design in a sense absorb the logic of the living laboratory by formalizing new frameworks for interaction. They must be accompanied by change and boldness of ideas and mindsets in order for organizational innovations and new practices to emerge. Finally, technologies are called upon to play an increasingly important role in bringing together and creating tension between various stakeholders in search of innovation. Each of the chapters presented in this section could consider the potential of new technologies to create collective spaces that accelerate organizational innovation (Ansell & Gash 2018).
The third topic, dealt with in Part 3 entitled “Reflective Insights on Organizational Innovations in Healthcare”, gives way for the systematic analysis of experiences to contemplate change and innovation, whether through research or through evaluation in context. This part highlights, through the various contributions that compose it, the importance of the knowledge-power nexus in understanding and shaping innovations (Ferlie & McGivern 2014). Organizational innovation emerges from a rather deliberate process and does not easily reveal all its subtlety. Systematic processes must be put in place in order to learn from experience and produce knowledge that can accompany and propel innovations. The idea is to produce, by means of a reflexive analysis, knowledge about the conditions for transforming an organization or a health system. The analysis of public healthcare policy offers an opportunity to learn in real time from initiatives aimed at bringing about large-scale transformations and generalizing organizational innovations.
The next challenge is to make this knowledge effective, i.e. to create the conditions for stakeholders to take an interest in it in order to act in favor of innovation. Management tools and policy instruments play a key role here, since they put into circulation representations of activities, behaviors and changes they can induce that were previously less or little known. Ideally, they make it possible to open up new objects to governance, whether it be the state of health of a population, quality of life or healthy living with illness (Jarzabkowski & Kaplan 2015). In all innovation processes, it is important to pay attention to the resource allocation channels that weigh in favor of or against organizational innovation. It is not enough to want to renew primary care or encourage the so-called grassroots innovation; an organization must be able to dedicate the resources that will enable these stakeholders to materialize their projects. These resources are not necessarily new, underlining the importance of being able to reallocate resources to emerging priorities or representations in the healthcare system.
The three parts that structure this book on organizational innovation in healthcare complement one another. Fostering innovation requires stakeholders with the capacity to influence, spaces to create and experiment, and knowledge about processes that can support and accelerate the challenging of the status quo and the implementation of new organizational modes or practices. One of the essential conditions for the governance of innovation in healthcare systems is the question of alignment and coherence between public policies and the dynamics and needs found in organizations and clinical settings. This book provides us with the pieces to tackle the puzzle of organizational innovation with seriousness and relevance. It will benefit from being complemented by a reflection on the political and social conditions that enable health systems to adapt better than others to the major contemporary challenges of health and thus to capitalize on innovation on a large scale, whether organizational or not.
Jean-Louis DENIS
CR-CHUM
Université de Montréal
March 2021
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Foreword by Norbert Nabet The Challenges of Altering Frontiers: For Other More Collaborative Approaches
Healthcare systems are complex, the result of historical evolutions that are sometimes contradictory, rich in their diversity but finally well enough organized to resist change, especially institutional change. In France, however, it is the institution that drives change: a hyper-regulated and over-administered system, the fruit of our poorly tamed health history, rich in specificities, achievements and compromises, and therefore of compartments and sectors with their own governance, representations, rates, authorities, hindered or finally protected by their own partitions.
In France, the law and the administration, in the name of quality, safety and equal access to healthcare, use their traditional tools to organize the system, its robustness and universality, as well as its performance and evolution.
On the one hand, spectacular health crises impose strong and visible, and therefore legislative, reactions. Accustomed to dealing with problems at this level of power, governments have become accustomed to the legislative ritual, turning each presidential term into an opportunity to reform, improve and transform the entire healthcare system, which everyone now, certainly for the sake of simplicity, agrees to refer to it as a healthcare “system”.
Moreover, since the beginning of the 2000s, two symbolic and operational guardianships have been more or less in competition with each other, each issuing its own rules, recommendations and therefore partitions to redundant central and territorial administrations.
Finally,
