Understanding Multilevel Governance Processes through Complexity Theory: An Empirical Case Study of the Quebec Health-Care System

This paper aims to contribute to a better understanding of multilevel governance processes. We do so by focusing on the in-depth examination of the institutional changes recently implemented in the Quebec health care delivery system that require a close collaboration between interdependent actors acting at various levels of governance. Our three research questions are: (1) How does multi-level governance emerge in a pluralist institutuional context? (2) How do multi-level governance processes shape the adaptive capacity of the organization to its environment? (3) How does institutional context influence these multi-governance processes?Our empirical investigation is inspired by the theory of complexity which invites us to pay attention to three processes: self-organization, eco-self organization and co-evolution. This study shows that the effectiveness of multi-level governance processes do not only go through the implementation of instruments aiming at aligning the action of lower government levels with the objectives of the upper levels as suggested by numerous existing works. More precisely, it suggests that more distributed and coordinated processes favor a more homogenous form of adaptation (Miller and Page, 2007) taking into account the interdependence between stakeholders.