Читать книгу Altering Frontiers - Группа авторов - Страница 16

The creation of a book is always the fruit of a long process. The present project began in 2019 when, in the vast majority of countries, the transformation of the health system was thought to be a long-term process, with uncertain results, and marked by a fiercely negotiated balance between “high” and “low”, between center and periphery, between institutional entrepreneurs and those more inclined to preserve so-called “assets”.

However, its manufacture concludes with a context that is completely new for many: the (global) health crisis of COVID-19 and the ways to combat it. Daily reports (TV, newspapers) recount the major difficulties faced by organizations and health professionals in informing, caring for and accompanying patients, users and caregivers: lack of personnel – and those who remain are exhausted – lack of masks and other protection, insufficient intensive care beds, etc. These are all the aspects of the healthcare system that are affected: hospitals, EHPAD, medical and social institutions providing support or accommodation for disabled children and adults, SAAD and SSIAD², social services, “front-line” professionals, etc. This crisis will have been a powerful indicator of dysfunctions that have already been in place for a long time.

At the same time, many testimonies have revealed daily the determination of all professionals and other stakeholders (charitable workers and citizens) to continue to practice their “profession for the other”. In many countries, everyone seemed to be rallying for the “common good”, based on a principle of solidarity in capitalist societies (Tirole 2016). What a lot of tinkering! In the sense that, in a do-it-yourself approach, the stakeholder knows the aims of his or her actions, but at the same time, he or she must identify or locate the resources to achieve them (Levis-Strauss 1962; Garud & Karnoe 2003).

These do-it-yourself projects, as varied as they are ingenious and surprising, are all based on the different facets of action that we have just mentioned, all of which are based on the identification of boundaries and the conditions under which they are crossed. However, they reveal, with renewed acuity, three ingredients for a sustainable transformation of the health system: the autonomy of the stakeholders, enabling them to invent solutions; the benevolence of the supervisory authorities, with a view to mobilize methodological and support resources to assist these professionals and organizations; and the need for a sense of control and evaluation to ensure the sustainability of this inventiveness.

Finally, it emerges from most of the chapters of the book that this crisis is also a call to put an end to a culture of “the fairest”. The crisis has revealed what can be called a slack of solidarity, when individuals, companies, merchants, etc., spontaneously offer their help and service. The term slack refers to the surplus (time, resources) which we do not know a priori what it can be used for, except when it has to be used! Schulman (1993) identifies two types of slack: that of resources (surplus not strictly engaged in current activities) and that of control relative to the degree of freedom in organizational activities (i.e. a set of actions that are not framed by formal modes of power, and supervision). It is thanks to these that the crisis is overcome as quickly as possible. May this lesson be kept in mind, not only because some people predict the multiplication and complexity of future crises, but more generally because it is an important condition for any innovative organization, when individuals have time, outside of protocolized and routine activities, to imagine how to renew themselves in a different way.