Governance and healthcare networks development. The case of remote transmission in electroencephalography

Abstract

The literature on governance of health systems demonstrates the essential role played by practitioners in the emergence of these networks. It also reveals a paradox between the freedom of the practitioners and the necessary intervention of a regulator for the standardization of practices. Our research goal is to study this paradox through a practical case and question the respective place of practitioners and the state in the management of health networks. This study focuses on the case of networks of remote transmission of electroencephalograms (EEG), which is the heart of a national development project. Our analysis is based both on interviews with managers of the project and the analysis of a questionnaire sent to stakeholders. The detailed analysis of these networks shows their operating difficulties and the need for a standardization of processes. Some field workers have realized it and their action is the basis of our study, confirming the essential nature of the involvement of health professionals in the transformations of the organization of care. We show that the establishment of these standards requires a contribution of the state in an effort to harmonize standards and practices, essential to the sustainability of health systems. We conclude that the governance of health systems requires that the state exceeds its role as prescribing standards to take on the role of a partner state, able to support the changes and needs of the field, also process aimed at resolving the paradox between freedom field players and standardization process.