Grant: Operating Grant

There is a broad consensus that the Canadian health care system needs to implement significant reforms to increase its performance and, ultimately, to ensure its sustainability. There is strong scientific evidence that high performing health care systems present several desirable characteristics. In Quebec, all publicly appointed Commissions identified characteristics and recommended policy options consistent with scientific evidence. However, even if the various reforms that were conducted in the last 20 years led to important structural changes in the administrative and delivery system, many critical elements were systematically ignored with the consequence that only partial reforms were implemented and the desired results were not achieved. The unimplemented elements were always those that entailed significant transformations for powerful interest groups. The objective of the project is to analyze and compare the perceptions of various stakeholders within the health care system (physicians, nurses, administrators) and to put them in relation with the current scientific evidence on interventions aimed at increasing performance. Firstly, interviews with spokespersons representing main stakeholders groups will document each group's position on a given set of propositions related to key characteristics of high performing healthcare systems. Secondly, a survey will be distributed to a sample of each group of stakeholders in order to test whether the discourses of organized group representing stakeholders do correspond to the views of their members. Better understanding the social positions and believes of major stakeholders will help identify their expectations. It is an essential step for analyzing if there is a way to reconcile their views, for identifying topics on which stakeholders perceptions should be influenced and levers that could be used in order to implement critical measures for developing a performing health care system and ensure its sustainability.