Governing major projects in healthcare

Before the pandemic, healthcare systems were under pressure everywhere in the world. Massive investments were engaged in healthcare to face the aging of the population, to integrate new technologies, and so on. This is a well-known story. During the pandemic, healthcare systems were all about to collapse. We all saw tough images. In post-pandemic times, we are left with the same overall system in need of investments, but with exhausted personnel and a lack of staff, not only in hospitals, but as a generalized situation in many countries. Yet, there is an intensification of investments in the healthcare system and several major projects are planned for the next few years. Moreover, several governments wish to accelerate projects’ delivery with the objective to quickly restart their economy. Knowing that large projects in healthcare are complex, and that the social context has profoundly changed, the question arises as to how governance of large healthcare projects evolved to face these challenges. In this chapter, we will build on a previous research program dedicated to the governance of major transformation projects in three university hospitals. Theoretical and empirical insights from this research program are identified and described. Then these insights are scrutinized in the face of the new challenges found in the healthcare literature. From this analysis, five major themes are identified and explained as crucial for the governance of major projects in healthcare: (1) organizational change, (2) learning, (3) cooperation/coordination, (4) teams/structure, and (5) performance. The chapter then offers a set of three directions for innovation in the governance of major projects in healthcare: post-pandemic profound renewal, shared leadership, and dynamic pluralism.