Evaluation of the implementation and effects of management through care and services pathways: A protocol study

Background: In 2015, the Government of Quebec undertook a vast reorganization of its health and social services network. This reform mainly aimed to promote and simplify access to services for the population, contributing to the improvement of the quality and safety of care, and increasing the efficiency and effectiveness of the network. Since 2016, several health care organizations (HCOs) have pushed reform even further by developing management through care and service pathways (MCSP). This study aims to identify, in a processual manner, the different factors involved in implementing MCSP in different HCOs, in the turbulent context of the COVID-19 pandemic. Method: The methodology of this research project is based on developmental evaluation. The objective of developmental evaluation is to guide organizations and actors in the adaptation and development of innovations in complex and turbulent environments. Data will be collected over a three-year period using five strategies: i) organizational questionnaires; ii) analysis of clinical-administrative databases; iii) documentary analysis (grey and scientific literatures); iv) participant observations and v) semi-structured interviews with key actors involved in the implementation of MCSP. Discussion: In addition to the operationalization of pathways, the implementation of MCSP i) involves transforming the governance of the health care organization both at the strategic and operational levels and ii) is a demanding process that requires changes in practices, modifications in the allocation and configuration of resources and the development of new collaborations between the different actors in the organization, the partners and the users involved in this transformation. Several studies claim that governance innovations can create conditions that are favourable to the emergence of innovations in terms of available services and responding to the needs of populations. This research will develop knowledge of the factors involved in implementing MCSP in complex and turbulent contexts and propose scale-up across the province. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study is founded by CIHR Project grant (2020-2026) #168973. The funders had and will not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The research protocol was reviewed and approved by Ethics Committee of the institution of health and social services on 28th January 2021 (2021-Projet #MP-31- 2021-3799). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.