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
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).
Unless otherwise indicated, all reports excerpts have been translated from French into English by the authors.
References
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.
Bégin C. P., et al. (Eds.). (1999) Le Système de santé québécois : Un modèle en transformation. Montréal: Presses de l’Université de Montréal Laval.
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.
Bradford, N. (1999/2000) Writing public philosophy: Canada’s royal commissions on everything. Journal of Canadian Studies, 34(4), 136–167.
Brunnelle, Y. (1993). La qualité des soins et des services: cadre conceptuel. Québec: Ministère de la Santé et des Services sociaux.
Buchan, H. (1998). Different countries, different cultures: convergent or divergent evolution for healthcare quality? Quality in Health Care, 7, S62–S67.
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.
Chaudhuri, N. B., et al. (2005). Extreme makeover: Can we achieve rapid improvement in Canada’s Healthcare System? Healtcare Papers, 6(2), 28–34.
Clair Commission. (2000). Les Solutions émergentes. Rapport de la Commission d’étude sur les services de santé et les services sociaux. Quebec: Author.
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.
de Pouvourville, G. (1997). Quality of care initiatives in the French context. international. Journal for Quality in Health Care, 9(3), 163–170.
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.
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.
Duplantie, J.-P. (2001). À petits pas... de la Commission Rochon à la Commission Clair. Ruptures, 8(1), 88–97.
Edelman, M. J. (1964). The symbolic uses of politics. Urbana: University of Illinois Press.
Ellis, R., & Whittington, D. (1993). Quality assurance in health care: A handbook. London: Edward Arnold.
Giraud, A. (2001). Accreditation and the quality movement in France. Quality in Health Care, 10, 111–116.
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.
Gosselin, R. (2001). À petits pas... de la Commission Castonguay-Nepveu à la Commission Rochon. Ruptures, 8(1), 78–87.
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.
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.
Graham, N. O. (1995). Quality in health care. Theory, application, and evolution. Gaithersburg: Aspen Publishers, Inc.
Guerriere, M. (2004). Hippocrates denied: Why Canada has yet to act on the patient safety imperative. Healthcare Papers, 5(3), 28–32.
Haddad, S. D., et al. (1997). Comprendre la qualité: en reconnaître la complexité. Ruptures, 4(1), 59–78.
Harteloh, P. P. M. (2003). The meaning of quality in health care: A conceptual analysis. Health Care Analysis, 11(3), 259–267.
Harvey, G. (1996). Quality in health care: Traditions, influences and future directions. International Journal for Quality in Health Care, 8(4), 341–350.
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.
JCAHO (1995). Patient’s perspective: Using patient input in a cycle for performance improvement. Joint Commission Journal on Quality Improvement, 21(2), 87–96.
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.
Leatherman, S., & Sutherland, K. (1998). Evolving quality in the new NHS: policy, process, and pragmatic considerations. Quality in Health Care, 7, S54–S61.
Lee, S. S. (1979) Quebec’s health system: A decade of change, 1967–77. Ottawa: Institute of Public Administration of Canada.
Lemieux, V., et al. (2005). Le système de santé au Québec: organisations, acteurs et enjeux. Presses de l’Université Laval, Sainte-Foy, Québec.
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.
Lim, M. K. (2004). Quest for quality care and patient safety: the case of Singapore. Quality and Safety in Health Care, 13, 71–75.
Lohr, K. N. (1990). Medicare: A strategy for quality assurance. Washington: National Academy Press.
Lucas, A. R. (2003). A public inquiries act. Issues Paper. Paper prepared for the Uniform Law Conference of Canada, Calgary.
Maioni, A. (2001). “Emerging solutions”: Quebec’s clair commission report and health care reform. Ottawa: CPRN backgrounder.
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.
Madhok, R. (2002). Crossing the quality chasm: Lessons from health care quality improvement efforts in England. BUMC Proceedings, 15(1), 77–83.
Marchildon, G. (2001). Royal commissions and the policy cycle in Canada: The case of health care. Saskatoon: The Saskatchewan Institute of Public Policy.
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.
Ministry of Health, Social Services (2006). Guaranteeing access. Meeting the challenges of equity, efficiency and quality. Quebec: Author.
Pineault, R. (2001). Le rapport de la Commission Clair. Avant-propos. Ruptures, 8(1), 58–59.
Pineault, R. (2006). In what direction is the Canadian healthcare system evolving? Journal of Public Health Policy, 27, 190–195.
Powell, M. (2003). Quasi-markets in British Health Policy: A Longue Durée perspective. Social Policy and Administration, 37(7), 725–741.
Press, I. (1997). The quality movement in U.S. health care: Implications for anthropology. Human Organization, 56, 1–8.
Prior, L. (2003). Using documents in social research. Thousand Oaks: Sage.
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.
Rochon Commission (1987). Rapport de la Commission d’enquête sur les services de santé et les services sociaux. Quebec: Author.
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.
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.
Yanow, D. (2000). Conducting interpretive policy analysis. Thousand Oaks: Sage.
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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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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DOI: https://doi.org/10.1007/s10728-007-0078-0