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PART 1
Innovations as Seen by Stakeholders

Introduction to Part 1

Taking up the challenge of “altering frontiers” through organizational innovations raises the double question of the place of different individuals in this profound transformation.

Individuals are first and foremost at the heart of this transformation because they are the driving force behind it. They are singular individuals – the innovators – who develop new interdisciplinary practices, implement decompartmentalization and transform usual routines (Gherardi 2008). They transform their practices by experimenting in “innovative spaces” typically outside the organization, sometimes protected from the rules that usually govern it (Bucher & Langley 2016). They are sometimes tired of the multiple social norms to which they cross in order to innovate (Alter 2011). However, they are clearly, for many, the heart and driving force of the organizational innovation process that enables decompartmentalization.

As for the rest of the professionals, even if they are not exactly innovators, are they not also the target of organizational innovations that aim to decompartmentalize? In this way, they discover and experience on a daily basis the transformations that have been designed for them and that they must appropriate and implement. These innovations transform their ways of working, shake up their skills and sometimes their professional identities (Robelet et al. 2005). This can also make them more efficient and even satisfy them by giving more meaning to their work, emphasizing that a decompartmentalized organization ensures better and more effective patient care or support.

“Altering frontiers” through organizational innovations is therefore bringing about interplay of identity dimensions as well as questions of competence or performance.

Finally, we must not lose sight of the fact that compartmentalization cannot be overcome without taking into account the major consequences that this can have. Indeed, in healthcare organizations, compartmentalization is merely a fortuitous and damaging consequence of significant bureaucracy (Weber 2003). Compartmentalization is also that. The sheer amount of bureaucracy means that employees are gradually losing out the overall vision and meaning of the work they do there and reduce their field of intervention to what is their only day-to-day work.

However, silos are also a simple and relatively effective organizational solution for maintaining and deepening employee expertise (Currie et al. 2012). In a healthcare activity where expertise is crucial and where its shortcomings can have immediate consequences on the lives of patients, it is understandable that compartmentalization may have appeared to be a satisfactory solution. By asking a radiologist to deal only with x-rays or a surgeon to specialize in the surgery of only one part of the body, a care facility ensures that the expertise will be maximal and that the patient’s care will be optimal.

However, it is only recently, with the increasing complexity of care and support (chronic diseases, aging of the population), that the coordination of many stakeholders in a multi-professional approach (different doctors, other health professionals but also patients themselves) has become necessary, revealing even more the restrictive limits of this compartmentalization. Today, when we think about the decompartmentalization of health organizations, it is necessary to also think about organizational devices that will enable the maintenance and the deepening of the expertise of all the professions and expertise (also known as lay) in the field of health and healthcare.

This book, which offers a multidisciplinary and multi-level analysis of current innovations in healthcare systems, had to begin with a reflection on the changing roles and skills of the stakeholders, those who, on a daily basis, act on the healthcare system.

Among these stakeholders, we wanted to analyze first the organizational innovations that are developed around the patients themselves. Although they are the main beneficiaries and stakeholders in the health system, it has long been known that their knowledge and experiences are ultimately difficult to be taken into account by health systems where, often, professional logics dominate.

This section on the players opens with an analysis of the experience of the UniverCité du Soin in Nice by Luigi Flora (Chapter 1). This network makes it possible to work, it seems, on an equal footing – patients, health professionals, caregivers, users and civil society. Its objective is to enable the development of experiential knowledge about care, particularly about chronic diseases. This experiment describes concretely the forms and effects of this “empowerment” of patients, users and civil society.

Chapter 2, proposed by Philippe Mossé, analyzes the new skills that emerge among health professionals as a result of this strengthening of cooperative work (between professionals, with patients and with other users of the healthcare system). The case of advanced practice nurses is a particularly good illustration of the effects of this organizational innovation. In particular, this case highlights the fact that, to be complete, the analysis must go beyond the case of individuals alone to position them within broader frameworks such as those of professional spaces.

Finally, an identical logic is found in the contribution of Bertrand Pauget (Chapter 3) who looks at communities of practice of volunteers in the care of the elderly in the Swedish care system. The analysis clearly shows that the long-term motivation of charitable workers depends on their inclusion in collectives – in this case communities of practice – which enable them to build a sense of purpose for their actions and to disseminate the most effective practices.

References

Alter, N. (2011). Comment les dirigeants des organisations peuvent tuer l’innovation ? Gestion, 36(4), 5–10.

Bucher, S. and Langley, A. (2016). The interplay of reflective and experimental spaces in interrupting and reorienting routine dynamics. Organization Science, 27(3), 594–613.

Currie, G., Lockett, A., Finn, R., Martin, G., Waring, J. (2012). Institutional work to maintain professional power: Recreating the model of medical professionalism. Organization Studies, 33, 937–962.

Gherardi, S. (2008). Aujourd’hui les plaques sont molles ! Revue d’anthropologie des connaissances, 2(1), 3–35.

Robelet, M., Serré, M., Bourgueil, Y. (2005). La coordination dans les réseaux de santé : entre logiques gestionnaires et dynamiques professionnelles. Revue française des affaires sociales, (1), 231–260.

Weber, M. (2003). Économie et société. Pocket, Paris.