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Doctors/Dr. LARIVIÈRE David


Hospital Director, French Army Reserve Officer in the Department of Health.

Supervisor: Martin Cloutier


Awareness of the risk of the disappearance of an organisation as a factor of resilience: a comparative study of transformation in public and private hospital structures.

The current context in the French hospital sector is one of extreme turbulence and even crisis, meaning that the question of the capacity of hospitals to successfully manage change has to be asked. This is undoubtedly all the more critical given the importance of being able to understand change management tools and the operational managerial implications. Such an understanding could help hospital managers benefit from existing practical experiences and approaches in successfully carrying out their own organizational transformations.
The research undertaken for this thesis explored whether the initiative taken by senior management teams to make their teams aware of the potential risk of their structure disappearing was in itself a change catalyst by mobilising individual and collective resilience. Resilience is understood to be the ability to react (individual) or to anticipate (collective) a crisis or disruptive events for an organisation. It is also a motor for change that senior managers are able to use to put into place the reorganization needed for their structure.
Through a comparative case study between a public health establishment (Public case) and a private non-profit establishment (Private case), the research question explored several dimensions of a central question: by which managerial mechanism is it possible to go from individual resilience (reaction to a crisis) to collective resilience (anticipating a crisis)? This research therefore involves on the one hand studying the missing link between individual and collective resilience in a hospital context and therefore understanding resilience factors in a hospital; on the other hand, it involves measuring if simply being aware of the risk of the structure disappearing can be considered to be a fundamental yet unique factor of organisational resilience. In practice, managerial experience shows that the passing from one state of resilience to another has not been covered by the literature. The hospital context and resilience factors in a hospital structure would appear to be a particularly interesting and characteristic area of research in order to add to the literature: indeed, for a number of years the health sector has been constantly changing not only from a perspective of governance, but also considering its regional organisation and its financing model.
The research behind this thesis was carried out using a mixed methodology involving the statistical quantification of qualitative data and the mapping of group concepts (CCG) - (Kane and Rosas, 2018; Kane and Trochim, 2007; Trochim, 2017; Rosas, 2017; Tremblay and Cloutier, 2015). From an empirical perspective, it enabled us to understand the relationship of the structure with the concepts behind resilience by building on the experience of operational hospital managers and senior managers whose work is part of a form of permanent transformation (Argyris, 1995).

Keywords: Individual resilience, Collective resilience, Preventive individual resilience, Crisis, Turbulence, Change, Transformation, Organisation, Disappearance, Survival, Anticipation, Reaction, Senior management team, Hospital, Health system, Communication, Appropriation, Project, Learning, Meaning.