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Comparative case study of Quality Improvement Support Agencies (QISAs) as a systemic quality strategy: France and Québec
  • Labante Outcha Dare,
  • François Champagne,
  • Jean-Louis Denis
Labante Outcha Dare
Universite de Montreal Ecole de Sante Publique

Corresponding Author:[email protected]

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François Champagne
Universite de Montreal Ecole de Sante Publique
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Jean-Louis Denis
Universite de Montreal Ecole de Sante Publique
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Abstract

In a high-quality health and social services system, policymakers encourage action at all levels of change to ensure the consistency of quality strategies, especially at the systemic level, in which the other three levels of change are nested and the whole system is structured. This study aims to present an analysis of Quality Improvement Support Agencies (QISAs) as a systemic strategy, which has been successfully implemented in several jurisdictions (countries and states). A comparative study of two critical cases in two different jurisdictions was carried out: Haute autorité de santé (HAS) in France and Institut national d’excellence en santé et services sociaux (INESSS) in Québec, Canada. Several sources of iteratively collected data were coded using a systematized approach. All data were processed and analyzed confidentially using the software QDA Miner 6.0.2. The results showed that HAS has a wider range of activities and INESSS has a narrower range. Their statutes of autonomy differ, with the former QISA more independent of the public power of its jurisdiction and the latter more at the service of public power. Though their products differ, these QISAs each have different effects (proximal, intermediate, and ultimate) on quality improvement in practice settings. Furthermore, it appears that they have each faced dilemmas in achieving systemic quality improvement. This study may inspire other jurisdictions to implement similar systemic quality improvement strategies or strengthen them if they have already been implemented.