in care organizations, as presented in section 1.3. This approach proposes that the patient be considered as a caregiver and, consequently, as a full-fledged member of the healthcare team (Karazivan et al. 2015). It therefore integrates the capacity of patients and their relatives to produce care (Coulter 2011). Patients are recognized for their experiential knowledge of living with the disease (Jouet et al. 2010) and the skills they mobilize (Flora 2012, 2015).
As such, they are considered legitimate persons to make the decisions best suited to their life, in collaboration with health professionals (whom we can no longer call caregivers). The patient is perceived as an individual (indivisible)7 and is progressively accompanied throughout his or her care journey to make free and informed health choices and take the care decisions that seem best suited to him or her. To do this, his experience of living with the disease and his skills are recognized as contributing to the care that concerns him. Thanks to the skills acquired through therapeutic education and reflexivity based on their own experience (Flora 2012, 2015), patients can strengthen their self-determination and self-management capacities.
Figure 1.2. The continuum of care practices. For a color version of this figure, see www.iste.co.uk/grenier/frontiers.zip
This innovative model (Karazivan et al. 2015; Pomey et al. 2015) is the result of the integration of patients into a Quebec faculty of medicine, thanks to the dean of this faculty, Jean Rouleau, and a patient, Vincent Dumez, who is also a specialist in change management in the faculty of medicine of the University of Montreal (Flora 2012). From this innovative initiative was born a model of co-construction that enabled the emergence of this model launched to enable the medical profession to adapt to the cascading mutations that physicians and healthcare systems have to face (Figure 1.3).
Figure 1.3. Different approaches to care. For a color version of this figure, see www.iste.co.uk/grenier/frontiers.zip
On the theoretical and conceptual level of the “Montreal model”, the partnership focuses on the recognition of experiential knowledge of patients (Flora 2012; Karazivan et al. 2015; Pomey et al. 2015), caregivers and citizens. This knowledge, derived from living with the disease, from experience of care and services or from living in the community, is seen as complementary to the knowledge of healthcare professionals (whether clinicians, managers or public decision-makers).
They are anchored in a vision of partnership whose essence is at the level of: (1) the individual care relationship (micro level) (Pomey et al. 2015), which is the basis for partnership interventions between patients and healthcare providers (individual and community members, peer associations and health professionals); (2) healthcare8, teaching and research organizations (meso level): and (3) government agencies (responsible for developing public policy) (macro level) (Pomey et al. 2015).
Figure 1.4. Patients’ skills in frame of reference. For a color version of this figure, see www.iste.co.uk/grenier/frontiers.zip
On the methodological level, the implementation of the partnership at the meso and macro levels, it is through the identification of the experiential knowledge of patients mobilized through skills that the partnerships were organized (Flora 2012).
It is on the basis of a repository of patient partner skills that the means of identifying patients with experiential knowledge to be mobilized according to the situation have been developed (Figure 1.4) (Flora 2015, p. 58).
At the micro level, in order to support a culture of partnership care, courses on interprofessional collaboration in partnership with the patient have been integrated into initial training at the University of Montreal in Quebec (Vanier et al. 2014)9.
Thus, during the first 3 years of the program, 14 health and psychosocial science professions were taught the five competencies of the reference system that people living with one or more chronic diseases develop. At the same time, the partnership was developed during the course of an interprofessional collaboration competency framework (Figure 1.5) (Raynault 2020).
These cross-references of reference systems integrated during the training of professionals gradually entering the healthcare environment made it possible, with greater frequency, to gradually support patients in making free and informed choices and in assuming them on a daily basis (self-determination), both in the care relationship with the various care providers and in the management of their lives (self-management). To enable the development of this culture of care in partnership with the patient, institutions have been created to support this process.
Figure 1.5. The competence framework for collaborative practice and patient partnership (source: DCPP & CIO-UdeM 2016a, p. 5)
After the creation of an entity mobilizing patients and their knowledge starting in 201010 at the Faculty of Medicine of the University of Montreal, a Canadian Chair on partnership with patients and the public was awarded to Dr. Antoine Boivin. This pan-Canadian initiative has led to the creation of a Center of Excellence for Patient and Public Partnership (Centre d’excellence du partenariat avec les patients et le public, CEPPP), combining the research chair and the DCPP.
The CEPPP’s intervention model is currently primarily at the meso and macro levels (development of partnership relationships between patients and health professionals at the level of community, teaching, care and research organizations, for example). However, its goal is to foster partnership in individual care relationships at the micro level (e.g. shared decision-making and support for chronic disease self-management between patients and clinicians). To meet this objective, an analysis was carried out to determine the level of engagement between patients and professionals; it shed light on the modalities needed by teams and organizations wishing to move toward an optimal partnership, while taking into account the fact that relationships are dynamic and can change over time (Figure 1.6) (Boivin et al. 2017, p. 16).
Figure 1.6. Distinctive record of the nature of patient-professional relationships
The partnership is a model of reciprocal engagement between members of
