Decentralized Management of Homecare Services for Seniors: Protocol for a Participatory Action Research (Preprint)

BACKGROUND The centralization of decision-making power in the public healthcare system has a negative impact on the practice of professionals and the quality of homecare services (HCS) for seniors. To improve HCS, decentralized management could be a particularly promising approach. To be effective, strategies designed to incorporate this management approach require attention to three elements: autonomy of local stakeholders, individual and organizational capacities, and accountability for actions and decisions. Not many studies have focused on strategies for integrating decentralized and collaborative management at the local level in HCS. OBJECTIVE The overall aim of this study is to rethink HCS management strategies with a view to integrating collaborative and decentralized practices in the day-to-day work of managers and professionals. The specific objectives are to: 1) identify and co-construct concrete and achievable decentralized management strategies, and 2) explore factors likely to influence their integration. METHODS This participatory action research involves a cyclical process. Before initiating the cycles, a preliminary stage consists of forming a steering committee composed of managers (n=3), professionals (n=3), seniors (n=3), informal caregivers (n=3) and the research team (n=3). This committee will facilitate multi-stakeholder consultation to co-construct local management strategies based on a real-life problem identified by the committee. The steering committee will also guide the research process. The first cycle will consist of establishing an initial plan of decentralized management strategies. During the observation phase, meetings of four homogeneous focus groups, including managers, professionals, seniors, and informal caregivers, will be held. During the reflection phase, a thematic analysis will be carried out, and data will be interpreted and validated by the steering committee. Then, in the action phase, results will be presented to managers and professionals so they can co-construct a plan of decentralized management strategies to prioritize. The second cycle will explore the factors involved. The observation, reflection, and action phases will be repeated. Ultimately, the results of the two cycles will be integrated in a model co-constructed by the steering committee. RESULTS Data collection is in progress; the partnership officially began on February 1, 2024, and the plan is to continue data collection through 2024. The steering committee will validate the data to ensure that they are accurate and that the results reflect the reality of local stakeholders. CONCLUSIONS By identifying decentralized and collaborative management strategies at the local level as well as factors to facilitate their integration in HCS, this approach can be used for other decentralized management projects in different areas of the healthcare system. This study will give decision-makers insight into strategies aimed at improving the management of their institution, which will enhance seniors’ well-being and the quality of their healthcare services.