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Performance durable en santé et territoire : méthode d'anticipation et d'évaluation des vulnérabilités pour les agences régionales de santé (MAEVA)

Abstract : Can we, today, address the citizens' healthcare without talking about his territory ? This seems unbelievable, and the French government has already understood this and to answer to this question has designed and launched the "ARS", which stand for "Healthcare Regional Agency", in order to define and manage healthcare strategy at its own territory level (region). But, before arriving to this conclusion, the healthcare system had to reform itself along four centuries moving from healthcare concept to healthcare system concept. This has been conducted through several reforms from decision makers that had to use quantifiable elements to perform so. Therefore, some specific indicators, called "health deterministic indicators", have been put in place. Then, the sum of all these along the years bring the French government to launch the ARS which are defined within the law called "HPST" standing for Hospital Patient Healthcare and Territory). Now, if we are looking closer to the ARS mission, it clearly appears that they are closely linked to the notion of "sustainable performance" for which it is important to define underneath concepts as "Performance", "sustainable performance" and of course "healthcare sustainable performance". Then, to applied those healthcare sustainable performance principles, the ARS would have to learn how this performance could be increased or decreased based on some specific mechanisms. Therefore, the notions of "risk" and "vulnerability" became key components of such an approach. However, looking forward it appears that the vulnerability has a close link to risk and that the risk is essentially linked to a mismatch between the "offering" and the "demand" or the "needs" of the citizens. Then, by integrating all those aspects, the ARS would became a healthcare sustainable performance for a territory vector, thanks to new governances, a better risk management politic and the usage of performance measures as healthcare expenses for a territory, regulation tool. Based on this it is easy to understand that the ARS will be at the heart of the reform and will have to drive the regional health system. But, and it is true for all sectors (private and public), the management of such a system cannot be done without an accurate information system. Then, the next question is "what is an information system for a health system?" but also, "how to feed this information system in order to let it provide relevant information?" Therefore, to understand this, it is necessary to understand the definition of all existing information system types and their role in the healthcare environment and how the citizen and the patient will take benefits of that. Based on this theory, it is now interesting to better understand the status of the current health information system and why he has failed in his pupil service missions, and that in order to better understand how, through a new ARS governance, it will be possible to have health information system able to reach the sustainable performance goals. The failure notification and the willingness to get the French healthcare system out of this trap is real. However, it is important to notice that to succeed in the mission regarding the information system, it will be necessary to adopt an accurate methodology. But, it is also important to understand that after investigation, no such methodology has been found and it appears necessary to build one in order to satisfy the needs of health professionals, citizens, patients. The final goal being to allows the French health system to reach the health sustainable performance goals by the understanding and the resolution of business pains coming from the citizen requests known and understood at the right time and the right location. It is easy to understand that cannot be done without a better understanding of the human, geographical, politic, social and health environment that could be better handled through new technologies. Therefore, it will be possible to put in place certain of these technologies that will enable this approach by allowing a global access to data or simplifying application integration into complex business processes or providing analysis and permanent traceability tools allowing to take "preventive" decisions (real time) or "corrective" decisions (after past facts analysis) . Everything, of course, being at maximum secured and with maximum integrity guarantee. This thought has bring to the definition of MAEVA methodology which seat in the middle of a particular context composed by actors (health professionals, citizens, politicians, patients, etc.), stimulus (known or unknown meaning handled or not), the health system itself (on which the methodology is applied) and results (benefits for the health system increasing the sustainable performance of the health system). To do so, I has been necessary to build the method in two "layers". The first layer is made of components called "fundamentals" which permit to define the project foundations that has to be implemented by following MAEVA rules. These fundamentals, counted as four (plus one) allow the definition of a global consensus for the project and for the associated community of practice in order to successfully deliver the related project. The "fifth" fundamental allows the rationale to pursue on a new version or to stop the project in its current stage if the necessary condition to continue it are not met. Once these basis have been setup, the method offer the capability to define five actions which will allow to manage the project from the beginning until the final delivery. These actions are: "Integration", allowing the integration of the data sources needed to the project implementation; "Detection", allowing the definition of "actuators" components bringing to a risky situation ; "Anticipation", allowing the definition of self defense mechanisms against the previously mentioned "actuators"; "Action", allowing the realization of the project mission; and at the end, "Evaluation", offering factual elements to analyze project outcomes and provide therefore facts to the fundamental "Decide". All these components are linked within the methodology through two "tools": Iteration, allowing to complete a phases with results coming from an upfront phase; and the Active Memory Zone (ZAM) which is used to be the project memory in order to store traceability data, but also "keep in mind" all taken decisions. This methodology, as defined, hasn't been designed theoretically in few months, but has been the result of real life projects analyze done during the past five years in the area of health system performance. It is also good to know that the MAEVA approach based on consensus will be a great help for the ARS, as they will have, since the beginning, work with people, processes and information coming from diverse horizons that were, until now, more in competition rather than in collaboration mood. But all of this is just about the first version of the methodology and already, due to read publications, it appears that some research works, like "Design Thinking" should be integrated partially or totally in a future "release" of MAEVA.
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Submitted on : Tuesday, February 15, 2011 - 4:31:35 PM
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Patrick Mallea. Performance durable en santé et territoire : méthode d'anticipation et d'évaluation des vulnérabilités pour les agences régionales de santé (MAEVA). Gestion et management. École Nationale Supérieure des Mines de Paris, 2010. Français. ⟨NNT : 2010ENMP0045⟩. ⟨pastel-00566253⟩



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