Accessibility and Active Offer

Marie Drolet, Pier Bouchard, Jacinthe Savard, Marie Drolet, Pier Bouchard, Jacinthe Savard

• Publisher: University of Ottawa Press
• Year: 2017
• ISBN:
  9780776625652
• Topic: Médecine
• Subtopic: Politique de santé

It is imperative that we train leaders who are able to intervene efficiently with service users and to support a better organization of the workplace. It is especially important to look at the many issues related to postsecondary training and human resources, such as recruiting and keeping these leading professionals. Accessibility and Active Offer thus combines theory and empirical data to help future professionals understand the workplace issues of accessibility and active offer of minority-language services.
This English-language adaptation of Accessibilité et offre active features an additional chapter by Richard Bourhis on issues specific to Anglophone communities in Québec.
This multidisciplinary collective work is the first to unite researchers in health, social work, sociology, political science, public administration, law and education, in order to gain more thorough knowledge of linguistic issues in health and social services, as well as of active offer of French-language services.
Published in English.

PART I

ENGAGING ACTORS: PUTTING THE STRATEGIC ANALYSIS TO THE TEST

CHAPTER 1

Active Offer, Actors, and the Health and Social Service System: An Analytical Framework

Sylvain Vézina, Université de Moncton and Sébastien Savard, University of Ottawa

Abstract

This chapter presents a theoretical framework inspired by strategic analysis, also called the sociology of organizations. By adopting this approach, researchers try to uncover the objectives and strategies used by the actors involved in order to better grasp the dynamics of the system of action, while at the same time taking into consideration the constraints arising from the formal structure. The concepts dealt with include the system of action, power, rules of the game, change, strategy, actor, issue, organization, and environment, all of which take into account the complexity of the challenges surrounding the practice of active offer in health and social services. One of the major contributions of this approach is that it provides an analytical framework making it possible to gain a better comprehension of the relationship between the actor and the system. These two components are essential not only for understanding the subject explored here, but also for identifying the strategies for action used by actors in a given community.

Key Words: active offer, social services and health, system of action, power, zone of uncertainty, strategic analysis, sociology of organizations, change, strategy, actor, issue, organization, environment.

Introduction

Access to health and social services that are safe and of comparable quality for official language minority communities (OLMCs) is a subject explored by a growing number of surveys, and, as a result, analyses (Vézina, 2015). Each one proceeds according to theoretical positions that are often conscious and acknowledged but are sometimes difficult to identify. Suggesting an analytical framework that makes it possible to amalgamate the greatest possible number of these perspectives in order to consider matters related to active offer is an onerous task. It is, nevertheless, what we propose to do in this chapter. We will argue that the organization is a construct in which we observe, among other things, relations of power and dependence, which rely on strategies developed around zones of uncertainty and give rise to the establishment of ever-evolving rules framing the cooperation of actors within as well as outside the organization. Although our choices are, by definition, subjective, we hope we are able to propose a way of theorizing the subject which will be of interest to many researchers and, especially, will enable us to address multiple aspects of active offer.

Thus, our first challenge is to identify an existing theoretical model that can integrate a wide variety of perspectives. Our second challenge is to establish, as clearly as possible, its potential, in view of the multiple dimensions of the subject of our research, active offer. Choosing a theoretical framework means adopting a series of general analytical tools developed by others before us through observations of reality and that allow us to explain the phenomena we are examining. Any theoretical model proposes a specific and consistent use of concepts that become analytical tools, in order to bring to light the logic underlying the phenomena observed, or even to predict these phenomena. In the following pages, we will suggest some tools we believe are most apt to help us understand active offer, its meaning, and the issues and challenges that come with it.

In concrete terms, we will refer to propositions and concepts drawn from the sociology of organizations.¹ These propositions seem useful to us in a number of ways. First, they offer a series of concepts to which researchers from different disciplines are able to relate, including the concepts of system of action, power, rules of the game, change, strategy, actor, issue, organization, and environment. Such concepts are able to take into account the complexity of challenges around the practice of active offer. We will consider them in more detail later on.

Next, the sociology of organizations provides an analytical framework that makes it possible to gain a better grasp of the relation between the actor (individual or group) and the system (hospital, social services, society…). From our perspective, this is a major contribution to the study of active offer. When considering the issues raised by active offer (either in research or in the offer of direct services to the population), we are faced with a significant challenge: we must decide if the problem, like the strategy of action, is first and foremost a matter of the actors involved; that is, the need for people working in health and social services who are conscious of the need for active offer and equipped to provide it. Or, on the other hand, is it a matter of the system; that is, the lack of up-to-date policies and procedures in the rules governing the employment of resources for the purpose of putting active offer into practice? The sociology of organizations addresses precisely the interaction between the two.

Finally, this theoretical model is intended to be concrete and move beyond the question of “why” to “how.” Indeed, the primary interest to those who work with this approach understands how human beings (all of whom pursue their individual goals, which can be divergent, or even completely opposite, from those of others) manage to resolve the problem of their cooperation in an organization and what their cooperation costs them. In a way, we are trying to understand the mechanisms and conditions of integrating diverse rationalities² and divergent interests in the pursuit of common objectives that are basic to the organization and indispensable to its survival. Here is a simple illustration of the problem in the context of our subject. We need to specify from the outset that the particular challenge of active offer occurs in organizations where individuals working in a variety of professions must perform their duties in a minority setting. We could, then, state that the sociology of organizations examines how these actors, be they Anglophone or Francophone, unilingual or bilingual, manage to reconcile their often divergent interests when it comes to providing safe and quality social services and health services in the official language of the choice of the person requiring a service. It is the relation between conflict and cooperation that we are trying to better understand, here. Both are inherent in the dynamics of organized action (Friedberg, 1993).

Furthermore, the health care sector interests a large number of researchers in the field of sociology of organizations. During the second half of the 1980s, driven by the research of Michel Crozier (1987), researchers focused mainly on hospital organizations (Bélanger, 1988; Binst, 1994; De Pouvourville, 1994; Gonnet, 1994; Moisdon, 1994). Since then, they have diversified into other areas of health care, notably from the angle of public policy (Borraz, 2008; Bergeron, 2010), rationalization (Benamouzig, 2005), prevention (Crespin & Lascoumes, 2000), the practice of medicine (Castel & Merle, 2002; Castel, 2008) &, consequently, the place of expertise (Henry, Gilbert, Jouzel, & Marichalar, 2015). In the field of social services, Savard, Turcotte, and Beaudoin (2004) used the framework of strategic analysis to study the power relations between public facilities and community organizations serving children and families, both of which provide social services to this population. This shows that the framework can be used to study the dynamics of inter-organizational partnership.

Organization as a Construct

For those who take this approach, the organization is contingent, in the sense that no “best” way of organizing human activity exists. Instead, there are infinite possible variants, depending on the objective situation—and the intentions—of individuals for which it is comprised. When considered from a subjectivist viewpoint (Burrell & Morgan, 1979), the organization is seen as a construct formed from conflictual and cooperative relations between individuals and groups they call “actors.” More precisely, the organization is recognized here according to the interactionist paradigm (Boudon, 1977); in other words, as the product of encounters between actors who are trying to define a framework to cooperate around common objectives. Starting from the idea that interactions between actors in a system are based on interests and objectives that may be concurrent or contradictory, the paradigm shows how power relations develop, as each person uses the resources in his or her own possession, and the zones of uncertainty under his or her own control, in order to force other actors to make concessions. This way, each person can achieve, at least in part, her or his own objectives. Conversely, however, this same actor, dependent on the resources possessed by others, cannot unilaterally impose rules and must instead negotiate and make compromises.

Physicians, managers, nursing staff, social workers, Francophones, Anglophones, men, and women, to name only a few, are connected in a variety of configurations according to the issues and the resources they have available to influence the dynamics of the system. Thereby, the system can respond as well as possible to their individual and collective interests when dealing with the issue at hand. In the perspective of the sociology of organizations, the active offer of social services and health care in the two official languages represents one issue among others. The way it is dealt with depends on both the performance of the actors and the recognition, by everyone involved, of its importance in achieving the objectives of the system. Starting from this idea, we would suggest that active offer cannot take place without an effective cooperation among actors, through their acknowledgement of their complementary roles and the clarification of the division of skills. Nonetheless, this cooperation will always be interrupted by conflict, whether on the level of values, interests, or objectives. A major part of the conflict is related to the competition among different actors for obtaining and using limited resources to achieve specific objectives. In short, cooperation cannot rely on a simple agreement around common values; it requires mechanisms such as learning and negotiation, or even bargaining (Castel & Carrère, 2007). Furthermore, cooperation will be impossible unless people consider the legitimate interests of the actors involved, be they interests of a professional, cultural, or labour condition, or of a different nature.

Power and Dependence: At the Heart of the Analysis

Power, a central notion of this model, is viewed from the angle of a transactional dynamics, where the logic of exchange, of negotiation, of giver-giving is predominant, rather than from the angle of oppression. The conception of power transmitted by this approach is also based on the principle that every power relationship is founded on a relationship of dependence that is fairly reciprocal between the actors in interaction. Thus, for exchanges or transactions to take place between actors, there must be interdependence between them. For example, one actor has one resource that I need. I negotiate with that actor so that either the resource is given to me or the resource does not infringe on my pursuit of my objectives. The other actor negotiates with me because I control one zone of uncertainty that is necessary for the actor to pursue his or her own objectives.

The notion of interdependence is therefore central to our understanding of how systems of action function. However, it is not to be confused with the notion of balance. Indeed, certain actors may possess more resources and control larger zones of uncertainty, giving them more negotiating power than other actors in the system. On the other hand, given that (according to this model) no actor possesses all the resources, the vision of power that is transmitted here is pluralist; that is to say, it introduces a priori the hypothesis that power is spread out among different actors. This conception is thus placed in opposition to the totalitarian vision of power, which postulates a relationship between dominant and dominated, where power is concentrated in the hands of dominant (often majority) groups. Crozier and Friedberg (1977) affirm that this vision of power ignores a fundamental aspect: that of exchange.

Even if the actor is constrained by the rules of the game and the strategies of other actors, this does not mean the actor is totally powerless: “Even in extreme situations, a man always retains a margin of liberty and cannot help but use it to beat the system.” (Crozier & Friedberg, 1977: 42, our translation). Inspired by the work of Leavitt (1958), the authors affirm that even the most disadvantaged actor will always have the final choice to accept or refuse what the other asks so that the “changer,” as well as the “changed,” will experience tension in the power relationship. The idea presents itself as follows: there is no power without a relationship, no relationship without an exchange, no exchange without a negotiation. For these authors, then, although organizations are established around the necessary cooperation between individuals, they also involve an exercise of power becaus...