Doctor DBA, Business Science Institute
Twitter : @philanhorn
(DBA thesis supervised by Pr. Zardet)
Why and how should patient-professional care partnerships be deployed within a regional health system? As in a business ecosystem, all actors must share the values, language and practices that aim to achieve their common goal. My research allows me to make recommendations on how to deploy this partnership not only at the level of care, but also in the organization of services and the governance of the system.
Impacts and main results of the research
The analysis of my findings revealed four key insights. 1. The care partnership is on the move. It is not a question of knowing whether it is appropriate to introduce it into our healthcare systems (nearly 90% of the actors say they know and practice it), but rather of supporting its deployment in a coordinated manner, so that it produces a maximum of positive effects, both on the functioning of the system and on the health of the population. 2. The deployment of the partnership requires an action plan. While more than 90% of professionals claim to practice it systematically or occasionally, less than 50% of patients actually perceive it. It is therefore necessary to share a language and a culture, and to pool practices and resources (the time invested by certain actors in the partnership later benefits other actors within the system). 3. The effect of partnership on health system coordination is certain, but not sufficient. It is perceived as a factor in continuity of care, while inter-organizational practices are developing, but structural obstacles hinder its deployment: absence of an electronic patient record, extreme fragmentation of organizations and funding, absence of evidence-based local research on the subject. 4. The temporal context is favorable. The Covid-19 pandemic has reinforced the interest of the partnership for nearly 60% of the actors interviewed. The national regulatory framework (health insurance law) finally integrates quality and coordination of care as serious avenues for cost control. At the cantonal level, political support for partnership projects is increasingly strong. Finally, several of these projects are nearing the end of their pilot phase and will be made permanent. I was able to translate these results into general recommendations, based on my theoretical framework, and recommendations with a managerial impact, intended for the organization in which I conducted my research.
Theoretical foundations of the research
I initially wanted to examine the deployment of the care partnership through the lens of organizational change theories (Van De Ven & Poole, 1995 / Kerber & Buono, 2005). However, I found them difficult to operationalize in a field where change is more incremental than radical. After a detour through the sociology of translation (Callon & Latour, 1986), I wanted to maintain an "organic" approach while returning to a framework better suited to management, and opted for that of business ecosystems (Moore 1993, 1996). It applies appropriately to the evolution of a regional health system, since it carries with it the notion of permanent adjustment of actors for the purposes of coordination and innovation (societal in my case). It lists the challenges to which the ecosystem is subjected throughout its life cycle, both from the point of view of cooperation and competition. On this basis, I was able to formulate general recommendations for the deployment of the care partnership in health systems.
I adopted a pragmatic constructivist epistemological posture and used mixed methods (Creswell & Plano Clark, 2018). The main axis was qualitative: an intervention research on the introduction of the anticipatory care project within my organization (Coghlan & Brydon-Miller, 2014 / Savall and Zardet, 1987, 2015) allowed me to follow about ten clinical situations and to organize interviews with patients, their relatives, professionals and managers of the institutions involved. I was able to contextualize this research thanks to two surveys by questionnaires conducted at one year intervals with the actors of the network, punctuated by exploratory and/or explanatory interviews. In all, 619 individual contributions were collected from 504 professionals and 115 patients. The quantitative data were administered and statistically analyzed with the Sphinx Déclic software, while the qualitative data (recordings and transcriptions of interviews on RedCap) were subjected to lexical analysis by grouping the verbatims, either by key ideas or by metadata (tags).
The teachers' opinion
I would like to congratulate Philippe Anhorn once again for this excellent, pedagogical and rigorous thesis, which is rich in numerous and high-quality results. His career path shows that even under difficult conditions, assuming professional responsibilities while preparing a DBA thesis is possible! (Pr. Véronique Zardet, thesis director)
The thesis is based on a real rigor of scientific observation in the framework of a complex problem involving a very large number of variables and fluctuating data. From this point of view, the beginning of research-intervention allows to build a relevant body of knowledge. (Pr. Marc Bonnet, rapporteur)
To go further
"The care partnership: an ecosystemic evidence" (Philippe Anhorn's doctoral thesis, 2021)
"When patients, relatives and caregivers are partners" (Article in the online journal Reiso, by Anhorn, P., Chinet, M., Nicolas, F., Devaux, L., Reber, R., 2020)
"The Montreal model: challenges of the relational partnership between patients and health professionals"(Article by Marie-Pascale Pomey et al. in Santé Publique, 2015)
"The death of competition: leadership and strategy in the age of business ecosystems" (Book by James F. Moore, 1st ed. HarperBusiness, New York, 2006)
Article translated from French with https://www.deepl.com/translator
Presentation of the article in video, by Philippe Anhorn