Altering Frontiers: Organizational Innovations in Healthcare

How can healthcare systems be transformed by reimagining their multiple silos to favor processes and practices that are more responsive to local, horizontal initiatives? Altering Frontiers analyzes numerous experiences, using a multidisciplinary approach, paying attention to certain actors, collectives and organizational arrangements. Through this work, levers are identified that promote lasting transformation: recognizing the legitimacy of the practices of many who are often "invisible"; trusting those who know their intervention territory; investing in methodological support; taking advantage of tools and procedures such as instruments for strategic and managerial discussion; and developing the capacity to absorb innovative ideas and experiences that circulate within the environment.

Table of Contents:
Foreword by Jean-Louis Denis: Adaptation, Trust and Methodology xi Jean-Louis DENIS Foreword by Norbert Nabet : The Challenges of Altering Frontiers: For Other More Collaborative Approaches xvii Norbert NABET Introduction: The Challenges of “Altering Frontiers”: The Multiple Facets of Boundaries to Cross and Articulate xxi Corinne GRENIER and Ewan OIRY Part 1. Innovations as Seen by Stakeholders 1 Introduction to Part 1 3 Chapter 1. Recognition of Patients’ Experiential Knowledge and Co-production of Care Knowledge with Patients and Citizens in the 21st Century 7 Luigi FLORA 1.1. Introduction 7 1.2. From “empowerment” to the “patient revolution”, an international trend 8 1.3. From paternalism to different forms of participation and partnership with patients 14 1.4. Innovative practices 14 1.5. Conclusion 25 1.6. References 26 Chapter 2. Innovative Organizations and Professional Strategies: The Nursing Professional Space 29 Philippe MOSSÉ 2.1. Introduction: experimenting experimentation 29 2.2. Participatory evidence-based policy: a new conceptual framework? 31 2.3. Article 51: a full-scale test 34 2.3.1. Experimenting for recognition 34 2.3.2. An expression of interest 36 2.4. The nursing space: a controlled extension 38 2.4.1. Asalée: a fragile experiment 39 2.4.2. The nurse in advanced practice: spearhead or first in line 41 2.5. Conclusion: new ways of doing things 46 2.6. Appendix: examples of emancipatory innovations in the 1990s 47 2.6.1. Nursing specialization versus the place of the manager 47 2.6.2. Stubborn labor relations 48 2.7. References 48 Chapter 3. Managed Communities of Practice in the Gerontology Sector: Case of a CoP of Gerontology Volunteers in Sweden 51 Bertrand PAUGET 3.1. Introduction 51 3.2. Context and questions 52 3.3. Conceptual framework 53 3.3.1. Volunteering 53 3.3.2. Communities of practice 53 3.3.3. Managed communities of practice 54 3.3.4. The interpretative framework of a piloted community of practice 55 3.4. Illustrations 55 3.4.1. The Swedish context 55 3.4.2. A community of practice piloted in the field of gerontology 56 3.5. Conclusion 58 3.6. References 59 Part 2. Innovations on the Collective Side 61 Introduction to Part 2 63 Chapter 4. Moving from Partitioning to Transversality in Operating Rooms using Robot-assisted Surgery 67 Delphine WANNENMACHER 4.1. Introduction 67 4.2. The context of operating rooms mobilizing the surgical robot 68 4.3. The issue of technical and non-technical skills in the context of robotic surgery 69 4.4. The effects of new technologies in terms of individual and collective skills 70 4.5. Viewing at the heart of robot-assisted surgery in urology 71 4.5.1. A pragmatic approach to analyzing the activity of an operating theater 71 4.5.2. A configuration of the operating room and an installation of the patient constrained by the surgical robot 72 4.5.3. A spatiotemporal separation and limited communication between team members 74 4.5.4. The impoverishment and disarticulation of individual and collective skills in the operating room, mobilizing the surgical robot 75 4.6. Discussion 77 4.7. References 79 Chapter 5. Clinical Poles of Activity, an Opportunity for New Cooperation Between the Actors? The Case of a Hospital 81 Christelle HAVARD 5.1. Key elements and objectives of polar reform 82 5.2. Improving cooperation and better articulating the logics present in the hospital: challenges and theoretical identification 83 5.3. Context and methodology of the study 86 5.4. Modalities of cooperation permitted by the establishment of the clinical poles 86 5.4.1. The articulation actors 86 5.4.2. Tools supporting articulation work 88 5.4.3. The instances of exchange and articulation 90 5.5. Conditions for the use of articulations 92 5.6. Cooperation in a polar structure, some research avenues 94 5.7. References 96 Chapter 6. Learning from Reforms Aiming to Disseminate Innovative Organizational Models: The Case of Family Medicine Groups in Quebec 99 Frédéric GILBERT 6.1. Introduction 99 6.2. Conceptual framework 100 6.2.1. The impact of intervention precision on the ability to learn 100 6.2.2. The impact of evaluations on learning capacities 101 6.3. Illustration of the analytical framework: the reflexive processes related to the implantation of family medicine groups in Quebec 103 6.3.1. Method and context of the study 103 6.3.2. Results of the analysis 104 6.4. Discussion 108 6.4.1. A brief overview of intervention theory 108 6.4.2. Evaluations that support rather than question 108 6.4.3. Evaluations that are not well integrated into the GFM policy 110 6.4.4. Improvements to increase learning potential in primary care reforms 110 6.5. Conclusion 110 6.6. References 111 Chapter 7. Variety and Performance of Innovative Organizational Structures: The Emergence of Territorial Support Platforms 115 Matthieu SIBÉ, Sandrine CUEILLE and Tamara ROBERTS 7.1. Introduction 115 7.2. Context of the study 118 7.2.1. Organizational forms for the care and support to complex patients: an overview of the literature 118 7.2.2. Territorial support platforms: a new organizational arrangement in the French healthcare system 119 7.2.3. Context of the study, expected empirical observations on organizational forms and performance of PTAs 120 7.3. Conceptual framework 122 7.3.1. Analytical framework and concepts from structural contingency theory 122 7.3.2. The adhocratic structural configuration: an innovative organizational form to carry out complex tasks in dynamic environments 123 7.4. Empirical analysis 125 7.4.1. Analysis of contingency factors (situational elements) and expected organizational form of PTAs 125 7.4.2. Organizational congruence and PTAs performance 133 7.5. Conclusion 136 7.6. Acknowledgments 137 7.7. References 137 Part 3. Reflective Insights on Organizational Innovations in Healthcare 141 Introduction to Part 3 143 Chapter 8. Proposals for New Approaches to Contributory Evaluation of Healthcare Pathways from Interface Organizations 147 Jessica GHELLER, Christian BOURRET and Gérard MICK 8.1. Introduction 147 8.2. Context and research questions 148 8.2.1. Background 148 8.2.2. Positioning for the method 150 8.2.3. Methodology 151 8.3. Framework for analyzing the processes of diffusion of organizational innovations: definition and principles (conceptual framework) 152 8.4. Empirical illustrations of the innovation diffusion processes supported by coordination platforms 153 8.4.1. A community of “expert” stakeholders, resulting from dynamic processes of territorial construction 154 8.4.2. Territory of practices as a framework for the intelligibility of processes for disseminating organizational innovations 156 8.4.3. Learning process 158 8.4.4. Process of building collective standards 161 8.5. Conclusion 165 8.5.1. Lessons 165 8.5.2. Perspectives 166 8.6. Acknowledgments 167 8.7. References 167 Chapter 9. Innovation and Absorptive Capacity of Organizations in the Healthcare Field 169 Corinne GRENIER and Christine DUTRIEUX 9.1. Introduction: absorbing to innovate 169 9.2. Context and questions: the challenge of openness 170 9.3. Theoretical framework: the notion of organizational absorption capacity 172 9.4. Responses to the three OAC pitfalls: illustrations 175 9.4.1. Entering the absorption process 175 9.4.2. The quality of what is absorbed 177 9.4.3. The transition from potential to realized 180 9.5. Conclusion 183 9.6. References 184 Chapter 10. Quality Management in Hospitals: The Two Faces of Rationalization Through Indicators 187 Hugo BERTILLOT 10.1. Introduction: are quality indicators a managerial innovation? 187 10.2. Context and issues 188 10.2.1. An institutional response in the context of a confidence crisis 188 10.2.2. From cautious indicators to equivocal uses 189 10.3. Management tools and organizational rationalization dynamics 190 10.3.1. What rationalization of professional organizations? 190 10.3.2. Investigating rationalization induced by quality indicators 191 10.4. A dynamic of professional rationalization? 192 10.4.1. Standardization of professional practices 192 10.4.2. Traceability of hospital activities 193 10.4.3. The local rooting of evidence-based medicine 195 10.5. A dynamic of managerial rationalization? 197 10.5.1. Control and competition 197 10.5.2. Rationalization and bureaucratization 199 10.5.3. A certain disenchantment with the hospital world 200 10.6. Conclusion: rationalizing through indicators to rationalize “softly” 202 10.7. References 203 List of Authors 205 Index 207

About the Author :
Corinne Grenier is Professor of Strategy and Innovation at KEDGE Business School, France, and is the director of the Center of Expertise Health & Innovation. She is also the scientific director of the MSAIS (Mastere Specialise Management des Structures et Activites Innovantes en Sante) program. Ewan Oiry is Full Professor in HRM at Ecole des Sciences de Gestion – Universite du Québec a Montreal (ESG-UQAM), Canada. His research focuses on competence management. He is co-lead of the AGRH Thematic Research Group "Competency Management - Didier Retour".