École nationale d'administration publique.
J Health Polit Policy Law. 2012 Aug;37(4):633-45. doi: 10.1215/03616878-1597457. Epub 2012 Mar 30.
Health care systems are under pressure to control their increasing costs, to better adapt to evolving demands, to improve the quality and safety of care, and ultimately to ameliorate the health of their populations. This article looks at a battery of organizational options aimed at transforming health care systems and argues that more attention must be paid to reforming the delivery mechanisms that are so crucial for health care systems' overall performance. To support improvement, policies can rely on organizational assets in two ways. First, reforms can promote the creation of new organizational forms; second, they can employ organizational levers (e.g., capacity development, team-based organizations, evidence-informed practices) to achieve specific policy goals. In both cases organizational assets are mobilized with a view to creating complete health care organizations -- that is to say, organizations that have the capacity to function as high-performing systems. The challenges confronting the development of more complete health care organizations are significant. Real health care system reforms may likewise require implementing ecologies of complex innovation at the clinical, organizational, and policy levels. Policies play a determining role in shaping these new spaces for action so that day-to-day practices may change.
医疗保健系统面临着控制成本不断增长、更好地适应不断变化的需求、提高护理质量和安全性、最终改善其人口健康的压力。本文探讨了一系列旨在改变医疗保健系统的组织选择，并认为必须更加关注改革对医疗保健系统整体绩效至关重要的提供机制。为了支持改进，政策可以通过两种方式利用组织资产。首先，改革可以促进新的组织形式的创建；其次，它们可以利用组织手段（例如，能力发展、以团队为基础的组织、循证实践）来实现具体的政策目标。在这两种情况下，都动员组织资产来创建完整的医疗保健组织——也就是说，有能力作为高绩效系统运作的组织。发展更完整的医疗保健组织所面临的挑战是巨大的。真正的医疗保健系统改革可能同样需要在临床、组织和政策层面实施复杂创新的生态系统。政策在塑造这些新的行动空间方面发挥着决定性作用，以便改变日常实践。
