Altering Frontiers

5 Foreword by Jean-Louis Denis

6 Foreword by Norbert Nabet

7 Introduction

8 Begin Reading

9 List of Authors

10 Index

11 Other titles from iSTE in Innovation, Entrepreneurship and Management

12 End User License Agreement

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Health and Innovation Set

coordinated by

Corinne Grenier

Volume 1

Edited by

Corinne Grenier

Ewan Oiry

First published 2021 in Great Britain and the United States by ISTE Ltd and John Wiley & Sons, Inc.

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms and licenses issued by the CLA. Enquiries concerning reproduction outside these terms should be sent to the publishers at the undermentioned address:

ISTE Ltd

27-37 St George’s Road

London SW19 4EU

UK

www.iste.co.uk

John Wiley & Sons, Inc.

111 River Street

Hoboken, NJ 07030

USA

www.wiley.com

© ISTE Ltd 2021

The rights of Corinne Grenier and Ewan Oiry to be identified as the authors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act 1988.

Library of Congress Control Number: 2021934597

British Library Cataloguing-in-Publication Data

A CIP record for this book is available from the British Library

ISBN 978-1-78630-707-1

The issue of organizational innovation in health is not new, but it is nonetheless topical. All health systems in high-income countries face significant challenges when adapting their health systems to changing demands, knowledge and preferences, economic circumstances or technologies (Denis et al. 2018). The current COVID-19 pandemic highlights the need for organizational innovation to better respond to the unexpected and ensure an adequate and accountable response. These organizational innovations are multifaceted and refer to a reconfiguration of the professional, clinical, managerial and civic logics, to name but a few, that structure the functioning of a healthcare system (Thornton & Ocasio 2008). The healthcare system has long been characterized by a significant gap between technical innovation and organizational or institutional innovation. While such a gap is not unique to the healthcare sector, it is surprisingly acute in this sector. Technical innovation in the broadest sense of the term is a powerful driver of change in the healthcare sector. New drugs and diagnostic and therapeutic technologies are penetrating the healthcare system and organizations at a speed that makes them difficult to master. What is looming in terms of cell therapies is described as a tsunami that could sweep away the healthcare system, or at least revive it without being able to escape the difficult question of costs and what should or should not be offered by our social welfare systems. Digital innovation and artificial intelligence will also bring about organizational and institutional transformations (Hinings et al. 2018).

Organizational innovation, which can be more broadly described as immaterial innovation, is difficult to bring about, or at least to such a degree that it would allow better control of so-called technical innovations. One need only think of the experience of healthcare systems in the face of the deinstitutionalization of care made possible (in principle) by the arrival of laparoscopic technologies in the 1990s. The development of ambulatory care has been slower than otherwise, and clinical or organizational environments have had difficulty capitalizing on this opportunity.

This is certainly a reflection of reasonable caution, since innovation must make it possible to produce quality care in complete safety. There is also the imprint left by professional, organizational or political rigidities that make this capitalization uncertain or late.

Healthcare is not alone in this fight for innovation. Other sectors of activity, including that of economically oriented companies, have long stressed the difficulty of renewing social relations of production in favor of greater adaptation to a constantly changing environment (Osty et al. 2007). In the healthcare sector, organizational innovations, which I would call “basic”, are also slow to materialize. Take, for example, the difficulty in linking the designation of responsibility for care, the establishment of incentives to take on this responsibility and the optimization of the use of clinical resources. The interest in France and elsewhere in the implementation of new organizational forms such as Accountable Care Organizations (ACOs) is a major challenge in terms of innovation (Lemaire 2019). More broadly, we could also highlight the difficulty for several healthcare systems to also refocus their mission toward emerging priorities (mental health, frailty, etc.). Obviously, this is not only a question of organizational innovation, but also of innovations in terms of mentalities and social relations between stakeholders. So what does this book offer us? Without claiming to do it justice in a few lines, it serves to better understand the strategies likely to promote and capitalize on organizational innovation. The interest of such a book lies not in its diagnostic scope – the problem is fairly well known – but in the avenues of response it proposes to the tricky issue of the cumbersomeness or inadequacy of organizational innovation in health. I will limit myself to some remarks on the three main theses that make up the three parts of the book. These three themes are partly overlapping and I will come back to them in conclusion.