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Vigilantly monitoring his patient’s vitals
π Health and biotech

“Hospitals must retain the agility acquired during the crisis”

Etienne Minvielle
Etienne Minvielle
CNRS Research Director at the Centre for Management Research of the Interdisciplinary Institute of Innovation (I³-CRG*)

The pan­dem­ic has put both our health­care sys­tem and hos­pi­tal man­age­ment meth­ods to the test. Dur­ing the first wave, health work­ers adopt­ed new, high­ly effec­tive man­age­ment tech­niques whilst work­ing in cri­sis mode. Will we retain these approach­es? In July 2020, Éti­enne Min­vielle and Hervé Dumez (CNRS/Institut Poly­tech­nique de Paris), pub­lished Le Sys­tème hos­pi­tal­ier français face à la crise Covid-19 [“How the French Hos­pi­tal Sys­tem Dealt with the Covid-19 Cri­sis”] a study based on 55 inter­views with health professionals. 

How would you sum up your field of expertise?

Health man­age­ment research is a field of social sci­ence that stud­ies key issues in pub­lic health, such as organ­i­sa­tion­al per­for­mance, coor­di­na­tion of health pro­fes­sion­als and treat­ment plans. It is a rel­a­tive­ly new field in France because health pro­fes­sion­als gen­er­al­ly have lit­tle for­mal man­age­ment training. 

Why did you decide to spe­cialise in this field? 

Over the course of my med­ical stud­ies, I became pas­sion­ate about man­age­ment. I stud­ied at the Essec Busi­ness School and have a doc­tor­ate in Man­age­ment Sci­ence from the Insti­tut Poly­tech­nique de Paris. Our coun­try has one of the best health sec­tors in the world when it comes to clin­i­cal prac­tice and research, but we have major man­age­ment prob­lems. Fix­ing these would lead to mas­sive improve­ments, as well as increase qual­i­ty, lim­it waste, and reduce inequal­i­ties. The field is still a minor­i­ty in the health­care sec­tor. I am try­ing to devel­op a large-scale patient-cen­tred approach to respond to spe­cif­ic needs of indi­vid­u­als. And to sub­se­quent­ly make that offer as wide­ly avail­able as possible. 

What lessons can we learn from the pandemic? 

Our health sys­tem has had to deal with an increas­ing num­ber of crises late­ly: ter­ror­ism, nat­ur­al dis­as­ters and, in our case, a pan­dem­ic. In order to face these chal­lenges and be more adapt­able, we have to adjust our skill set to imple­ment new kinds of man­age­ment strategies. 

Do you think our hos­pi­tals were adapt­able enough dur­ing the lock­down dur­ing the first wave of Covid-19? 

Yes. Our study sum­marised this in six points. We observed: 

  1. A great deal of organ­i­sa­tion­al cre­ativ­i­ty, includ­ing the mass devel­op­ment of tele-health ser­vices. This some­times involved a more relaxed approach to cer­tain rules, such as exchang­ing med­ical infor­ma­tion via What­sApp, which under nor­mal con­di­tions is a vio­la­tion of patient confidentiality. 
  2. For­ward plan­ning: health pro­fes­sion­als assessed the sit­u­a­tion and made deci­sions in real-time, high­light­ing the vital impor­tance of field stud­ies. Data obtained from an assess­ment of the sit­u­a­tion in the French city, Mul­house, was used to make deci­sions in Paris, for instance. 
  3. Sup­port­ive man­age­ment based on lis­ten­ing, exten­sive com­mu­ni­ca­tion, the con­sid­er­a­tion of everyone’s per­spec­tive and flat­tened hier­ar­chies made a big dif­fer­ence. This went hand in hand with fair dis­tri­b­u­tion of finan­cial resources between ser­vices, phys­i­cal pres­ence of lead­ers, and transparency.
  4. Adap­ta­tion through autonomous, co-oper­a­tive group work. For instance, rapid test­ing and eval­u­a­tion of new patient ori­en­ta­tion pro­to­cols were devel­oped by local teams.
  5. New part­ner­ships between start-ups and hos­pi­tals, and between pub­lic and pri­vate institutions. 
  6. Gov­ern­ment sup­port such as removal of finan­cial con­straints and pro­vi­sion for local initiatives. 

How can we fos­ter cre­ativ­i­ty in an envi­ron­ment which is under­stand­ably high­ly regulated? 

Humil­i­ty and doubt must be val­ued above all things. Cre­ativ­i­ty can only hap­pen when there is a will­ing­ness to let go of pre­vi­ous assump­tions. And errors must be recognised. 

What did we see dur­ing the sec­ond wave of the pandemic?

First off, it was slow­er and more wide­ly spread. Because of its re-appear­ance after a short peri­od of calm, health­care teams who are often tired are being test­ed again. The word that comes back most often is ‘weari­ness’. An abil­i­ty to adapt is still nec­es­sary but with an empha­sis on sup­port­ive man­age­ment. The ini­tial sol­i­dar­i­ty is wan­ing thin, so it is impor­tant to sup­port teams on a dai­ly basis and address wor­ries of health­care professionals. 

Between the two waves, were we see­ing man­age­ment return to the way it was before? Or were ser­vices retain­ing the knowl­edge learnt from pre­vi­ous crises? 

Under nor­mal cir­cum­stances, per­for­mance relies on spe­cial­i­sa­tion, hier­ar­chy and eval­u­a­tion; con­trary to adapt­abil­i­ty which relies on short net­works and quick reac­tions. How­ev­er, if we take a clos­er look, we can see that prox­im­i­ty man­age­ment is essen­tial in both cas­es. It encour­ages adap­ta­tion and can work to resist the loss of attrac­tive­ness we are see­ing in the health professions. 

Con­di­tions at hos­pi­tals have dete­ri­o­rat­ed; the organ­i­sa­tion­al struc­ture is unclear and under­mined by pol­i­tics. This makes health­care a tough work envi­ron­ment, and the ongo­ing cri­sis high­lights the urgent need for prox­im­i­ty man­age­ment. The bound­ary between nor­mal con­di­tions and those of the cri­sis is now blurred. For that rea­son, we could say that the man­age­ment chal­lenge needs to deal with a ‘nor­mal crisis’. 

Does the entire cul­ture have to change? 

I don’t real­ly like the word “cul­ture”. There is no man­u­al for chang­ing a cul­ture. To me, train­ing is para­mount. A head of depart­ment, for exam­ple, is often cho­sen on their exper­tise as a researcher, which does not nec­es­sar­i­ly make them a good man­ag­er who can unite staff, fos­ter cre­ativ­i­ty, encour­age intro­spec­tion, and so on. For me, the key is on-the-ground man­age­ment training. 

Is there a “post-Covid cri­sis” in pub­lic health? 

Yes, because we have realised that large scale threats are real, some­thing that would have been impos­si­ble with­out the pan­dem­ic. Think back to the begin­ning of the year: the signs were there, in Chi­na, in Italy, but peo­ple were often in denial. 

Will we see more crises on the same scale? 

Prob­a­bly. We will face oth­er threats, such as bio-attacks, new epi­demics, cyber-attacks, cli­mate change, and ter­ror­ism. We live in an uncer­tain world, and we must be pre­pared. Dur­ing the cri­sis, the army built an emer­gency mil­i­tary hos­pi­tal (in Mul­house) in record time, as part of a test for a chem­i­cal attack response. Staff wore very uncom­fort­able NBC suits. We need to under­stand that each cri­sis is unprece­dent­ed, that each sit­u­a­tion requires a new strat­e­gy. But we are learn­ing. We saw, for instance, that staff who had lived through the 2001 chem­i­cal explo­sion at the Toulouse AZF plant retained good cog­ni­tive reflex­es and adaptability. 

How did they behave? 

They were resilient. They had a way of remain­ing con­struc­tive under pres­sure, which is absolute­ly essen­tial. In times of sud­den, short-term crises, sol­i­dar­i­ty is per­va­sive. In chron­ic sit­u­a­tions, how­ev­er, that sol­i­dar­i­ty erodes. Organ­ic sol­i­dar­i­ty (“we are all in the same boat”) gives way to a more mechan­i­cal sol­i­dar­i­ty (“we are in this togeth­er, but rela­tion­ships must be nego­ti­at­ed”). Unless man­age­ment finds a way to coun­ter­act this, we will lose our effectiveness. 

Interview by Clément Boulle

Contributors

Etienne Minvielle

Etienne Minvielle

CNRS Research Director at the Centre for Management Research of the Interdisciplinary Institute of Innovation (I³-CRG*)

A former intern at the Paris hospitals, a graduate of ESSEC and holder of a doctorate from the Ecole Polytechnique, Etienne Minvielle is also Director of Quality, Risk Management and Patient Relations at the Gustave Roussy Institute.
*I³-CRG: a joint research unit of CNRS, École Polytechnique - Institut Polytechnique de Paris, Télécom Paris, Mines ParisTech