种被广泛鼓励的策略，旨在使干预措施更有针对性。这样做可以帮助预防抵触情绪并鼓励对评估的遵守。然而，这个过程很少有报道。本文旨在通过描述与法语社区卫生中心联合会（FCHC）下属社区卫生中心（CHC）合作制定评估计划的过程来填补这一空白。
我们在对评估计划的共同制定进行文献研究后，对参与其制定的利益相关者进行了半结构化访谈。
在法语区比利时，CHC 的数量不断增加，且变得更加多样化。对于 FCHC 而言，这种增长和多样化对 CHC 的意义（身份挑战）以及受益方对自称为 CHC 的组织的质量期望（质量挑战）构成了挑战。面对这双重挑战，FCHC 决定使用参与式行动研究开发一个评估计划，最初称为 Label。在共同制定的过程中，该初始计划版本被放弃，转而采用新名称“DEQuaP”。这个新名称体现了评估计划在目标和设计方面的新变化。在研究共同制定过程时，我们将这些变化归因于两个争议。第一个争议涉及 FCHC 下属的 CHC 希望有多少种以及哪种类型的多样性。第二个争议涉及 FCHC 作为一个联合会的组织方式。它揭示了两个专业群体之间的紧张关系，在本文中，我们称之为“政治专业主义”和“务实专业主义”。
这些争议表明，CHC 评估计划的制定背后存在着重要的潜在挑战。这为了解基层医疗多学科组织身份的演变提供了信息。在制定该评估计划过程中出现的问题也表明，考虑反映和体现这些组织当前现实以及开发这些评估方法的方式的评估方法的重要性。
