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Unpacking the Meaning of Quality in Quebec’s Health-care System: The Input of Commissions of Inquiry

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Abstract

The paper explores how several commissions of inquiry established in Quebec, Canada, have, over time, contributed in redefining the meaning of quality in health-care and its management. Adopting an interpretive analysis of commissions’ reports, the paper examines the particular ‘conceptual boxes’ used by their members to tackle quality and the embedded nature of their work. It is shown that although quality was always considered, this was generally done by bringing into focus specific quality domains and issues, some new, others not so new. In addition, the various management approaches to quality featured in the reports were informed by evolving templates; although this evolution was not as straight and unwavering as some retrospective studies of quality in health-care seem to indicate. A common thread to all commissions is the fact that, beyond the definition of general principles, responsibility for quality oversight was not clearly assigned and criteria on whether quality initiatives should be voluntary or compulsory were often left unspecified. Further, quality was never regarded by the commissions as a strategic aspect of health-care. It is speculated that these failings on the part of commissions may partly explain the unassertive course of action taken by the provincial government in the area.

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Notes

  1. The material produced by the three commissions was nevertheless considerable; the Castonguay-Nepveu Commission published a seven-volume final report (1,752 p) and twenty-one sponsored studies, the Rochon Commission released an extensive final report (803 p), supported by 45 commissioned studies, whereas the Clair Commission, of more modest proportions and shorter duration, issued a final report (454 p) and a separate volume featuring annexes (419 p).

  2. Unless otherwise indicated, all reports excerpts have been translated from French into English by the authors.

References

  1. Aucoin, P. (1990). Contributions of commissions of inquiry to policy analysis: An evaluation. In A. P. Pross, et al. (Eds.), Commissions of inquiry. Toronto: Carswell.

    Google Scholar 

  2. Bégin C. P., et al. (Eds.). (1999) Le Système de santé québécois : Un modèle en transformation. Montréal: Presses de l’Université de Montréal Laval.

  3. Bergeron, P., Gagnon, F. (2005) La prise en charge étatique de la santé au Québec: Émergence et transformations. In V. Lemieux, et al. (Eds.), Le système de santé au Québec: Organisations, acteurs et enjeux. Québec: Presses de l’Université Laval.

  4. Bradford, N. (1999/2000) Writing public philosophy: Canada’s royal commissions on everything. Journal of Canadian Studies, 34(4), 136–167.

    Google Scholar 

  5. Brunnelle, Y. (1993). La qualité des soins et des services: cadre conceptuel. Québec: Ministère de la Santé et des Services sociaux.

    Google Scholar 

  6. Buchan, H. (1998). Different countries, different cultures: convergent or divergent evolution for healthcare quality? Quality in Health Care, 7, S62–S67.

    PubMed  Google Scholar 

  7. Castonguay-Nepveu Commission (1969–1972) Rapport de la Commission d’enquête sur la santé et le bien-être social. Volumes I à VII. Author, Quebec.

  8. Chaudhuri, N. B., et al. (2005). Extreme makeover: Can we achieve rapid improvement in Canada’s Healthcare System? Healtcare Papers, 6(2), 28–34.

    Google Scholar 

  9. Clair Commission. (2000). Les Solutions émergentes. Rapport de la Commission d’étude sur les services de santé et les services sociaux. Quebec: Author.

    Google Scholar 

  10. Davies, A. (1999). Using contracts to enforce standards: The case of waiting times in the National Health Service. In C. McCrudden (Ed.), Regulation and deregulation: Policy and practice in the utilities and financial services industries. Oxford: Clarendon Press.

    Google Scholar 

  11. de Pouvourville, G. (1997). Quality of care initiatives in the French context. international. Journal for Quality in Health Care, 9(3), 163–170.

    Article  Google Scholar 

  12. Donaldson, L. (1999) Quality in health care: The UK perspective. Paper given at the Commonwealth Fund/The Nuffield Trust 1999 Margaret E Mahoney Symposium Ditchley Park, UK.

  13. Dubois, C. A., & Denis, J.-L. (2001). De la Commission Castonguay-Nepveu à la Commission Clair: le façonnement socio-historique de l’imputabilité dans le système de soins de santé au Québec. Montréal: Chaire Fondation Canadienne de Recherche sur les Services de Santé.

    Google Scholar 

  14. Duplantie, J.-P. (2001). À petits pas... de la Commission Rochon à la Commission Clair. Ruptures, 8(1), 88–97.

    Google Scholar 

  15. Edelman, M. J. (1964). The symbolic uses of politics. Urbana: University of Illinois Press.

    Google Scholar 

  16. Ellis, R., & Whittington, D. (1993). Quality assurance in health care: A handbook. London: Edward Arnold.

    Google Scholar 

  17. Giraud, A. (2001). Accreditation and the quality movement in France. Quality in Health Care, 10, 111–116.

    Article  PubMed  CAS  Google Scholar 

  18. Glynn, J. J., & Perkins, D. (1997). Control and accountability in the NHS market: a practical proposition or logical impossibility. International Journal of Public Sector Management, 10(1/2), 62–75.

    Article  Google Scholar 

  19. Gosselin, R. (2001). À petits pas... de la Commission Castonguay-Nepveu à la Commission Rochon. Ruptures, 8(1), 78–87.

    Google Scholar 

  20. Gow, J. I., & Guertin, A. (1998). L’administration publique: rationalisation et responsabilisation. In R. Boily (Ed.), L’Année politique au Québec, 1996–1997. Montreal: Éditions Fides.

    Google Scholar 

  21. Graefe, P. (2003) From deadbeat dad to quality-time parenting? The federal government and intergovernmental relations in health policy. International Journal of Canadian Studies, 28, 91–110.

    Google Scholar 

  22. Graham, N. O. (1995). Quality in health care. Theory, application, and evolution. Gaithersburg: Aspen Publishers, Inc.

    Google Scholar 

  23. Guerriere, M. (2004). Hippocrates denied: Why Canada has yet to act on the patient safety imperative. Healthcare Papers, 5(3), 28–32.

    PubMed  Google Scholar 

  24. Haddad, S. D., et al. (1997). Comprendre la qualité: en reconnaître la complexité. Ruptures, 4(1), 59–78.

    Google Scholar 

  25. Harteloh, P. P. M. (2003). The meaning of quality in health care: A conceptual analysis. Health Care Analysis, 11(3), 259–267.

    Article  PubMed  CAS  Google Scholar 

  26. Harvey, G. (1996). Quality in health care: Traditions, influences and future directions. International Journal for Quality in Health Care, 8(4), 341–350.

    Article  PubMed  CAS  Google Scholar 

  27. Jenson, J. (1994). Commissioning ideas: Representation and royal commissions. In S. D. Phillips (Ed.), How Ottawa spends 1994–95: Making change. Ottawa: Carleton University Press.

    Google Scholar 

  28. JCAHO (1995). Patient’s perspective: Using patient input in a cycle for performance improvement. Joint Commission Journal on Quality Improvement, 21(2), 87–96.

    Google Scholar 

  29. Lazar, H., Banting, K., Boadway, R., et al. (2004). Federal-provincial relations and health care: Reconstructing the partnership. In H. Lazar, F. St-Hilaire (Eds.), Money, politics and health care: Reconstructing the federal-provincial partnership. Montreal: McGill-Queen’s University Press.

    Google Scholar 

  30. Leatherman, S., & Sutherland, K. (1998). Evolving quality in the new NHS: policy, process, and pragmatic considerations. Quality in Health Care, 7, S54–S61.

    PubMed  Google Scholar 

  31. Lee, S. S. (1979) Quebec’s health system: A decade of change, 1967–77. Ottawa: Institute of Public Administration of Canada.

    Google Scholar 

  32. Lemieux, V., et al. (2005). Le système de santé au Québec: organisations, acteurs et enjeux. Presses de l’Université Laval, Sainte-Foy, Québec.

  33. Lesemann, F. (1981). Du pain et des services. La réforme de la santé et des services sociaux au Québec. Montréal: Éditions coopératives Albert Saint-Martin.

    Google Scholar 

  34. Lim, M. K. (2004). Quest for quality care and patient safety: the case of Singapore. Quality and Safety in Health Care, 13, 71–75.

    Article  PubMed  CAS  Google Scholar 

  35. Lohr, K. N. (1990). Medicare: A strategy for quality assurance. Washington: National Academy Press.

    Google Scholar 

  36. Lucas, A. R. (2003). A public inquiries act. Issues Paper. Paper prepared for the Uniform Law Conference of Canada, Calgary.

  37. Maioni, A. (2001). “Emerging solutions”: Quebec’s clair commission report and health care reform. Ottawa: CPRN backgrounder.

    Google Scholar 

  38. Maioni A. (2003). Quebec and the health council: Some reflections. In P. Baranek (Ed.), Report of the invitational workshop on a health council. Toronto: The Atkinson Foundation.

    Google Scholar 

  39. Madhok, R. (2002). Crossing the quality chasm: Lessons from health care quality improvement efforts in England. BUMC Proceedings, 15(1), 77–83.

    PubMed  Google Scholar 

  40. Marchildon, G. (2001). Royal commissions and the policy cycle in Canada: The case of health care. Saskatoon: The Saskatchewan Institute of Public Policy.

    Google Scholar 

  41. McNeil, R. (1999). De la qualité pour tous. Programme d’amélioration continue de la qualité des services et de la satisfaction des usagers. Montréal: Régie régionale de la Santé et des services sociaux de Montréal-Centre.

    Google Scholar 

  42. Ministry of Health, Social Services (2006). Guaranteeing access. Meeting the challenges of equity, efficiency and quality. Quebec: Author.

    Google Scholar 

  43. Pineault, R. (2001). Le rapport de la Commission Clair. Avant-propos. Ruptures, 8(1), 58–59.

    Google Scholar 

  44. Pineault, R. (2006). In what direction is the Canadian healthcare system evolving? Journal of Public Health Policy, 27, 190–195.

    Article  PubMed  Google Scholar 

  45. Powell, M. (2003). Quasi-markets in British Health Policy: A Longue Durée perspective. Social Policy and Administration, 37(7), 725–741.

    Article  Google Scholar 

  46. Press, I. (1997). The quality movement in U.S. health care: Implications for anthropology. Human Organization, 56, 1–8.

    Google Scholar 

  47. Prior, L. (2003). Using documents in social research. Thousand Oaks: Sage.

    Google Scholar 

  48. Renaud, M. (1977). Réforme ou illusion? Une analyse des interventions de l’État québécois dans le domaine de la santé. Sociologie et sociétés, 9(1), 127–152.

    Google Scholar 

  49. Rochon Commission (1987). Rapport de la Commission d’enquête sur les services de santé et les services sociaux. Quebec: Author.

    Google Scholar 

  50. Scala, F. (1997). Pratiques discursives et savoir social: l’exemple de la commission royale sur les nouvelles techniques de reproduction. Politique et Sociétés, 16(3), 105–127.

    Google Scholar 

  51. Tuohy, C. H. (1999). Accidental logics: The dynamics of change in the health care arena in the United States, Britain, and Canada. Toronto: Oxford University Press.

    Google Scholar 

  52. Yanow, D. (2000). Conducting interpretive policy analysis. Thousand Oaks: Sage.

    Google Scholar 

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Acknowledgments

I am indebted with Rachel Caron, research assistant, who helped in the gathering of information and preliminary analysis of material used as the basis for this paper. Yvon Brunelle and Frédéric Lesemann provided insightful comments on earlier drafts. The opinions stated in the paper, however, are solely those of the author.

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  1. Groupe de recherche sur les aspects sociaux de la santé et de la prévention (GRASP), Université de Montréal, Succursale Centre-ville, P.O. Box 6128, Montreal, QC, Canada, H3C 3J7

    Oscar E. Firbank

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Firbank, O.E. Unpacking the Meaning of Quality in Quebec’s Health-care System: The Input of Commissions of Inquiry. Health Care Anal 16, 375–396 (2008). https://doi.org/10.1007/s10728-007-0078-0

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