Abstract :
[en] This qualitative and inductive doctoral research makes a contribution to public policy sciences by analysing different aspects of the process pertaining to the implementation of a specific public policy in the Belgian health sector: the “Integrated Care for Better Health” plan (IC4BH), launched on 19 October 2015 with the intention of integrating care with regard to chronic patients in Belgium. Based on an ethnographic approach, this research draws on several data collection methods: interviews (N=24), focus groups (N=7), direct observation (N=97 — corresponding to 213 hours of observation), documentary analysis (operational documents) and a multifocused literature review.
This manuscript is comprised of seven different chapters. The first chapter is dedicated to methodological aspects, while the next four chapters each correspond to a specific paper (published or as yet unpublished) summarized in an abstract at the beginning of each of those chapters. Each paper deals with a precise research question in order to study different dimensions pertaining to the implementation of the IC4BH plan.
The first paper (Chapter 2) addresses the question of how the particular Belgian federal configuration may have had an influence on the implementation of this public policy in the health care sector in Belgium, and, more specifically, on the implementation gap that is apparent when comparing expected and real outcomes in terms of the IC4BH plan implementation.
The second paper (Chapter 3) focuses on the pilot project phenomenon, regarded as an object for research, trying to understand how the use of multidisciplinary pilot projects as implementation instruments contributed to reshaping the modes of public governance in the Belgian health sector, in a context of transition and ongoing devolution.
The third paper (Chapter 4) tackles the issue of knowing how the use of pilot projects as implementation instruments structured horizontal collaboration between the parties involved in a pilot project. It would seem that the use of the pilot project instrument created the conditions allowing the progressive emergence of specific forms of organisation, taking the form of collaborative care networks, and more specifically, of what could be called community-based integrated care networks.
Eventually, the fourth paper (Chapter 5) combines the results of three different studies in an inductive secondary analysis, and presents a cross-level approach of the concept of empowerment, one of the integrated care components, which is viewed as an umbrella term in the scientific literature. The paper analyses how the polysemy of this concept might have an influence on its collective operationalisation, when different health care stakeholders have to work together.
After having developed additional empirical elements in Chapter 6, the discussion focuses on certain presuppositions, shortcomings, ambiguities, paradoxes and absurdities, all of which were identified during the ethnographic fieldwork carried out as part of this doctoral research and that might have contributed to the emergence of the previously noted implementation gap. The empirical material collected as part of this ethnographic research is first analysed by mobilising, inter alia, the analytical framework produced by Vreugdenhil et al. (2010) pertaining to the project phenomenon. Second, the notions of co-creation and process inclusivity are discussed in the context of the implementation of the pilot projects’ loco-regional action plans. Later, the research perspectives identified thanks to this doctoral research are presented before concluding the discussion. Last, but not least, a general conclusion is presented.
