Changing nothing in an organisation... in order for everything to change

In recent years, debates on hospital functioning have focused mainly on issues of decision-making power, reigniting battles between medical and administrative authorities. These debates have consumed a great deal of energy for limited results. When Guillaume Couillard took over as head of the Paris Psychiatry & Neurosciences University Hospital Group (GHU), he was a fervent advocate of continuous improvement (a concept invented by Japanese industry fifty years ago) and, true to his principles, he set about asking those who work within the hospital to improve its functioning without changing its structures. By making it a point to visit the field twice a week in order to listen to caregivers and methodically encourage them to resolve the obstacles they encounter and address residual frustrations and friction, the stranglehold gradually loosened, communication and trust improved, and the GHU began to function better, without changing its governance or organisational structure.