{"id":463,"date":"2018-06-03T17:13:55","date_gmt":"2018-06-03T16:13:55","guid":{"rendered":"http:\/\/www.dernieresnouvellesdufront.com\/?p=463"},"modified":"2018-06-03T17:14:14","modified_gmt":"2018-06-03T16:14:14","slug":"puis-mintzberg-vint","status":"publish","type":"post","link":"https:\/\/www.dernieresnouvellesdufront.com\/?p=463","title":{"rendered":"Puis Mintzberg vint"},"content":{"rendered":"

Chers coll\u00e8gues,<\/p>\n

Avant un bouquet de printemps cueilli en fl\u00e2nant le long du web, un grand merci \u00e0 Fr\u00e9d\u00e9ric Pierru, qui a attir\u00e9 mon attention le dernier ouvrage du pape du management, et du management m\u00e9dical en particulier, Henry Mintzberg.<\/p>\n

Au soir de sa prestigieuse carri\u00e8re, l\u2019universitaire canadien a publi\u00e9 en 2017 Managing the Myths of Health Care: Bridging the Separations between Care, Cure, Control, and Community<\/em>. C\u2019est un livre de premi\u00e8re importance car il \u00e9mane du meilleur connaisseur de la question et bat en br\u00e8che toute la pens\u00e9e manag\u00e9riale technocratique dominante, y compris en France. Il affirme la n\u00e9cessit\u00e9 d\u2019un management m\u00e9dical sp\u00e9cifique non quantophr\u00e9nique.<\/p>\n

Ce livre doit \u00eatre signal\u00e9 de toute urgence \u00e0 ceux qui r\u00e9fl\u00e9chissent \u00e0 l\u2019avenir de nos \u00e9tablissements hospitaliers, \u00e0 l\u2019\u00c9lys\u00e9e, \u00e0 Matignon, avenue de S\u00e9gur, et bien s\u00fbr avenue Victoria, m\u00eame si Mintzberg explique qu\u2019ils ne sont justement pas les plus aptes pour d\u00e9cider : \u00ab Much of the significant change in health care has to come initially from the ground up, not the top down, let alone from experts who have not practiced health care. <\/em>[\u2026] Health care cannot function without management, but it can certainly function without a form of management that has become too common. I call it remote-control management because it is detached from the operations yet determined to control them. It works badly even in business, from where it has come. In health care, it reorganizes relentlessly, measures like mad, promotes a heroic form of leadership, favors competition where there is the need for cooperation, and pretends that this calling should be managed like a business. The more of all this we get, the more dysfunctional health care becomes. [\u2026] Most everywhere, the essential problem in health care may lie in forcing detached administrative solutions on to practices that require informed and nuanced judgments. \u00bb<\/em><\/p>\n

Voici quelques passages parmi les plus significatifs\u00a0:<\/p>\n

– \u00ab Maybe it\u2019s all so simple, if we can just change our concept of the health care world: to reorganize our heads instead of our institutions, so that we can think differently about systems and strategies, sectors and scale, measurement and management, leadership and organization, competition and collaboration. \u00bb<\/em><\/p>\n

– \u00ab This professional form of organizing is the source of health care\u2019s great strength as well as its debilitating weakness. In its administration as in its operations, it categorizes whatever it can, in order to apply standardized practices whose results can be measured. When the categories fit, this works wonderfully well. The physician diagnoses appendicitis and operates; the government or insurance company ticks the appropriate box and pays. But what happens when the fit fails? For example, who cares for the patient who falls between the categories, say, with some form of autoimmune illness that medicine has yet to prototype? Or how about the patient who fits the category but is ignored as a person, and so does not respond adequately to the treatment? Even more damaging can be the misfit between managers and professionals, as they pass each other like ships in the night, the managers in their hierarchy of authority, the professionals in their hierarchy of status. \u00bb<\/em><\/p>\n

– \u00ab Likewise, I question conventional ways of developing managers, MBA programs and the like included. Mostly they teach an analytical approach to a job that is primarily practiced as craft with art. Moreover, I am suspicious of measurement too, at least as a panacea, and I believe that strategic planning is an oxymoron: strategies have to be learned on the ground, not deemed in offices. \u00bb<\/em><\/p>\n

– \u00ab Measurement can be fine, so long as it is used sensibly. But too often, in management and sometimes medicine as well, it is used mindlessly. Health care needs to become more effective by getting less efficient. \u00bb<\/em><\/p>\n

– \u00ab Strategies cannot be planned formally because they are about attaining synthesis, not just doing analysis. And that requires flexible learning, not formal planning. \u00bb<\/em><\/p>\n

– \u00ab Evidence has to be put in its place\u2014namely, where it can aid judgment, not replace it. There are times when the evidence is so weak that professionals have to rely on judgment, based on experience. But never is the evidence so strong that they can afford to suspend judgment. \u00bb<\/em><\/p>\n

– \u00ab Many successful leaders are not \u201ctransformational\u201d or \u201ccharismatic\u201d so much as healthy and engaged: they connect with and respect people, whom they see as colleagues, not \u201csubordinates,\u201d let alone a \u201cworkforce.\u201d And so they cooperate naturally with them. I believe that the great organizations are robust communities of human beings, not generic collections of \u201chuman resources.\u201d It is the collective efforts of these human beings that make its leadership appear to be great. \u00bb<\/em><\/p>\n