The integrated network of services for the elderly in loss of autonomy of Bois-Francs: an innovation put to the test
Even though by and large appreciated, the Quebec socio-health system is the subject of many critiques that reveal its shortcomings, both with regard to accessibility and continuity of services. Since the publication of the Clair Commission Report in 2000, problems of discontinuity have commonly been attributed to the so-called silo mentality within the bureaucracy. Between the personnel of the different organizations and the practitioners of diverse professions, barriers arise that hinder the collaboration necessary for the provision of better integrated services. In that regard, various local experiments were conducted throughout the 1990s, in particular to respond to the needs of the elderly in loss of autonomy. The first experiment, conducted in Bois-Francs and launched in 1997, represents one of the most advanced models of integration not only for Quebec but also for North America as a whole. In this article, we show how this experiment is exemplary of the collective work that is required by the actors from a wide range of professions, locations and hierarchical levels such that an innovation can be realized and maintained over time. We also show how the reform of the Quebec socio-health system launched in 2003 has put this experiment to the test by removing the initiative from the hands of the stakeholders and managers who had initially developed and realized it.