Governance, health policy implementation and the added value of regionalization.

OBJECTIVES In this paper we focus on governance and the added value of regionalization in the context of health policy implementation. What are regional boards' patterns of action in the governance process?How do these patterns favour policy implementation? ANALYTICAL FRAMEWORK: To enhance our understanding of the role of regional boards in governance processes, we relied on four conceptual constructs that corresponded to models of collective action: political, technocratic, democratic and cognitive. Alongside the four models, we analyzed the impact of governance on health policy implementation using Mazmanian and Sabatier's general analytical framework, which identifies three types of variables that affect public policy implementation: (1) variables related to the complexity of the problem, (2) statutory variables that structure the implementation of the policy and (3) non-statutory variables related to the context. METHODS We conducted a qualitative, longitudinal case study of the regional implemention of the Program to Combat Cancer in Quebec. FINDINGS This research stresses the added value of a clinico-administrative governance of change, whereby regional boards, in synergy with clinical leaders, participate in the orientation of collective action. Analysis of the regional board's patterns of action reveals the utility of combined technocratic, democratic, political and cognitive actions.