In late 1996, CLSCs in Montreal were instructed to implement a guichet unique (single-point access) approach to providing services to maintain aging clients in their home. This study evaluated that implementation and its impact on practitioners and their professional practice. The researchers obtained their data through focus groups, questionnaires, and individual interviews. They conclude that responding to the complex needs of an increasingly aged population requires an integrated approach. They note, however, that a number of problems have occurred in the introduction of case management in the CLSCs studied: workers have heavy caseloads; case managers risk burnout because of an increasing number and complexity of tasks; and case managers do not have the authority to give direction to practitioners in all the services that they must coordinate. They recommend training for case managers in their new tasks; training for the partners in the hoped-for “continuum of services” (e.g., doctors, hospitals, community organizations) to ensure a clear understanding of their roles; clear criteria for definition of the clientele; and caseload standards that do not overburden workers. Although the guichet unique approach aims in part to reduce hospitalization and institutionalization of the aging population and thus reduce public expenditures, this study did not address the issue of relative costs. Regarding the process of change itself, the researchers note that the contingency-management style facilitates the change process.
This project was supported by the Health Transition Fund, which was created in 1997 to provide support for evidence-based decision-making in health care reform by supporting pilot and evaluation projects which test innovative approaches to health care delivery. The views expressed herein do no necessarily represent the official policy of federal, provincial, or territorial governments.