Abstract
Since 206, Quebec's health and social services institutions have developed care and service pathways to improve access and continuity. Each institution created specific implementation strategies and management models. The pandemic disrupted these efforts, in different ways for each institution and its environment.Our presentation proposes to explore the zones of tension between the initial conditions and the current conditions (post-pandemic recovery context) of the implementation of the pathways. What has (not) changed in the implementation strategy, what has (not) changed in the implementation context? What are the coherences and incoherences between the changes in the environment and the changes in the practices?Our research team has been monitoring and evaluating the implementation in 4 institutions since 207 (in real time and retrospectively). Data were collected through semi-directed interviews with key actors (n=42) at operational, tactical and strategic levels in 4 health and social services institutions. The analysis was based on the conceptual framework of collaborative governance developped by Bryson, Crosby and Stone (2006) and on the model of robust governance strategies in a turbulent environment developed by Ansell, Sorensen and Torfing (2020).Our data show different strategies : One institution tried to use the same pre-COVID strategy, which had already shown its limitations, to implement pathways in a post-pandemic recovery context; another completely changed its strategic orientation and abandoned the implantation of pathways as they were previously conceptualized; another tried a new way of implementing pathways, but conceptualized in the same way; the last continued to implement in a very different way from the others, reinforcing its solo implementation strategy. Our analyses show that the situations are different depending on the environment and conditions of each institution: its governance structure and process, the turnover (or not) of key actors, the strategic vision and concrete practices in terms of (matrix) governance, the previous collaboration with partners, and the management practices during the COVID period.This study draws lessons on how health systems can (and must) implement adaptable interventions that evolve in contexts that are bound to change in time and space. This project is part of a multi-year international program. Matrix management and collaborative governance are at the heart of trajectory management and this program. The next steps will be to document the differentiated effects of these implementation strategies on the performance outcomes of healthcare organizations.