Transformation of the Montreal Network: Research Collective

Introduction

The combined challenge of the availability of new technologies and new means of communication and the crisis in public finances has led the State to revisit the organization of its network of health services, which has resulted in the reconfiguration of this network in Montreal-Centre. This has meant a redefinition and reorganization of social and health services implying the reassignment of human, material, and financial resources in all the region’s health establishments (hospitals, CLSCs, etc.) and a reduction of the budgets devoted to health services.

The reconfiguration arose from the implementation of measures defined in the plan drawn up by the Régie régionale de la santé et des services sociaux (RRSSS: hereafter cited in this document simply as the Régie or the Régie régionale). These measures cover fields related to physical and mental health, social adaptation, prevention of illness, and health promotion. Begun in April 1995, implementation of the transformation planned is now completed.

To ensure follow-up on the impact of the measures implemented, the Régie oversees the evaluation of its regional network. Three components of the transformation have thus been chosen for evaluation: user satisfaction, achievement of the objectives of the reconfiguration, and their impact on the health and well-being of the population. The last component falls under the mandate of the Public Health Department. An earlier document describes the process involved in defining the research program; presents the theoretical framework behind that process; identifies the indicators chosen; and shows how they relate to the theoretical framework and the potential effects of the reconfiguration as identified by health professionals. This document also contains the technical indicator sheets used in monitoring and the projects carried out to achieve the program’s goals.

The first report on monitoring results has just been published. The present document summarizes the findings that a group of researchers from various milieus agreed to pool as members of a research collective. The goal is to bring together the results of several research projects which have examined the transformation plan's impact on the health of Montrealers, so as to provide the designers of that plan with the best possible feedback. The information presented here is only that currently available; several projects are still in progress.

This research collective aims to pinpoint as precisely as possible the impact of the transformation on Montreal’s health system and to provide decision-makers with the information needed for a clear-eyed view of these transformations and their future.

The first chapter of this document enumerates the research projects on which the information is based and the researchers who agreed to join the collective. The second presents the methods used to produce the synthesis. The third describes the main structural changes characterizing the transformations carried out in Montreal. This description contextualizes the observations drawn in the synthesis. In the fourth chapter, we synthesize the findings and interpret them in accordance with the research perspective adopted. Finally, in the fifth chapter, we conclude by stating what our interpretation implies for the network's decision-makers and what avenues of research should be pursued to gain better insight into the effects of the reconfiguration.