Читать книгу Altering Frontiers - Группа авторов - Страница 14

In most developed countries, health systems and organizations at first glance seem a kind of mystery to anyone wishing to understand their mechanisms and dynamics. Their challenges are well known, and meeting them is a challenge (aging population, rise in chronic diseases, technological upheavals made possible by the arrival of Big Data and artificial intelligence, financial equilibrium, increasing inequalities in access to healthcare and healthcare services, the desire for greater patient autonomy and the legitimacy of their voice and experiences, etc.). Conditions are identified as being reinforced by a system that is too procedural, losing its ability to respond in a personalized and individualized manner to the needs of its users and patients. It appears to be “ungovernable” through the usual channels when it comes to dealing with crises with sudden manifestations that are part of a complex network of causes (such as the COVID-19 pandemic or climate change).

Once this diagnosis has been made, the avenues for transformation have also been identified around the central priority of altering frontiers in a system that is too strongly compartmentalized: inventing new forms of governance and cooperation to counter the impossibility of doing things “collectively” in a pluralist system, and giving back room for maneuver and spaces for inventiveness and transformation to local stakeholders in the face of a system that is heavily top-down and has little trust and legitimacy in a number of stakeholders; and yet, health systems remain difficult to transform when there is an extraordinary number of experiments, creative approaches, local dynamics, organizational reorganizations, etc.

In order to go beyond this apparent paradox, it is necessary to adopt relevant viewpoints that broaden analytical perspectives that are conducive to transformation.

This is why the angle of this book is that of “altering frontiers”, at the micro (stakeholders), meso (various collectives, organized groups) and now macro (organizations) levels. Indeed, the expression “altering frontiers” offers different viewpoints, enabling the researcher and professional and institutional stakeholders to rethink what constitutes a boundary and to act on them in order to organize or coordinate activities differently. This book therefore proposes a new way of analyzing organizational innovations that aim to transform the healthcare system from a vertical and compartmentalized approach to a more horizontal and decompartmentalized one. This approach provides a multifaceted view of the drivers, favorable conditions and methodological principles that can support sustainable transformations in order to “rebuild institutions”.