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Building Transformative Capacities by Expanding the Academic Mission Across the Care Continuum: A Realist Evaluation

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Transitions and Boundaries in the Coordination and Reform of Health Services

Part of the book series: Organizational Behaviour in Healthcare ((OBHC))

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Abstract

This chapter aims to understand how organizational actors in Academic Health Centres (AHCs) mobilize transformative capacities through the process of expanding the academic mission across the care continuum in the enactment of a policy reform. Using a realist evaluation approach, a single qualitative embedded case study was conducted in Quebec, Canada. Empirical data collected through document review and semi-structured interviews with key informants were first categorized as context, intervention, mechanism or outcome, and then sub-categorized as forms of institutional work. This study reveals that the development of transformative capacities through policy reform aiming to expand the academic mission across boundaries is a heterogeneous, nonlinear and relational process. Further research could explore the role of relational work in aligning actors across hierarchical boundaries through large-scale health system transformation.

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Author information

Authors and Affiliations

  1. Faculty of Medicine and Health Sciences Research, University of Sherbrooke, Longueuil, QC, Canada

    Élizabeth Côté-Boileau

  2. Charles-Le Moyne – Saguenay– Lac-Saint-Jean Research Center on Health Innovations, Longueuil, QC, Canada

    Élizabeth Côté-Boileau & Marie-Andrée Paquette

  3. Doctoral Award Fellow, Fonds de recherche Québec - Santé, Montreal, QC, Canada

    Élizabeth Côté-Boileau

  4. Health Standards Organization, Ottawa, Canada

    Élizabeth Côté-Boileau

  5. Health Administration Department, School of Public Health, University of Montreal, Quebec, Canada

    Jean-Louis Denis

  6. University of Montreal Hospital, Research Center, Quebec, Canada

    Jean-Louis Denis

  7. Canada Research Chair (Tier I) holder on Health system design and adaptation (Canadian Institutes of Health Research), Montreal, Canada

    Jean-Louis Denis

Authors
  1. Élizabeth Côté-Boileau
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  2. Marie-Andrée Paquette
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  3. Jean-Louis Denis
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Corresponding author

Correspondence to Élizabeth Côté-Boileau .

Editor information

Editors and Affiliations

  1. Institute of Health Sciences Education, McGill University, Montréal, QC, Canada

    Peter Nugus

  2. Department of Family Medicine, McGill University, Montréal, QC, Canada

    Charo Rodriguez

  3. School of Public Health, University of Montreal, Montréal, QC, Canada

    Jean-Louis Denis

  4. Department of Human Resource Management, HEC Montréal, Montréal, QC, Canada

    Denis Chênevert

Appendix A: Detailed CIMO Configurations

Appendix A: Detailed CIMO Configurations

CIMO

Contexts

Interventions

Mechanisms

Outcomes

Betting on restructuring: unleashing power relations

Systemic restructuring through policy reform

Structural integration of pre-existing structures

Reinforcement of existing power relations across hierarchical, geographical and knowledge boundaries

(Decreased relational capacity)

Partial openness to the idea of being part of an academic institution

REINFORCEMENT: Decreased operational capacity

Creation of new formal spaces for exchange across boundaries

Emergence of distributed and trusting relations across boundaries

(Increased relational capacity)

Emergence of a shared and holistic vision of the academic mission

TRANSFORMATION: Increased conceptual capacity

Navigating distributed governance and structural ambiguity

New distributed governance structure

Creation of a new management structure

Emergence of structural ambiguity towards distribution of roles and accountability relationships

(Decreased structural capacity)

Limited leadership capacities of this new structure

INVARIANCE: Limited relational capacity

Creation of a new senior management board

Reinforcement of centralization in governance capacities

(Limited relational capacity)

Exclusive opportunities to exchange, reflect on and appropriate the meaning of the academic mission

INVARIANCE: Limited conceptual capacity

Capitalizing on relationships to accelerate change

Structural integration of pre-existing management structures

Dissemination of a new organizational policy for education

Consolidation of pre-existing trust relationships

(Increased relational capacity)

Accelerated capacities to create new formal coordination mechanisms across boundaries

REINFORCEMENT: Increased structural capacity

Culmination of performance pressures

Adoption of a new mandated integrated performance management system

Emergence of a positive organizational vision across boundaries

(Increased conceptual capacity)

Emergence of a shared vision of the academic mission as a vector for an organizational culture of innovation

TRANSFORMATION: Increased conceptual capacity

Managing the tension between perceived value and operational capacity

Lack of operational guidelines to translate organizational vision

Emergence of discrepancies between expectations and the availability of management support and resources

(Limited structural capacity)

Prioritization of other operations that were structurally secured

REINFORCEMENT: Limited operational capacity

Shift in managerial approach towards reciprocity

Appreciative vision of new managerial support

(Increased conceptual capacity)

Emergence of distributed leadership across management structures

TRANSFORMATION: Increased relational capacity

Crossing boundaries; reconciling the good and the messy

Clinical governance restructuration

Creation of a new clinico-administrative management structure

Emergence of structural ambiguity around the distribution of roles and accountability relationships between managerial and clinical actors

(Decreased structural capacity)

Lack of structural integration of the academic mission within clinical governance capacities

INVARIANCE: Decreased structural capacity

Development of healthcare and services pathways

Emergence of positive relationships between clinical-administrative management teams

(Increased relational capacity)

Increased utilization of knowledge transfer resources as one of the six components of the academic mission

TRANSFORMATION: Increased operational capacity

From inertia to improvement; starting with relationships

Limited overall transformative capacities towards the integration of the academic mission

Restructuring of the senior management governance board

Reinforcement of structural ambiguity around the distribution of roles and accountability relationships

(Decreased structural capacity)

Reinforcement of the academic mission as a strategic performance and improvement lever

TRANSFORMATION: Increased conceptual capacity

Reorientation of organizational vision towards clinical relevance

Emergence of discrepancies between new organizational vision and lack of operational guidance

(Limited conceptual capacity)

Clarification of the alignment of the academic mission with more specific structures of the organizational design

TRANSFORMATION: Increased structural capacity

Development of new inclusive collaborative mechanisms within clinical-administrative structures

Emergence of steps towards structural integration within clinical governance

(Increased structural capacity)

Development of a strategic framework for the integration of the academic mission within healthcare and service pathways

TRANSFORMATION: Increased operational capacity

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Côté-Boileau, É., Paquette, MA., Denis, JL. (2020). Building Transformative Capacities by Expanding the Academic Mission Across the Care Continuum: A Realist Evaluation. In: Nugus, P., Rodriguez, C., Denis, JL., Chênevert, D. (eds) Transitions and Boundaries in the Coordination and Reform of Health Services. Organizational Behaviour in Healthcare. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-26684-4_14

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