Explaining variation of implementation outcomes of centralized waiting lists for unattached patients: A comparative multiple case study in Quebec
Open accessAbstract
Purpose: Centralized waiting lists (CWLs) for patient attachment to a primary care provider have been implemented across Canada, including Quebec. Little is known about the implementation of CWLs and the factors that influence implementation outcomes of such primary care innovations. The purpose of this paper is to explain variations in the outcomes of implementation by analyzing the characteristics of CWLs and contextual factors that influence their implementation. Design/methodology/approach: A multiple qualitative case study was conducted. Four contrasting CWLs were purposefully selected: two relatively high-performing and two relatively low-performing cases with regard to process indicators. Data collected between 2015 and 2016 drew on three sources: 26 semi-structured interviews with key stakeholders, 22 documents and field notes. The Consolidated Framework for Implementation Research was used to identify, through a cross-case comparison of ratings, constructs that distinguish high from low-performing cases. Findings: Five constructs distinguished high from low-performing cases: three related to the inner setting: network and communications; leadership engagement; available resources; one from innovation characteristics: adaptability with regard to registration, evaluation of priority and attachment to a family physician; and, one associated with process domain: engaging. Other constructs exerted influence on implementation (e.g. outer setting, individual characteristics), but did not distinguish high and low-performing cases. Originality/value: This is the first in-depth analysis of CWL implementation. Results suggest important factors that might be useful in efforts to continuously improve implementation performance of CWLs and similar innovations.
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Prior research has found evidence that family physicians "cherry-pick" healthier patients for attachment, avoiding patients with more complex health needs.
“This is coherent with prior research that has found evidence that family physicians “cherry-pick” healthier patients for attachment, avoiding patients with more complex health needs (e.g. mental health problems, intellectual disability) [44, 46–49].”
From Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada (2022) · cites this paper as [48]
In Results > Characteristics of the innovation (page unavailable), staff report that some family physicians did not want patients with mental health problems and preferred referrals without those added needs. This supports the claim of selective attachment, but the passage does not address the cited sentence’s example of intellectual disability. (LLM, conf=0.85)
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Self-citation
- Authors
- Malham, S. A., Smithman, M.-A., Touati, N., Brousselle, A., Loignon, C., Dubois, C.-A., Nour, K., Boivin, A., & Breton, M.
- Affiliations
- Université de Sherbrooke (CA)
- École Nationale d'Administration Publique (CA)
- Université de Montréal (CA)
- Centre intégré de santé et de services sociaux de la Montérégie-Centre (CA)
- Corresponding author
- Breton, Mylaine
- ORCID
- Venue
- Journal of Health Organization and Management
- Publisher
- Emerald
- Published
- 2019-08-08
- Volume
- 33
- Issue
- 5
- Pages
- 563-587
- ISSN
- 1477-7266 (ISSN-L)
- PMC
- PMC7068727
- OpenAlex
- W2953717254
- Cited by
- 9
- References
- 43
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 1
- FWCI
- 2.04
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Health Organization and Management (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UVic’s Research and Learning Repository (University of Victoria) (submittedVersion)
- Funders
- Canadian Institutes of Health Research
- Fonds de Recherche du Québec - Santé (28974)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
- Keywords
- patient attachment, primary care, implementation outcomes, implementation research, Consolidated Framework for Implementation Research, inner setting, leadership engagement, Quebec
- MeSH terms
- Stakeholder Participation, Canada, Family Practice, Health Services Accessibility, Humans, Interviews as Topic, Primary Health Care, Quebec, Waiting Lists, Program Development, Organizational Case Studies, Qualitative Research
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