Papers by Mélanie Perroux
Perspective infirmière : revue officielle de l'Ordre des infirmières et infirmiers du Québec
Learning Health Systems, 2019
Introduction: The capacity for teams and organizations to evolve and to thrive in ever-shifting e... more Introduction: The capacity for teams and organizations to evolve and to thrive in ever-shifting environments is attributed to their collective intelligence. Collectively, intelligent team could prevent repetition of past mistakes and can help organizations and people work more efficiently. Researchers aimed to find a framework or a tool that could help explain collective intelligence in primary healthcare organizations. Methods: The framework was developed iteratively following a three-step process based on the Pragmatic utility concept analysis, each step fetching data from both literature and the team's expertise: (i) finding an existing framework, (ii) developing an initial framework, (iii) testing and refining the framework. Results: A broad literature search led researchers to focus more specifically on two interrelated frameworks, both concepts were created within the educational field. We first adapted these concepts to healthcare teams, then to the increasing interdisciplinarity of primary healthcare teams. We also subdivided the framework into clinical or organizational domain. Finally, we performed a secondary analysis from existing data of a larger project that aimed to evaluate seven primary care teams in Quebec. Conclusions: This first attempt to conceptualize collective intelligence in a way that is specific to primary healthcare teams helps identify strengths and areas in which teams could potentially improve. From a theoretical perspective, the framework facilitates understanding of the concept of collective intelligence in primary healthcare teams. Our current results show a strong potential for this tool, but other tests and systematic validations are to be expected in order to better link collective intelligence and team performance.
Healthcare Policy | Politiques de Santé, 2018
Point de vue des parties prenantes sur les solutions visant l' amélioration de la performance du ... more Point de vue des parties prenantes sur les solutions visant l' amélioration de la performance du système de santé RESEARCH PAPER
BMC Family Practice, 2018
Background: There is only limited evidence to support care redefinition and role optimization pro... more Background: There is only limited evidence to support care redefinition and role optimization processes needed for scaling up of a stronger primary care capacity. Methods: Data collection was based on a keyword search in MEDLINE, EMBASE and CINAHL databases. Three thousand, two hundred and twenty-nine documents were identified, 1851 met our inclusion criteria, 71 were retained for full-text assessment and 52 included in the final selection. The analysis process was done in four steps. In the end, the elements that were identified as particularly central to the process of transforming primary care provision were used as the basis of two typologies. Results: The first typology is based on two structural dimensions that characterize promising multiprofessional primary care teams. The first is the degree to which the division of tasks in the team was formalized. The second dimension is the centrality and autonomy of nurses in the care model. The second typology offers a refined definition of comprehensiveness of care and its relationship with the optimization of professional roles. Conclusions: The literature we analyzed suggests there are several plausible avenues for coherently articulating the relationships between patients, professionals, and care pathways. The expertise, preferences, and numbers of available human resources will determine the plausibility that a model will be a coherent response that is appropriate to the needs and environmental constraints (funding models, insurance, etc.). The typologies developed can help assess existing care models analytically or evaluatively and to propose, prospectively, some optimal operational parameters for primary care provision.
Nursing Outlook, 2019
The complexity and difficulties involved with the development and implementation of advanced prac... more The complexity and difficulties involved with the development and implementation of advanced practice roles have resulted in slow and sporadic deployment within and across countries including Canada and Spain. Examination and comparison of contextual factors showed multiple commonalities across two countries that influence advanced practice nursing development and implementation. The results of this project have the potential to contribute significantly to define objectives, implementation and assess the elements characterizing the transferability and implementation of advance practice nursing roles. Assess and measure complex contextual characteristics is important if we aim to continue to develop greater international knowledge about what affects advanced practice development and implementation, in order to better inform local contexts.
Santé Publique, 2013
Mélanie Perroux et al., « Besoins perçus et participation sociale des personnes ayant un traumati... more Mélanie Perroux et al., « Besoins perçus et participation sociale des personnes ayant un traumatisme crânien léger »,
Health policy (Amsterdam, Netherlands), 2018
Healthcare systems performance is the focus of intense policy and media attention in most countri... more Healthcare systems performance is the focus of intense policy and media attention in most countries. Quebec (Canada) is no exception, where successive governments have struggled for decades with apparently intractable problems in care accessibility overall, poor performance, and rising costs. This article explores the underlying causes of the disconnection between the high salience of healthcare system dysfunctions in both media and policy debates and the lack of policy change likely to remedy those dysfunctions. Academically, public policies' evolution is usually conceptualized as the product of complex, long-term interactions among diverse groups with specific power sources and preferences. In this context, we wanted to examine empirically whether divergences in stakeholders' views concerning various healthcare reform options could explain why certain policy changes are not implemented despite consensus on their programmatic coherence. The research design was an explorator...
BMC Health Services Research, 2017
Background: While greater reliance on nurse practitioners in primary healthcare settings can impr... more Background: While greater reliance on nurse practitioners in primary healthcare settings can improve service efficiency and accessibility, their integration is not straightforward, challenging existing role definitions of both registered nurses and physicians. Developing adequate support practices is therefore essential in primary healthcare nurse practitioners' integration. This study's main objective is to examine different structures and mechanisms put in place to support the development of primary healthcare nurse practitioner's practice in different healthcare settings, and develop a practical model for identifying and planning adequate support practices. Methods: This study is part of a larger multicentre study on primary healthcare nurse practitioners in the province of Quebec, Canada. It focuses on three healthcare settings into which one or more primary healthcare nurse practitioners have been integrated. Case studies have been selected to cover a maximum of variations in terms of location, organizational setting, and stages of primary healthcare nurse practitioner integration. Findings are based on the analysis of available documentation in each primary healthcare setting and on semi-structured interviews with key actors in each clinical team. Data were analyzed following thematic and cross-sectional analysis approaches. Results: This article identifies three types of support practices: clinical, team, and systemic. This three-level analysis demonstrates that, on the ground, primary healthcare nurse practitioner integration is essentially a team-based, multilevel endeavour. Despite the existence of a provincial implementation plan, the three settings adopted very different implementation structures and practices, and different actors were involved at each of the three levels. The results also indicated that nursing departments played a decisive role at all three levels. Conclusions: Based on these findings, we suggest that support practices should be adapted to each organization's environment and experience and be modified as needed throughout the integration process. We also stress the importance of combining this approach with a strong coordination mechanism involving managers who have indepth understanding of nursing professional roles and scopes of practice. Making primary healthcare nurse practitioner integration frameworks more flexible and clarifying and strengthening the role of senior nursing managers could be the key to successful integration.
Implementation Science, 2017
Background: Health systems worldwide struggle to identify, adopt, and implement in a timely and s... more Background: Health systems worldwide struggle to identify, adopt, and implement in a timely and system-wide manner the best-evidence-informed-policy-level practices. Yet, there is still only limited evidence about individual and institutional best practices for fostering the use of scientific evidence in policy-making processes The present project is the first national-level attempt to (1) map and structurally analyze-quantitatively-health-relevant policymaking networks that connect evidence production, synthesis, interpretation, and use; (2) qualitatively investigate the interaction patterns of a subsample of actors with high centrality metrics within these networks to develop an in-depth understanding of evidence circulation processes; and (3) combine these findings in order to assess a policy network's "absorptive capacity" regarding scientific evidence and integrate them into a conceptually sound and empirically grounded framework. Methods: The project is divided into two research components. The first component is based on quantitative analysis of ties (relationships) that link nodes (participants) in a network. Network data will be collected through a multi-step snowball sampling strategy. Data will be analyzed structurally using social network mapping and analysis methods. The second component is based on qualitative interviews with a subsample of the Web survey participants having central, bridging, or atypical positions in the network. Interviews will focus on the process through which evidence circulates and enters practice. Results from both components will then be integrated through an assessment of the network's and subnetwork's effectiveness in identifying, capturing, interpreting, sharing, reframing, and recodifying scientific evidence in policy-making processes. Discussion: Knowledge developed from this project has the potential both to strengthen the scientific understanding of how policy-level knowledge transfer and exchange functions and to provide significantly improved advice on how to ensure evidence plays a more prominent role in public policies.
PLOS ONE, 2016
This article discusses the nature and structure of scientific collaboration as well as the associ... more This article discusses the nature and structure of scientific collaboration as well as the association between academic collaboration networks and scientific productivity. Based on empirical data gathered from the CVs of 73 researchers affiliated with an academic research network in Canada, this study used social network analysis (SNA) to examine the association between researchers' structural position in the network and their scientific performance. With reference to Granovetter's and Burt's theories on weak ties and structural holes, we argue it is the bridging position a researcher holds in a scientific network that matters most to improve scientific performance. The results of correlation scores between network centrality and two different indicators of scientific performance indicate there is a robust association between researchers' structural position in collaboration networks and their scientific performance. We believe this finding, and the method we have developed, could have implications for the way research networks are managed and researchers are supported.
BMJ Open, 2015
Introduction: The overall aim of this project is to help develop knowledge about primary care del... more Introduction: The overall aim of this project is to help develop knowledge about primary care delivery models likely to improve the accessibility, quality and efficiency of care. Operationally, this objective will be achieved through supporting and evaluating 8 primary care team pilot sites that rely on an expanded nursing role within a more intensive team-based, interdisciplinary setting. Methods and analysis: The first research component is aimed at supporting the development and implementation of the pilot projects, and is divided into 2 parts. The first part is a logical analysis based on interpreting available scientific data to understand the causal processes by which the objectives of the intervention being studied may be achieved. The second part is a developmental evaluation to support teams in the field in a participatory manner and thereby learn from experience. Operationally, the developmental evaluation phase mainly involves semistructured interviews. The second component of the project design focuses on evaluating pilot project results and assessing their costs. This component is in turn made up of 2 parts. Part 1 is a pre-and-post survey of patients receiving the intervention care to analyse their care experience. In part 2, each patient enrolled in part 1 (around 4000 patients) will be matched with 2 patients followed within a traditional primary care model, so that a comparative analysis of the accessibility, quality and efficiency of the intervention can be performed. The cohorts formed in this way will be followed longitudinally for 4 years. Ethics and dissemination: The project, as well as all consent forms and research tools, have been accepted by 2 health sciences research ethics committees. The procedures used will conform to best practices regarding the anonymity of patients.
SSRN Electronic Journal, 2015
Since 2011, we’ve worked to create a dialogue between Canada’s journalists and academic health po... more Since 2011, we’ve worked to create a dialogue between Canada’s journalists and academic health policy experts to enrich the quality and quantity of health policy stories in the Canadian media. We work with a Media Advisory Board made up of journalists and professors of journalism from across the country who let us know what their needs, constraints and objectives are from a journalistic perspective. We also have a network of more than 80 health policy academics who are ready and available to be interviewed by the media and provide a non-partisan, evidence-based perspective from their areas of expertise.Working together, we have created a number of tools for enabling media coverage of health policy issues in Canada, including the preparation of media backgrounders, infographics, posters, podcasts and videos that highlight the evidence, and we conduct webinars, seminars and conferences by and for both journalists and academics alike.But our most successful initiative thus far has been having our academic experts authorOp-Ed articles on health policy issues — highlighting the evidence; they work with a professional editor to follow specific media guidelines, and then we publish the commentaries in the biggest media outlets across the country. The table below illustrates how successful this strategy has been and how receptive media outlets have been to these stories — increasingly so.This book is a selection of Op-Eds we’ve published in media outlets across the country (in both French and English) from October 2013 to October 2014. It thus provides a snapshot of Canadian health policy in the news. It is the third volume in our series (see also Canadian Health Policy in the News (2013) Making Evidence Matter in Canadian Health Policy (2014)) — all made available for free so that they may be read and used widely in educational settings.Topics are organized by chapter headings that address issues such as our challenges with providing Mental Health care; new models for Pharmaceutical Policy and commentaries that flag the myths and truths about our Aging Population and how it will impact health services. Health Care Costs and Spending are always a concern and are raised by many of the essays here including the costs of health human resources and technology. Many of our academics address the ways in which Health is More than Health Care including such issues as poverty, housing and education, while others caution that More Care is Not Always Better. Still other commentaries highlight the dangers and opportunities with Private, For-Profit Solutions to health care funding and delivery, and others compare Canadian and American Health Systems.Collected together, we hope these Op-Eds engage and enrich the dialogue and debate on a health care system that’s so important to Canadians. As we head into a federal election year in 2015, it seems certain that many of these issues will come to the fore, and it serves our democratic system that they be aired and discussed with evidence as the foundation. With journalists and academics in partnership to communicate health policy in the news, we can help navigate the evidence together.
BMC Health Services Research, 2015
Background: Integrating Nurse Practitioners into primary care teams is a process that involves si... more Background: Integrating Nurse Practitioners into primary care teams is a process that involves significant challenges. To be successful, nurse practitioner integration into primary care teams requires, among other things, a redefinition of professional boundaries, in particular those of medicine and nursing, a coherent model of inter-and intra-professional collaboration, and team-based work processes that make the best use of the subsidiarity principle. There have been numerous studies on nurse practitioner integration, and the literature provides a comprehensive list of barriers to, and facilitators of, integration. However, this literature is much less prolific in discussing the operational level implications of those barriers and facilitators and in offering practical recommendations. Methods: In the context of a large-scale research project on the introduction of nurse practitioners in Quebec (Canada) we relied on a logic-analysis approach based, on the one hand on a realist review of the literature and, on the other hand, on qualitative case-studies in 6 primary healthcare teams in rural and urban area of Quebec. Results: Five core themes that need to be taken into account when integrating nurse practitioners into primary care teams were identified. Those themes are: planning, role definition, practice model, collaboration, and team support. The present paper has two objectives: to present the methods used to develop the themes, and to discuss an integrative model of nurse practitioner integration support centered around these themes. Conclusion: It concludes with a discussion of how this framework contributes to existing knowledge and some ideas for future avenues of study.
Nursing Research and Practice, 2014
Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined rol... more Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strateg...
Healthcare Policy | Politiques de Santé, 2013
Recent years have witnessed important public investments in physicians' compensation across Canad... more Recent years have witnessed important public investments in physicians' compensation across Canada. The current paper uses data from Quebec to assess the impact of those investments on the volumes of services provided to the population. While total physician compensation costs, average physician compensation and average unit cost per service all rose extremely fast, the total number of services, number of services per capita and average number of services per physician either stagnated or declined. This pattern is compatible with the economic target income hypothesis and raises important policy questions. Résumé Ces dernières années, d'importants investissements publics dans la rémunération des médecins ont été consentis partout au Canada. Cet article utilise les données du Québec pour évaluer l'impact de ces investissements sur le volume de services fourni à la population. Alors que les dépenses totales liées à la rémunération des médecins, la rémunération moyenne par médecin DATA MATTERS
Interview Guide (Combined). (DOCX 34 kb)
Canadian journal of community mental health, 2020
Malgre l’offre de soins de sante mentale dans les soins primaires, la fragmentation des soins de ... more Malgre l’offre de soins de sante mentale dans les soins primaires, la fragmentation des soins de sante mentale et physique demeure. Cet article analyse des modeles de prise en charge qui permettrai...
Uploads
Papers by Mélanie Perroux
This strategy aims to reach out to the government, policy makers and the various actors providing services to caregivers for the creation of an interdepartmental committee. In collaboration with community organizations related to caregivers, the objective is to establish the operational and financial parameters of a national support strategy for caregivers. This committee must be based on an inclusive vision of caregivers, which means that it should take into consideration all situations and conditions of persons being cared for (caregivers for adults or children with disabilities or major illnesses, caregivers for senior citizens, etc.). The committee should also be based on the following five approaches:
- The free, informed and revocable choice to be a caregiver
- The recognition of the expertise of caregivers
- The comprehensive, systematic, ongoing and discrete assessment of the needs of caregivers to provide appropriate and ongoing services
- The fight against caregivers’ impoverishment
- The knowledge development of organizations for caregivers and support of their expertise and leadership
Such a strategy is beneficial for the caregivers, as for the people they help and the society that supports them. In our opinion, being a caregiver is an extra role; caregivers have the right not to take on the full responsibility to provide the care and services needed to the person being helped and handle their effects.