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2024

Successful and sustainable innovation in a health network, the case of a hospital and community health centre in a rural region of Canada

Stéphanie Collin, Nancy Michaud et Claudie Ringuette
Cet article est une traduction de :
Une innovation réussie et durable au sein d’un réseau de santé, soit un hôpital et centre de santé communautaire en région rurale au Canada [fr]

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1Around the world, public decision-makers are trying to find structural arrangements to improve the performance of health systems. The regionalization strategy has been favored for several decades by most Canadian provinces. These new arrangements were not enough to significantly improve the delivery of health services and care. Some authors maintain that a strengthening of collaboration and participation is essential, thus leaving the "top down" logic to make way for the "bottom up" logic. In this paper, we examine the relational dynamics between the actors associated with a regional health authority and their influence on the emergence and adoption of an innovative practice, namely a hospital and community health center in a rural area, with regards to access to health care and services for Francophone minority communities in the province of New Brunswick, the only one of the 12 Canadian provinces and territories with an official bilingual status (English and French). Two questions arose from this main objective: 1) What are the favorable conditions for innovation in a model of organization in health regions and 2) Can experiments and adaptations lead to lasting social changes in the communities served by a regional health authority?

2The context of our study is followed by a description of New Brunswick’s public health system, in particular the structural reform which led to the amalgamation of eight regional health authorities (RHA) into two, one of them being the subject of our research: the Vitalité Health Network (VHN). The VHN operates officially in French, although under New Brunswick's Official Languages ​​Act (2002), it is required to communicate with citizens in the official language of their choice. The following figure shows (in green) the geographical zones served by the VHN, namely Beauséjour, located in the south-east of the province and the three geographical zones covering the whole of northern NB, in this case the Northwest, the Restigouche and Acadie-Bathurst. Compared to the other regional health authority in the province, the citizens served by the VHN live in Francophone communities which are often in rural areas, have a relatively old population and present a low socioeconomic level.

3We present a case study from the VHN, namely the Lamèque Hospital and Community Health Center (LCHC) (represented by the yellow heart in the figure), which corresponds to an innovative practice that has emerged thanks to the commitment of local actors. The official opening of the LCHC took place in 2005 and since then, it has 12 beds (3 beds for people at the end of life and 9 beds for patients awaiting placement in a nursing home). Its mandate is twofold: 1) To provide the primary health care that citizens need and 2) To improve the health of the population. According to 2022 statistics, it serves a population of a little over 10,300 people. The isolation of this region can be a source of concern but can also be considered as a significant factor in the commitment and solidarity of the communities towards the CSCL. Actions aimed at involving citizens in the provision of health services concerning them were implemented and thought was given to activities that would allow health professionals, such as a dietitian or a social worker, to act effectively towards the community to strengthen their autonomy. To achieve this, the LCHC would focus on five programs or services that went hand in hand with a vision of promoting healthy lifestyles and prevention: 1) chronic disease management, 2) smoking and second-hand smoke, 3) overweight and obesity (eating habits), 4) physical inactivity and lack of exercise, and finally 5) low self-esteem (resilience). They created partnerships with schools and businesses in the region, in addition to organizing guided tours in grocery stores.

4Through a qualitative research method, a total of 18 semi-structured interviews as well as two focus groups were conducted in 2021 and 2022 with a variety of respondents (volunteers, administrators, managers and professionals) thus offering a diversified and complete perspective of the emergence and adoption of innovative practices within a RHA.

5Our results illustrate the conditions that allowed the LCHC to meet the needs of the communities living on its territory. About 20 years after its creation, convincing results on the health of citizens living in the territory covered by the LCHC are noted. The emergence and sustainability of an innovative practice require a consensus on the definition of health, the presence of institutional entrepreneurs and a redefinition of roles and responsibilities between the central authority and local actors. The LCHC is a good example of the reciprocal commitment of local stakeholders to empower themselves, set up a common project and enter collaborative relationships. Our research demonstrates how centralization cannot hide community roots and that collaborative governance is required for innovative practices to emerge and lead to lasting social change.

Figure 1 : Geographic zones served by the VHN

Figure 1 : Geographic zones served by the VHN
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Titre Figure 1 : Geographic zones served by the VHN
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Stéphanie Collin, Nancy Michaud et Claudie Ringuette, « Successful and sustainable innovation in a health network, the case of a hospital and community health centre in a rural region of Canada »Revue francophone sur la santé et les territoires [En ligne], Décentralisation et territorialisation sanitaire, mis en ligne le 22 mars 2024, consulté le 17 juillet 2025. URL : http://journals.openedition.org/rfst/2072 ; DOI : https://doi.org/10.4000/rfst.2072

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