Why and how should the health care partnership between patients and professionals be deployed within a regional health care system? As in a business ecosystem, all the players must share the values, language and practices that aim to achieve their common goal. My research enables me to make recommendations on how to deploy this partnership not only at the level of health care, but also in the organisation of services and the governance of the system.
The analysis of my findings revealed four key insights. 1. The health care partnership is on the move. It is not a question of knowing whether it is appropriate to introduce it into our health care systems (nearly 90% of the players say they are familiar with it and put it into practice), but rather a question of supporting its introduction in a coordinated manner, so that it produces as many positive effects as possible, both on the running of the system and on the health of the population. 2. The deployment of the partnership requires an action plan. Although 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 the coordination of the health care system is certain, but not sufficient. It is perceived as a factor in continuity of health care as inter-organisational practices develop, but there are structural obstacles to its deployment: absence of digital patient records, excessive fragmentation of organisations and funding, absence of evidence-based local research on the subject. 4. The historical context is favourable. The Covid-19 pandemic has reinforced the interest in partnership for nearly 60% of the actors interviewed. The national regulatory framework (health care insurance law) is finally leading to quality and coordination of health care as serious ways of controlling costs. At the more local level (Swiss Cantons), political support for partnership projects is increasingly strong. Finally, several of these projects are reaching the end of their pilot phase and will be continued. I was able to translate these results into general recommendations, based on my theoretical framework, and recommendations with a managerial impact, intended for the organisation in which I conducted my research.
I initially wanted to examine the deployment of the health care partnership from the perspective of organisational change theories (Van De Ven & Poole, 1995 / Kerber & Buono, 2005). However, I found them difficult to operationalise in a field where change is more incremental than radical. After making a diversion into the sociology of translation (Callon & Latour, 1986), I wanted to retain an ‘organic’ approach while returning to a framework better suited to management, and opted for that of business ecosystems (Moore 1993, 1996). It can be suitably applied to the evolution of a regional health care system, since it carries with it the notion of the 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 health care partnership in health systems.
I adopted a pragmatic constructivist epistemological approach and used mixed methods (Creswell and Plano Clark, 2018). The main focus was qualitative involving intervention research into the introduction of a preventative health care project within my organisation (Coghlan & Brydon-Miller, 2014 / Savall and Zardet, 1987, 2015). This allowed me to investigate a dozen cases of clinics and to conduct interviews with patients, their relatives, professionals and managers of the institutions involved. I was able to contextualise this research thanks to two questionnaire surveys addressed at a year’s interval to actors in 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 processed and analysed statistically using the Sphinx Déclic software, while the qualitative data (recordings and transcriptions of interviews on RedCap) were analysed lexically by grouping the verbatims either by key ideas or by metadata (tags).
- Le partenariat de soins : une évidence écosystémique – The health care partnership: ecosystemic evidence (DBA thesis by Philippe Anhorn, 2021)
- Quand patients, proches et soignants sont partenaires – When patients, relatives and carers are partners (Article in the online journal Reiso, by Anhorn, P., Chinet, M., Nicolas, F., Devaux, L., Reber, R., 2020)
- Le Montreal model : enjeux du partenariat relationnel entre patients et professionnels de la santé – The Montreal model: challenges of the relational partnership between patients and health care 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 (James F. Moore, 1st edition. Harper Business, New York, 2006)
Feedback from panel members
Once again, I would like to congratulate Philippe Anhorn for this excellent, instructive and academically rigorous thesis, which contains numerous high-quality results. His career path shows that even under difficult conditions, assuming professional responsibilities while pursuing a DBA thesis is possible! (Prof. Zardet, thesis supervisor)
The thesis draws on genuinely rigorous scientific observation in the context of a complex problem involving a very large number of variables and evolving data. From this point of view, a research-intervention approach makes it possible to build up a highly relevant body of knowledge (Prof. Bonnet, examination panel member)