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Centralized waiting lists (CWLs) for patient attachment to a primary care provider have been implemented across Canada, including Quebec. Little is known about the implementation of CWLs and the factors that influence implementation outcomes of such primary care innovations. The purpose of this paper is to explain variations in the outcomes of implementation by analyzing the characteristics of CWLs and contextual factors that influence their implementation.

A multiple qualitative case study was conducted. Four contrasting CWLs were purposefully selected: two relatively high-performing and two relatively low-performing cases with regard to process indicators. Data collected between 2015 and 2016 drew on three sources: 26 semi-structured interviews with key stakeholders, 22 documents and field notes. The Consolidated Framework for Implementation Research was used to identify, through a cross-case comparison of ratings, constructs that distinguish high from low-performing cases.

Five constructs distinguished high from low-performing cases: three related to the inner setting: network and communications; leadership engagement; available resources; one from innovation characteristics: adaptability with regard to registration, evaluation of priority and attachment to a family physician; and, one associated with process domain: engaging. Other constructs exerted influence on implementation (e.g. outer setting, individual characteristics), but did not distinguish high and low-performing cases.

This is the first in-depth analysis of CWL implementation. Results suggest important factors that might be useful in efforts to continuously improve implementation performance of CWLs and similar innovations.

This study aims to investigate into the future of cancer and cancer research in preparation for a strategic plan for a cancer research centre.

The study used framework foresight, a method for creating scenarios and their implications developed by the MS program in Foresight at the University of Houston.

The study identified four scenarios: a continuation scenario in which progress in detecting and treating cancer progressed as it has over the past few decades, a collapse scenario in which attention was diverted from medical research due to a climate crisis, a new equilibrium scenario in which cost became the overriding concern for cancer treatment, and a transformation scenario in which individuals took control of their treatment through Do-It-Yourself remedies. Those scenarios suggested four strategic issues for the planning exercise: the growing volume of genomic and clinical data and the means to learn from it, the increased involvement and influence of patients in diagnosis and treatment, the ability to conduct research in a time of fiscal austerity and declining levels of trust in all professions, including medicine.

The paper not only provides guidance for cancer centers but also for medical practice in general.

The client used the scenarios and their implications as part of its considerations in strategic planning.

This paper represents the first time that Framework Foresight has been applied to a medical topic.