Processus d'implantation d'une mesure législative favorisant la sécurité des patients : le cas de la Loi 113 au Québec
In Quebec, Bill 113 was passed in 2002 to reduce the incidence and consequences of adverse events during health care. This law requires making several changes in both administrative and clinical settings, including the establishment of risk management committees, establishing policies for disclosure to patients and systematic reporting of adverse events in hospitals. However, the ability of these institutions to implement the measures required by law has been questioned by some authors. The aim of this thesis was to study the process of implementing Bill 113 from a theoretical framework integrating organizational development, institutional and political approaches. To do so, we conducted a multiple case study, each case being represented by a type of hospital qualified in the context of our study as « small », « large » and « academic ». Data collection procedures consisted of interviews with administrators and health professionals, observation of risk management committee meetings, and analysis of administrative documents from each institution.  The results suggest a gradual implementation of the law that varies from one hospital to another and the presence of conflicts between professional and organizational practices and new legal standards. The latter seem to have been adopted at the administrative level, while the professional and organizational standards have continued to dominate the clinical level, a situation that led to a climate of mistrust between the administrative and clinical settings, particularly among doctors from each hospital. The results of our study also suggest that strategies that have most contributed to change result from a strong and legitimate leadership of the principal agents of change, such as steering and risk manager, and stewardship of the organizational environment. However, despite ongoing efforts mobilized within each institution to implement the law, there has been continuing resistance by some key players. In conclusion, the involvement and contribution from stakeholders inside and outside the organization are necessary to achieve a shared vision and align the different interventions to ensure the successful implementation of the law.
Patient safety hospital legislation measures Change