Evaluation of the implementation of the Montreal at home/chez soi project

BMC Health Services Research

Catherine Vallée¹  Guy Grenier³  Marie-Josée Fleury² 

[1]Rehabilitation Department, Laval University, Quebec GIV 0A6, Quebec, Canada

[2]Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre Research Centre, Montreal Addiction Rehabilitation Centre - University Institute, 6875 LaSalle Blvd., Montreal H4H 1R3, Quebec, Canada

[3]Douglas Hospital Research Centre, Montreal H4H 1R3, Quebec, Canada

关键词: Evidence based practices;    Housing first program;    At home/chez soi project;    Supported housing;    Homelessness;    Mental health;    Hindering and enabling factors of innovation;    Implementation process;   

Others  :  1090755
DOI  :  10.1186/s12913-014-0557-6

 received in 2014-06-27, accepted in 2014-10-24,  发布年份 2014

【 摘 要 】

Background

Homelessness and mental disorders constitute a major problem in Canada. The purpose of the At Home/Chez Soi pilot project was to house and provide supports to marginalised groups. Policymakers are in a better position to nurture new, complex interventions if they know which key factors hinder or enable their implementation. This paper evaluates the implementation process for the Montreal site of this project.

Methods

We collected data from 62 individuals, through individual interviews, focus groups, questionnaires, observations and documentation. The implementation process was analysed using a conceptual framework with five constructs: Intervention Characteristics (IC), Context of Implementation (CI), Implementation Process (IP), Organizational Characteristics (OC) and Strategies of Implementation (SI).

Results

The most serious obstacle to the project came from the CI construct, i.e., lack of support from provincial authorities and key local resources in the homelessness field. The second was within the OC construct. The chief hindrances were numerous structures, divergent values among stakeholders, frequent turnover of personnel and team leaders; lacking staff supervision and miscommunication. The third is related to IC: the complex, unyielding nature of the project undermined its chances of success. The greatest challenges from IP were the pressure to perform, along with stress caused by planning, deadlines and tension between teams. Conversely, SI construct conditions (e.g., effective governing structures, comprehensive training initiatives and toolkits) were generally very positive even with problems in power sharing and local leadership. For the four other constructs, the following proved useful: evidence of the project’s scope and quality, great needs of services consolidation, generous financing and status as a research pilot project, enthusiasm and commitment toward the project, substantially improved services, and overall user satisfaction.

Conclusion

This study demonstrated the difficulty of implementing a complex project in the healthcare system. While the project faced many barriers, minimal conditions were also achieved. At the end of the study period, major tensions between organizations and teams were significantly reduced, supporting its full implementation. However, in late 2013, the project was unsustainable, calling into question the relevance of achieving a significant number of positive conditions in each area of the framework.

【 授权许可】

   
2014 Fleury et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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