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The authors' perspective:
It has been more than two years since one of the most important events of the beginning of this century, the Covid-19 virus pandemic, reached us, challenging our health systems and putting the whole socio-economic apparatus of our societies in jeopardy. Studies, both quantitative and qualitative, have multiplied on the spread of the virus, the impact of periods of confinement, the transformations in the world of work, in the personal field, etc.
One angle, however, remains little valued in this now prolific literature, even during the crisis - the organizational (Lorino & Mottis, 2020). Yet, for us, this is the very heart of the matter, on a par with the economic, sociological or political angle. What the crisis seems to reveal to us, beyond the obvious need to strengthen coordination (city/hospital, health/medical/social, etc.), is that most often the transformation comes from the actors themselves, who do not wait passively for directives to be implemented or for the law to evolve, and who have the capacity to set in motion the dynamics of transformation and adaptation in the face of changes in their environment. This is the working hypothesis adopted by the coordinators of this book. It is this spirit of initiative, this capacity to imagine and implement new organizations adapted to new situations, often in a very short time, that we had already emphasized in our first volume, and that we are extending in this second.
This observation seems to us to be all the more important as we see the emergence of a new healthcare landscape, which seeks to give a new place to field actors. These now have more of a hand in proposing new forms of collaboration and care configuration (in the image of Article 51 of the 2018 Social Security Financing Law). This place values their role, creativity and adaptability. In terms of public action, we are thus seeing the installation of a new regime of governmentality, no longer based solely on a posture of planning or regulation, but on stimulating and accompanying collective exploration (Cazin, 2017; Baly, 2019; Aubert, 2021; Jobin, 2022). In this new scenario, it is the relevance of performance measurement itself, which was once designed for a compartmentalized world (e.g. activity-based/fee-based pricing) without integrating the pathway logic, that is called into question. The gap between the organization and the management tools deployed within it is widening, forcing us to consider replacing them with other, more appropriate tools (Kletz & Moisdon, 2021).
The Covid crisis has undoubtedly been a gas pedal of this transformation. On the one hand, moments of financial leniency on the part of the state, based on the "whatever it takes" policy, have rendered obsolete a vision of health care that is too cost-oriented. On the other hand, the crisis has erased the strict control posture of the public administration, which has been confronted with its inability to dictate all decisions from above, often unsuited to each of the realities emanating from such a dense and complex organization.
In both respects, we can say that the crisis has served as a catalyst for change, which in our book is attested by several of the contributions.
The second volume thus takes up the original idea of the first, giving a voice to those who have shaped these new organizations and who, for us, are the embodiment of the system's organizational agility. As researchers who are very close to the field, we are convinced that the organizational angle is the fundamental issue in the evolution of the healthcare system. The last two years
years illustrate this point, since they have been marked by a "certainty of uncertainty" not only linked to Covid but also to a succession of situations that are just as novel and co-occurring (war in Ukraine, inflation, new epidemics, crisis in the attractiveness of the health professions, etc.), which cannot be left without an organizational analysis.
The texts that follow are written by authors from very different backgrounds, who one might not expect to find associated in a book, but who are nevertheless brought together here for their original contributions concerning the Covid crisis. These precious views are positioned at new scales and levels of observation, ranging from the industrial sector to the analysis of international experiences. This wealth of starting points, while helping to reinforce our argument for the importance of the organizational and field perspective in understanding the world, particularly that of health care, does not make the task of organizing them any easier.
Rafael Cavalcante is a PhD student at the Centre de Gestion Scientifique - i3, Mines Paris - PSL. A medical doctor in Brazil, he is interested in the management of health organizations and the evolution of the health system. He is doing his thesis in partnership with the Assistance Publique - Hôpitaux de Paris (AP-HP).
Caroline Jobin is a teacher-researcher at the EPF - École d'ingénieur-e-s (formerly the Ecole Polytechnique Féminine) and a researcher at Mines Paris - PSL (Centre de Gestion Scientifique - i3). Her activities focus on innovation and engineering management, with a particular attention to the health sector. She completed her thesis at Mines Paris in partnership w
Frédéric Kletz is a teacher-researcher at MINES ParisTech (Centre de Gestion Scientifique). In addition to teaching management science to engineering students (accounting, cost evaluation, HRM, etc.), his research activity, in the field of hospital management, focuses on change management and managerial innovations in hospitals, occupational health (especially absenteeism management), and public action in the sector.
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