Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2015

Open Access 01-12-2015 | Study protocol

Understanding cancer networks better to implement them more effectively: a mixed methods multi-case study

Authors: Dominique Tremblay, Nassera Touati, Danièle Roberge, Mylaine Breton, Geneviève Roch, Jean-Louis Denis, Bernard Candas, Danièle Francoeur

Published in: Implementation Science | Issue 1/2015

Login to get access

Abstract

Background

Managed cancer networks are widely promoted in national cancer control programs as an organizational form that enables integrated care as well as enhanced patient outcomes. While national programs are set by policy-makers, the detailed implementation of networks is delegated at the service delivery and institutional levels. It is likely that the capacity to ensure more integrated cancer services requires multi-level governance processes responsive to the strengths and limitations of the contexts and capable of supporting network-based working. Based on an empirical case, this study aims to analyze the implementation of a mandated cancer network, focusing on governance and health services integration as core concepts in the study.

Methods/design

This nested multi-case study uses mixed methods to explore the implementation of a mandated cancer network in Quebec, a province of Canada. The case is the National Cancer Network (NCN) subdivided into three micro-cases, each defined by the geographic territory of a health and social services region. For each region, two local health services centers (LHSCs) are selected based on their differences with respect to determining characteristics. Qualitative data will be collected from various sources using three strategies: review of documents, focus groups, and semi-directed interviews with stakeholders. The qualitative data will be supplemented with a survey that will measure the degree of integration as a proxy for implementation of the NCN. A score will be constructed, and then triangulated with the qualitative data, which will have been subjected to content analysis. Qualitative, quantitative, and mixed methods data will be interpreted within and across cases in order to identify governance patterns similarities and differences and degree of integration in contexts.

Discussion

This study is designed to inform decision-making to develop more effective network implementation strategies by thoroughly describing multi-level governance processes of a sample of settings that provide cancer services. Although the study focuses on the implementation of a cancer network in Quebec, the rich descriptions of multiple nested cases will generate data with a degree of generalizability for health-care systems in developed countries.
Appendix
Available only for authorised users
Literature
1.
Provan KG, Beagles JE, Leischow SJ. Network formation, governance, and evolution in public health: the North American Quitline Consortium case. Health Care Manage Rev. 2011;36(4):315.CrossRefPubMedPubMedCentral
2.
Provan KG, Fish A, Sydow J. Interorganizational networks at the network level: a review of the empirical literature on whole networks. J Manage. 2007;33(3):479–516.
3.
Ferlie E. Making wicked problems governable? The case of managed networks in health care. Oxford, UK: Oxford University Press; 2013.
4.
Taplin SH, Clauser S, Rodgers AB, Breslau E, Rayson D. Interfaces across the cancer continuum offer opportunities to improve the process of care. J Natl Cancer Inst Monogr. 2010;2010(40):104–10.CrossRefPubMedPubMedCentral
5.
Calman K, Hine D. A policy framework for commissioning cancer services: a report by the Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales. London: Department of health; 1995. January 20, 2016.
6.
Commission on Cancer. Cancer program standards: ensuring patient-centered care. Chicago, IL: 2016.
7.
Department of Health. The NHS cancer plan: a plan for investment, a plan for reform. London: National Health Service; 2000.
8.
Meyrieux B. INCa: projet d’établissement et orientations stratégiques 2012–2015. Bulletin Infirmier du Cancer. 2012;12(4):100–3.
9.
Department of Health WA. Model of care for cancer. Perth: WA: Cancer & Palliative Care Network; 2008. January 20, 2016.
10.
Evans J, Matheson G, Buchman S, MacKinnon M, Meertens E, Ross J, et al. Integrating cancer care beyond the hospital and across the cancer pathway: a patient-centred approach. Healthc Q. 2015;17:28.CrossRefPubMed
11.
Vandenberg T, Coakley N, Nayler J, DeGrasse C, Green E, Mackay JA, et al. A framework for the organization and delivery of systemic treatment. Curr Oncol. 2009;16(1):4–15.CrossRefPubMedPubMedCentral
12.
Turrini A, Cristofoli D, Frosini F, Nasi G. Networking literature about determinants of network effectiveness. Public Adm. 2010;88(2):528–50.CrossRef
13.
Sheaff R, Benson L, Farbus L, Schofield J, Mannion R, Reeves D. Network resilience in the face of health system reform. Soc Sci Medicine. 2010;70(5):779–86.CrossRef
14.
Popp J, MacKean G, Casebeer A, Milward H, Lindstrom R. Inter-organizational networks—a review of the literature to inform practice. Washington DC: IBM Center for the Business of Government; 2013.
15.
Provan KG, Milward HB. Health services delivery networks: what do we know and where should we be headed? Healthc Pap. 2006;7(2):32–6.CrossRefPubMed
16.
Provan KG, Nakama L, Veazie MA, Teufel-shone NI, Huddleston C. Building community capacity around chronic disease services through a collaborative interorganizational network. Health Educ Behav. 2003;30(6):646–62.CrossRefPubMed
17.
Haines M, Brown B, Craig J, D'Este C, Elliott E, Klineberg E, et al. Determinants of successful clinical networks: the conceptual framework and study protocol. Implement Sci. 2012;7:16.CrossRefPubMedPubMedCentral
18.
19.
Wistow G, Dickinson H, Evans JM, Ross BG. Shared mental models of integrated care: aligning multiple stakeholder perspectives. J Health Organ Manag. 2012;26(6):713–36.CrossRef
20.
Addicott R, McGivern G, Ferlie E. The distortion of a managerial technique? The case of clinical networks in UK health care. Brit J Manage. 2007;18(1):93–105.CrossRef
21.
22.
Hébert R, PRISMA Group, Raîche M, Gueye NR, Dubuc N, Tousignant M. Impact of PRISMA, a coordination-type integrated service delivery system for frail older people in Quebec (Canada): a quasi-experimental study. J Gerontol B Psychol Sci Soc Sci. 2010;65B(1):107–18.CrossRefPubMed
23.
24.
Wedding U, Kodding D, Pientka L, Steinmetz HT, Schmitz S. Physicians’ judgement and comprehensive geriatric assessment (CGA) select different patients as fit for chemotherapy. Crit Rev Oncol Hematol. 2007;64(1):1–9.CrossRefPubMed
25.
Kodner D. Whole-system approaches to health and social care partnerships for the frail elderly: an exploration of North American models and lessons. Health Soc Care Communit. 2006;14(5):384–90.CrossRef
26.
Bernabei R, Landi F, Zuccala G. Health care for older persons in Italy. Aging Clin Exp Res. 2002;14(4):247–51.CrossRefPubMed
27.
Sargent P, Pickard S, Sheaff R, Boaden R. Patient and carer perceptions of case management for long-term conditions. Health Soc Care Communit. 2007;15(6):511–9.CrossRef
28.
Béland F, Hollander MJ. Integrated models of care delivery for the frail elderly: international perspectives. Gac Sanit. 2011;25 Suppl 2:138–46.CrossRefPubMed
29.
Kaluzny AD, Warnecke RB. Managing a health care alliance: improving community cancer care. 2nd ed. Washington: Beard Books; 2000.
30.
Provan KG, Milward HB. A preliminary theory of interorganizational network effectiveness: a comparative study of four community mental health systems. Admin Sci Quart. 1995;40(1):1–33.CrossRef
31.
Hatchuel A. Prospective et gouvernance: quelle théorie de l'action collective? In: Heurgon E, Landrieu J, editors. Prospective pour une gouvernance démocratique. La Tour d'Aigues: Éditions de l'Aube: Colloque de Cerisy; 2000. p. 29–42.
32.
Provan KG, Kenis P. Modes of network governance: structure, management, and effectiveness. J Public Adm Res Theory. 2008;18(2):229–52.CrossRef
33.
Addicott R, Ferlie E. Understanding power relationships in health care networks. J Health Organ Manag. 2007;21(4-5):393–405.PubMed
34.
Pomey MP, Denis JL, Contandriopoulos AP. Un cadre conceptuel d'analyse de la gouvernance clinique dans les établissements de santé. Pratiques et organisation de soins. 2008;39(3):183–94.
35.
36.
Denis J-L, Champagne F, Pomey MP, Préval J, Tré G. Toward a framework for the analysis of governance in health care organizations and systems. Preliminary report presented to the Canadian Council on Health Services Accreditation. Montréal: Université de Montréal; 2005.
37.
38.
39.
40.
Stake R. Multiple case study analysis. New York: Guilford; 2005.
41.
Fitzgerald L, Dopson S. Comparative case study designs: their utility and development in organizational research. In: Buchanan DA, Bryman A, editors. The SAGE handbook of organizational research methods. Thousand Oaks, CA: SAGE Publications; 2009. p. 465–83.
42.
Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. 3rd ed. Thousand Oaks, CA: SAGE Publications; 2009.
43.
Tremblay D, Roberge D, Cazale L, Touati N, Maunsell E, Latreille J, et al. Evaluation of the impact of interdisciplinarity in cancer care. BMC Health Serv Res. 2011;11:144.CrossRefPubMedPubMedCentral
44.
Tremblay D. La traduction d’une innovation organisationnelle dans les pratiques professionnelles de réseau: l’infirmière pivot en oncologie [Ph.D. thesis]. Montréal: Université de Montréal; 2008.
45.
Roberge D, Denis J-L, Cazale L, Comtois E, Pineault R, Touati N, et al. Évaluation du réseau intégré de soins et de services en oncologie: l'expérience de la Montérégie. Rapport final de recherche. Ottawa: Fondation Canadienne de la recherche sur les services de santé; 2004.
46.
Tremblay D, Drouin D, Lang A, Roberge D, Ritchie J, Plante A. Interprofessional collaborative practice within cancer teams: translating evidence into action. A mixed methods study protocol. Implement Sci. 2010;5:53.CrossRefPubMedPubMedCentral
47.
Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 4th ed. London: SAGE Publications; 2009.
48.
Guest G, Namey EE, Mitchell ML. Collecting qualitative data: a field manual for applied research. Thousand Oaks: SAGE Publications; 2013.
49.
Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82.CrossRef
50.
Saldana J. The coding manual for qualitative researchers. Thousand Oaks: SAGE Publications; 2009.
51.
Dillman DA, Smyth JD, Christian LM. Internet, mail and mixed-mode surveys: the tailored design method. 3rd ed. Hoboken, NJ: John Wiley Co.; 2009.
52.
Fitzgerald L, Ferlie E, McGivern G, Buchanan D. Distributed leadership patterns and service improvement: evidence and argument from English healthcare. Leadersh Q. 2013;24(1):227–39.CrossRef
53.
54.
Shortell SM, Gillies RR, Anderson DA. Remaking health care in America. The evolution of organized delivery system. Second ed. New York: Jossey-Bass; 2000.
55.
Shortell SM, Gillies RG, Anderson DA, Mitchell JB, Morgan KL. Creating organized delivery systems: the barriers and facilitators. Hosp Health Serv Admin. 1993;38(4):447–66.
56.
Dobrow MJ, Paszat L, Golden B, Brown AD, Holowaty E, Orchard MC, et al. Measuring integration of cancer services to support performance improvement: the CSI survey. Healthc Policy. 2009;5(1):35–53.PubMedPubMedCentral
57.
Cazale L, Tremblay D, Roberge D, Touati N. La vignette: une stratégie novatrice pour apprécier la qualité des soins d'équipes interdisciplinaires en oncologie. Rev Epidemiol Sante Publique. 2006;54(5):407–20.CrossRefPubMed
58.
James LR, Demaree RG, Wolf G. Estimating within-group interrater reliability with and without response bias. J Appl Psychol. 1984;69(1):85–98.CrossRef
59.
60.
Yin RK. Validity and generalization in future case study evaluations. Evaluation. 2013;19(3):321–32.CrossRef
61.
Patton MQ, LaBossière F. L'évaluation axée sur l'utilisation. In: Ridde V, Dagenais C, editors. Approches et pratiques en évaluation de programme. Montréal: Les Presses de l'Université de Montréal; 2009.
62.
Denis J-L, Lehoux P, Tré G. L'utilisation des connaissances produites. In: Ridde V, Dagenais C, editors. Approches et pratiques en évaluation de programme. Montréal: Les Presses de l'Université de Montréal; 2009.
63.
Baumbusch JL, Kirkham SR, Khan KKB, McDonald H, Semeniuk P, Tan E, et al. Pursuing common agendas: a collaborative model for knowledge translation between research and practice in clinical settings. Res Nurs Health. 2008;31(2):130–40.CrossRefPubMed
Metadata
Title
Understanding cancer networks better to implement them more effectively: a mixed methods multi-case study
Authors
Dominique Tremblay
Nassera Touati
Danièle Roberge
Mylaine Breton
Geneviève Roch
Jean-Louis Denis
Bernard Candas
Danièle Francoeur
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2015
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-016-0404-8

Other articles of this Issue 1/2015

Implementation Science 1/2015 Go to the issue

Systematic review

A systematic review of the use of the Consolidated Framework for Implementation Research

Erratum

Erratum to: ‘A modified theoretical framework to assess implementation fidelity of adaptive public health interventions’

Research

Implementing a social network intervention designed to enhance and diversify support for people with long-term conditions. A qualitative study

Study protocol

Study protocol: realist evaluation of effectiveness and sustainability of a community health workers programme in improving maternal and child health in Nigeria

Study protocol

A mixed methods protocol to evaluate the effect and cost-effectiveness of an Integrated electronic Diagnosis Approach (IeDA) for the management of childhood illnesses at primary health facilities in Burkina Faso

Research

A multifaceted implementation strategy versus passive implementation of low back pain guidelines in general practice: a cluster randomised controlled trial