Poster (Scientific congresses and symposiums)
Pilot projects as public policy instruments : The case of integrated care pilot projects for chronic patients in Belgium
De Winter, Mélanie
2018EHMA 2018 Annual Conference – Making It Happen
 

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Keywords :
pilot projects; policy instruments; policy implementation
Abstract :
[en] In October 2015, the Belgian Health Ministers launched the joint plan “Integrated Care for Better Health” (IC4BH) targeting chronic patients (1). Through this plan, they expressed their intention to bring about a major transition from a fragmented care system to an integrated care one for such patients. Whilst the authorities knew that they wanted to move towards an integrated care system, they nevertheless did not know how to implement it in the Belgian-specific context. Therefore, they opted for an iterative and incremental implementation. In an original manner, they decided to rule out “top down” solutions and launched a call for multidisciplinary four-year pilot projects to involve field actors and generate “bottom-up” solutions. The Belgian authorities have often used pilot projects in the health sector to test new solutions and new ways of working. For more than ten years, there has been an increasing number of calls for pilot projects in the Belgian health sector (e.g. “protocol 3” projects for frail old people, “psy 107” projects in the mental health sector, home hospitalisation pilot projects, mobile health projects, etc.). However, these new integrated care pilot projects are particular in the sense that they simultaneously target several diseases, encompass larger target groups than the previous ones (thousands of people per project) and cover larger geographic areas. But above all, they involve many more different actors in a phased co-creation process, i.e. policy-makers, civil servants, patients’ representatives, first-line and second-line care actors (hospitals, medical health centres, general practitioners, nurses, etc.) together with non-medical actors (e.g. social and cultural actors). These actors have different and often diverging interests, which raises major inter-organisational and inter-professional collaboration issues. Implementing integrated care challenges usual governance schemes. The authorities aim at developing “loco-regional networks”, viewed as governance modes supporting the transition from a competitive to a collaborative care system (2). In this paper, pilot projects, which Vreugdenhil and Ker Rault see as “…means to establish communication between actors that usually do not cooperate” (3-p.122), are viewed as public policy instruments (4) supporting that kind of transition. Thereby, the researcher addresses the following question, the guiding thread of this paper: how does using multidisciplinary pilot projects as implementation instruments reshape modes of public governance in the Belgian health sector in a context of transition and ongoing devolution? The researcher focuses on how these instruments transform “the relationship between the governing and the governed” (5-p.3), between all the actors of the care production chain who have to learn how to work together, cooperate and collaborate to achieve integrated care in Belgium. This qualitative and inductive research draws on several data collection methods: interviews (N=22), focus groups (N=7), direct observation (109.5 hours), documentary analysis (operational documents) and a literature review. Keywords: pilot projects, policy instruments, policy implementation, governance, integrated care References: 1. Belgian Ministry of Social Affairs and Public Health. Plan conjoint en faveur des malades chroniques: « Des soins intégrés pour une meilleure santé ». [Internet]. 2015. Available from: http://www.integreo.be/sites/default/files/public/content/plan_fr.pdf 2. Buttard A, Santos CD, Tizio S. Networking Healthcare. From a competitive call to a medical cooperation as a guarantee of a found confidence. Recherches en Sciences de Gestion. 2012;6(93):21–43. 3. Vreugdenhil H, Ker Rault P. Pilot Projects for Evidence-Based Policy-Making: Three Pilot Projects in the Rhine Basin. German Policy Studies. 2010;115–51. 4. Lascoumes P, Le Galès P, editors. Gouverner par les instruments. Paris: Presses de la Fondation Nationale des Sciences Politiques; 2004. 370 p. (Gouvernances). 5. Lascoumes P, Le Gales P. Introduction: Understanding Public Policy through Its Instruments? From the Nature of Instruments to the Sociology of Public Policy Instrumentation. Governance. 2007 Jan;20(1):1–21.
Disciplines :
Sociology & social sciences
Author, co-author :
De Winter, Mélanie ;  Université de Liège - ULiège > Département des sciences sociales > Sociologie des ress. hum. et des systèmes institutionnels
Language :
English
Title :
Pilot projects as public policy instruments : The case of integrated care pilot projects for chronic patients in Belgium
Publication date :
June 2018
Event name :
EHMA 2018 Annual Conference – Making It Happen
Event place :
Budapest, Hungary
Event date :
du 20 au 22 juin 2018
Audience :
International
Available on ORBi :
since 03 July 2018

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