I vår porträttserie har vi idag nöjet att presentera Bertrand Pauget, föreläsare i företagsledning vid Karlstads Universitet. Han forskar för tillfället inom teknisk och social innovation ur ett hållbarhetsperspektiv inom utvecklingen av hälso- och sjukvårdssystemet. Bertrand Pauget studerar särskilt hälsokrisen utlöst av COVID-19 och skillnaderna mellan det franska och det svenska sjukvårdssystemet samt hur krisen hanteras i de olika länderna.

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In the framework of our portrait series, we are pleased to present today Bertrand Pauget, University Lecturer in Business Administration in the University of Karlstad. His current research focuses on technological and social innovation with a view to a more sustainable development of the healthcare system. In recent years, health has become one of the most important sectors, with more than 11% of GDP devoted to health in France and 11.9% in Sweden.

You have a DEA in history and a PhD in management sciences. Moreover, you are currently studying health management. What exactly does this area mean?

Management means organising together, taking into account the diversity of people, to take joint action towards a specific goal. In my opinion, it is difficult to have a strict definition since it depends on the organisations, the culture and the way of looking at the future. Health management is about looking at how people organise themselves and how they choose to sustain an organisation.

Could you please tell us more about your current projects?

We are currently running a project with the Karlstad hospital to improve cooperation between all the hospital’s staff, and between departments.

Another focus of my research is retirement home. This is a sector that is growing rapidly, due to two factors : the arrival of baby boomers of retirement age (some of whom are already experiencing health difficulties), and the growing number of people suffering from Alzheimer’s disease. This creates management problems in terms of accommodating all these people in an institution. Depending on whether you are in France or Sweden, there are cultural differences and several ways of working , based on the organisation and the regulatory context. But what connects them are increasingly strong constraints, with organisations under pressure.

I also carry out a prospective work on what the public sectors will become, such as culture, cultural tourism, health, etc. over the next 10 to 15 years, in order to gain a better understanding of the constraints that will weigh on the organisations in these sectors in the coming years. The trends are known, but the speed at which they arrive and the way in which we react always bring a lot of uncertainty. It is on these elements that I am working to help some sectors reflect on themselves to try to project themselves into the future, integrate constraints and imagine a future that suits them.

You are looking at the current COVID-19 pandemic, what has this crisis brought to light in the French and Swedish health systems?

In the case of the COVID-19 epidemic, the unexpected came from the rapidity of the contagion. For several years now, we have seen that health funding has been under extreme pressure, which has led to protests by medical staff in France and Sweden. Today we are reaching a tipping point where investment in state-of-the-art technology (equipment, maintenance) is no longer possible in some hospitals. This creates a growing gap between hospitals that are unable to acquire the latest ultra-modern equipment and those that can still keep up with the latest technology. This leads to multi-speed medicine and poses profound philosophical problems, not about equal access to care but about the quality of care that is offered. This is a real question of society, which is not yet decided at the moment. To make up for these shortcomings, we have noticed that the medical staff are trying to work differently to keep the system afloat, although we are beginning to see the limits of this. What the crisis shows us is that there is an incredible capacity for resilience, but to believe that the systems, i.e. the way in which carers and paramedics work together, can endure, as it currently exists, is a delusion. We have managed, today, to absorb the shock of COVID-19 with health systems that, despite all the difficulties, have stood firm and have not collapsed. Now the question that arises is how to imagine the health system of tomorrow and how much we are prepared to invest.

We must ask ourselves what a hospital brings to society and whether the resulting externalities are positive for the community. A second approach is to adopt the perspective of the carers in reorganising the health system. This development through the provision of care is one of the current possibilities for hospital development.

Whichever approach is chosen, the question that ultimately arises is how citizens will take up the subject of health to bring it back to the forefront of the public arena and enable a paradigm shift.

 

What explains the difference in crisis management between France and Sweden?

I will refrain from describing which system is the most efficient, but the difference in management can be explained by the confidence in the efficiency of the government, which at the time of the health crisis was comparatively very high in Sweden (~70%) and very low in France (~30%). The Swedish government has aligned itself with the expertise of the Swedish Public Health Agency. In France, the health councils made recommendations but the government took the final decision. The chain of responsibility is not the same. The difference is also explained by cultural elements: physical distance is easier in Sweden because culturally there is no kissing or handshaking. There are of course other variables, but this already gives some clues.

The crises we are experiencing – financial, economic and now health – and those we will face in the future – environmental, migratory – are global. The constraints are the same for everyone, it is the responses that are different. We therefore have a lot to share, to progress together in the face of crises and to win in cooperation, especially between France and Sweden.