AIM – HOPE International Conference Paris, 20-21 January 2005
3. THE MANAGERIAL PROJECT OF THE
INSTITUT MUTUALISTE MONTSOURIS
Professor François Laborde, Institut Mutualiste Montsouris, France
The birth of a corporate spirit, especially in a hospital, is all about individuals and what they want. At
the same time, the hospital administration must be closely involved. In parallel, the functions and
responsibilities of each stakeholder must be defined, as must the different procedures. In short, all the
different players must know to whom they are accountable.
Within the Institut Mutualiste Montsouris, the implementation of a new managerial project involved the
following choices: the creation of medico-surgical departments (cardiac, digestive, orthopaedics,
neurology, thoracic, etc.) with one single manager responsible for a team of doctors and surgeons,
while the post of head nurse was done away with and this person was replaced by an executive nurse
in each department.
Head of
department
Doctors and surgeons in
the department
Department supervisor
Manager of the department
secretariat
This organization is underpinned by the following principles and tools:
- regular assessment of all the players
- an analytical accounts system to ensure traceability of expenses
- entry of information by the doctors themselves
- an efficient information system.
At the same time, the departments must obtain a delegation of means enabling them to meet the
requirements of the internal target contracts. These contracts are negotiated every year between the
general management and the departments (at levels n and n-1). They identify the targets to be
achieved in terms of activity, productivity, management, organization and involvement of the
departments in hospital-wide projects.
Furthermore, decentralization offers certain advantages. For one thing, it increases motivation
(because the staff are more responsible for what gets done) and more efficient decision-making
(because decisions are taken on the ground).
Nonetheless, one possible major drawback should be borne in mind: the risk of the re-emergence of
small independent empires. Within the Institut Mutualiste Montsouris, this risk is avoided by a series of
checks: a procedure guide outlines the general house rules of the hospital and benchmarks set out in
management charts allow the management to check every month whether the contractual targets are
met.
Five years on from the introduction of this system in the Institut Mutualiste Montsouris, we can assess
our progress.
For patients, the medico-surgical departments are a real asset, since this organization facilities the
diagnostic process. For the hospital, the functioning of the department provides a means of measuring
the productivity of each player and therefore to identify the progress margin. For the staff, profitsharing is an avenue that must be explored.