The Multi-Clientele Assessment Tool as a control mechanism in home care: A poststructuralist analysis

Introduction and background: In Quebec (Canada), the Multi-clientele Assessment Tool (Outil d’évaluation multi-clientèle, OEMC) profoundly transformed the practice of home care professionals (HCP), including nurses. Since 2015, all home care patients with a completed OEMC have been counted to assess the performance of services. If performance targets are not reached, funding renewal is threatened, exerting pressure on HCPs.
Objective: The objective of this article is to review the OEMC’s implementation in order to understand its political nature and its impacts on the practice of HCPs and patients’ lives.
Material and method: Drawing on the works of Michel Foucault and Gilles Deleuze, we propose a poststructuralist analysis of OEMC documents.
Results: Shifting from disciplinary societies to societies of control, the OEMC insidiously contributes to the regulation of home care services as well as patients’ lives. The will of HCPs to apply their field of expertise is in opposition with the OEMC’s purposes.
Discussion and conclusion: To not complete the OEMC when it is deemed unnecessary would require a negotiation by HCPs. However, HCPs’ autonomy is compromised by discourses repressing all forms of resistance.