Combining the Viable System Model and Kotter’s 8 Steps for Multidepartment Integration in Hospitals
Résumé
Integration between different departments is a major challenge for hospitals. It is considered as a key step towards greater efficiency. Yet research in industrial engineering does not provide satisfactory answers to this issue. Multi-departments issues are under-investigated and the implementation of recommendations is scarce. In this article, we focus on the first phases of a change program aiming at the better integration of a hospital sub-system. We propose an original methodological combination: Stafford Beer’s Viable System Model, an organizational cybernetics model, is coupled with John Kotter’s 8 steps for leading change, a change management method. We implement this approach in an action-research project in a French hospital’s outpatient chemotherapy sub-system. The method allows us to diagnose structural issues in the system, to build a change program and to launch its implementation effectively. The first elements of an integrated vision are already present in the hospital.
L'intégration des différents services en un ensemble coordonné est un défi important pour les hôpitaux afin d'augmenter leur efficience. A ce jour, les solutions apportées par la recherche en génie industriel pour aider les praticiens à y parvenir sont insuffisantes. Les problématiques multi-services sont insuffisamment traitées et l'implémentation des recommandations est rare. Cet article s'intéresse aux premières phases d'un programme de changement visant à renforcer l'intégration d'un sous-système hospitalier. Nous proposons une combinaison méthodologique originale : le Viable System Model, un modèle cybernétique d'organisation, est couplé à une méthode de conduite du changement, les 8 étapes de John Kotter. Cette approche, implémentée en recherche-action sur la délivrance de chimiothérapies ambulatoires dans un hôpital français, nous permet de diagnostiquer les problèmes structurels de l'organisation, de construire un programme de changement et de le lancer efficacement. Les premiers éléments d'une vision intégrés sont déjà présents dans l'hôpital. Abstract – Integration between different departments is a major challenge for hospitals. It is considered as a key step towards greater efficiency. Yet research in industrial engineering does not provide satisfactory answers to this issue. Multi-departments issues are under-investigated and the implementation of recommendations is scarce. In this article, we focus on the first phases of a change program aiming at the better integration of a hospital subsystem. We propose an original methodological combination: Stafford Beer's Viable System Model, an organizational cybernetics model, is coupled with John Kotter's 8 steps for leading change, a change management method. We implement this approach in an action-research project in a French hospital's outpatient chemotherapy subsystem. The method allows us to diagnose structural issues in the system, to build a change program and to launch its implementation effectively. The first elements of an integrated vision are already present in the hospital. Mots clés – Viable System Model, intégration, gestion hospitalière, conduite du changement, recherche-action.
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