i3, une unité mixte de recherche CNRS (UMR 9217)

Institut Interdisciplinaire de l'Innovation

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Journey to the heart of the health system: 100 testimonies to learn to manage with the crisis by Hervé Dumez and Etienne Minvielle
Posted on 14 October 2021

The first part of the book gives voice to the actors themselves. Through their testimonies, it reconstructs the unfolding of the crisis in its different, very contrasting phases (the extreme phase of spring 2020, the respite of summer, the second wave of autumn and winter 2020-2021, during which it was necessary to learn to take care of Covid and non-Covid patients, i.e. to learn to manage with the crisis, and finally the third wave in March-April 2021).

These testimonies allow us to revisit the major questions that arose:

  • Has the state been too centralizing?
  • Have physicians regained power in the hospital?
  • Have the ARS played their role?
  • Was the system managed in an overly hospital-centric way?
  • Did public-private cooperation work?How was the support for the teams?
  • What was the effect of the over-mediation of the crisis?

They show that the answers to these questions are more complex than the "cookie cutter" judgments that have flooded TV shows and social networks.

The second part focuses on the lessons to be learned from crisis management as practiced by the actors. At the level of hospitals, it shows how resilience capacities were deployed by insisting on the fundamental level of teams and their creativity. Faced with a crisis of unprecedented scope and duration, despite the initial flabbergasting, then the fatigue and weariness, the teams held on and succeeded in taking care of Covid and non-Covid patients. On the supervisory side, the research shows how it is a coupling between guidance (and not the multiplication of fussy instructions without taking into account the operational aspects) and support for local initiatives that was decisive. The set highlights the practices that have enabled the system to resist in a context of profound uncertainty and despite disparities. The third part addresses the question of the future in the light of what the crisis can teach us. Other crises will probably arise, and the problem will be not so much to manage these crises as to manage with them. For the health system, and hospitals in particular, this is the future challenge. How can we ensure that the best of the crisis, i.e. the capacity for initiative of the teams and the support of the governance, can be preserved and amplified in a health system where all levels are rethought around an inclusive management? Management and management have a bad press in the health system. They are associated with cost containment and financial constraints. But the hospital and the system can only hold and perform its function through management. A hospital department only takes good care of the patients entrusted to it if the team is well managed. Quality of care, quality of life at work and cost control are not necessarily mutually exclusive when they are based on local management, centered around the best care path for the patient. In this case, it is a whole set of practical skills on coordination, teamwork and the implementation of innovation that build the ability to organize. As after any crisis and as has been done in the past, we start thinking about yet another structural reform of the system, one that is cumbersome to implement and often disappointing in its effects. Even if some structures can be simplified and rethought, this is not what the system and the hospital need. What is needed is a real managerial project centered on the patient's journey, the heart of which is the strengthening of skills within the teams, supported jointly by the directors of the establishments and the doctors and nurses, guided and accompanied by the supervisory authorities. This book outlines the basic principles.


Hervé Dumez is the director of the Management Research Center (CRG) of the Ecole Polytechnique, director of the Interdisciplinary Institute of Innovation (i3). He is the author and co-author of numerous articles and books, including Competition in Europe (Edition du Seuil with Alain Jeunemaître), Accountability, a new societal requirement (Dalloz) and How Business Organizes Collectively (Edward Elgar with Sandra Renou).


Etienne Minvielle is a CNRS research director and Professor at the Ecole Polytechnique (i3- CRG Centre de Recherche en Gestion). He is also attached to the Gustave Roussy Institute as a public health physician. His research on the organization of the health care system has been published in the best-known journals in the field, including The British Medical Journal, Public Administration Review and Social Science and Medicine.