Évaluation de l’implantation d’un système régional d’admission en hébergement et en soins de longue durée pour personnes âgées au Québec

Abstract

Between 1975 and 1984, the Quebec public healthcare network adopted a new admission process for residential and chronic-care homes for elderly people no longer able to function independently. This was known as the CTMSP (type classification for long-term care and services) system. Preparation and distribution of this management tool met with some resistance because of the large number of people involved and the very specific Quebec and North American context. This article reconstructs the events leading to the adoption of the CTMSP system by the Quebec minister of health and social services and the regional health and social service councils from the archives of these organizations as well as interviews with ten key people who provided information. Commissioned by those responsible for the network from university researchers, the system was tested in a community health department before being adopted by regional councils looking for an integrated admissions system, and was then officially adopted by the health department in 1984 and put into general use throughout the province. Diachronic analysis of the CTMSP distribution process reviews the linear phase-oriented model of the preparation-adoption-implementation type. The decision-making process resembles a long and laborious succession of highly repetitive positions in which the power games of managers, designers, and professionals are decisive factors. Early participation of pressure groups interested in the preparation of the system, and feedback information followed by action, are the main forces of the CTMSP implementation strategy. The North American context of economic rationalization and the Quebec administrative decentralization crisis of the late 1970s can be seen as opportunities or constraints tha also helped to shape implementation.