What has Quebec done to encourage interprofessional collaboration? It is important to understand that, as soon as the network was created, we established this principle, in particular, by applying the CLSC primary care model. But, as you may already know, the CLSC model has not been very successful, because of challenges with physician recruitment, among other things.
It didn't take us long to realize that we had to use other avenues. So we began using legislative channels to encourage collaboration. Bill 90 was introduced in 2002 to foster greater flexibility in the organization of work and to allow for some overlap with disciplines so as to ensure a continuous and comprehensive approach to complex problems. Those changes were also applied to mental health and human relations in 2009 with the introduction of Bill 21, which has not yet come into force.
On top of the legislative changes, we also stressed the importance of collaboration in different policies. In particular, the cancer and mental health policies refer to the importance of interprofessional collaboration.
We also tried to incorporate the collaboration principle into the organization of services, especially in primary care. Quebec set up family medicine groups, where physicians and nurses work together. In other areas of care, client programs based on interprofessional collaboration were established. Quebec has also invested a great deal in information technology since 2006 to facilitate interprofessional collaboration.
Is this major focus on collaboration warranted? What do the findings show? Numerous studies discuss collaboration and its benefits, especially the improvements to the continuity, accessibility and use of services. Collaboration has also been shown to better address needs.
That being said, the validity of the findings has drawn a bit of criticism in recent years. Some studies have methodological weaknesses. A publication bias has also been observed, meaning that journals have a tendency to publish only studies showing the positive effects of the approach. Some recent studies have also shown that the quality of care is not tied solely to the level of interdisciplinary interaction. Other variables come into play. What that means, then, is we may need to gain a better understanding of the processes giving rise to the effects. So the research has to be done.
As for the process of interprofessional collaboration, a number of empirical studies show the difficulties of collaboration owing to several factors. One is the fact that professional logic models do not encourage collaboration because they are based on the principle of exclusivity of fields of practice. Furthermore, practitioners are not trained to work in collaboration. Power struggles also hinder collaboration. It is important not to underestimate how difficult it is to change entrenched practices that make perfect sense to those who follow them.
What does the empirical research reveal about the information technologies used to enhance collaboration? Some have been successful, of course. But there is a significant challenge around the technologies and their use owing to a variety of risks. They may be technical risks stemming from response times, for instance, or human risks stemming from the resistance of practitioners. Organizational risks also exist; they have to do with the alignment between technologies and the organization of work, and so forth.
What all those studies show, then, is that information technologies do not necessarily have an impact on practices.
In light of those findings, what would we recommend?