Implementing public policy in a non-directive manner : capacities from an intermediary organization

SETTING: We investigate the capacities of an organization responsible for bridging top-down instructions emanating from a law on public health with the bottom-up realities of health service providers working on population-based health. This article traces the implementation of this law, which requires service-provider organizations to base their actions (planning, prevention, and curative activities) upon the expressed and non-expressed needs of the local population. We investigate a case in the province of Québec that took place over more than 10 years. INTERVENTION: The state strategy involved a key structure: an intermediary organization named IPCDC/KSCDI. We first describe how the organization emerged; the expertise involved from the academic, service, and policy domains; the support provided to service-provider organizations; and the achievements. We then highlight the critical capacities the intermediary organization had to nurture. OUTCOMES: We identify five critical capacities of the intermediary organization: the business intelligence to read and adjust to the given environment of certain organizations, a dedication to collective means, a win-win mentality, scientific connectivity, and the animation of safe havens. IMPLICATIONS: It may be important to focus attention on a capacity approach to intermediary organizations. These capacities can potentially enable governmental organizations to compile a stock of resources that can be mobilized and transferred to support future implementations of other reforms. They could also benefit public health partners in the community who collaborate with service providers and actors who aspire to become intermediary organizations. Finally, the performance measurement of implementing reforms in a non-directive manner could be based on indicators related to these five critical capacities.