There’s no doubt that the next 20 years will bring about radical transformations that will profoundly change the hospital sector, driven by the cumulative effects of digital innovation, technology, demographics, regional healthcare pathways… and the share of national wealth that public authorities will want or be able to allocate to health.

Contrary to popular belief, the hospital world has already evolved significantly over the past 20 years: its territorial scope (hospital groups – GHTs), its funding methods (activity-based payment – T2A), its governance (clinical divisions, supervisory boards, executive boards), its care modalities (increasingly less invasive and more outpatient-based), and the reimbursement rate for care has not decreased, despite the rising costs of medical advancements…

This evolution did not come without pain, nor did it produce uniform results. In the hospital sector, decisions to “move” forward are rarely driven by positive arguments for change. Rather, it is the threats and risks of inaction that bring stakeholders on board. It is within this context that the Ministry, regional health agencies (ARS), and hospital managers have turned to consulting firms to help design, roll out, and implement these changes.

Since mid-2022, the role of consulting firms has come under strong criticism. The complaints are numerous: exorbitant costs relative to the value provided, acting as Trojan horses for “new public management,” a corporate-style hospital approach, incompetence, lack of legitimacy… to the point that some consulting firms have ceased activity in the healthcare sector, or even in the public sector altogether. As a law on the use of consultants by the State is under discussion, here are some reflections from the authors’ shared experiences, offering a fresh perspective on what consulting firms can and should contribute to hospitals today and in the future.

When is consulting truly effective and useful for a healthcare facility’s performance?

With 200 professions coexisting daily, hospitals are not inherently lacking in internal expertise. Consulting should therefore be the exception, not the rule.

We see four situations where consulting is particularly relevant:

• When a project requires specific expertise or refers to a similar situation that was successfully addressed in another facility. Through their ability to provide comparisons or assemble tailor-made teams, consulting firms can bring real added value by sharing feedback and spreading innovation across facilities.

• When a facility, for various reasons, needs an external perspective or voice, to assert positions that would have less impact if expressed internally.

• To meet tight deadlines and maintain change momentum: the project management methodology of consulting firms, their ability to separate the essential from the trivial, their results-oriented mindset, external perspective, and capacity to dedicate teams all help reduce the risk of project stagnation.

• When internal teams are juggling too many initiatives at once, and due to this lack of “bandwidth”, need to outsource the design or follow-up of certain projects to manage a temporary overload.

These reasons for seeking external consulting are not unique to the public sector. The private sector—both industry and services—relies on consulting firms far more extensively, often for the same reasons, and more so outside France than within.

Several factors explain client dissatisfaction or project failure.

Some are inherent to public hospitals themselves: a consulting team must be guided and supervised by its client, who needs to devote leadership time (both the hospital director and the chief medical officer) at every key project phase. This oversight involves both mission direction, strategic decision-making, and adapting the mission content as client needs evolve.

Moreover, healthcare staff often struggle with “performative” language in Franco-English jargon that feels abstract or patronizing, especially when coming from individuals who’ve never worked in a hospital. They question the legitimacy of these consultants—particularly when the fees resemble what they see as the annual salary of several nurses.

Finally, public hospitals simply do not have the same financial capacity to pay for consulting as the private sector. This has sometimes led firms to downplay the number of senior consultants involved and over-rely on juniors or even interns. Yet hospital clients expect custom solutions, not off-the-shelf advice. They are a different kind of client, with a unique psychology shaped by their proximity to suffering and death. Recognizing this specificity and having a deep understanding of hospital operations and daily life is a key factor for success.

And what about tomorrow?

Tomorrow’s hospital will face major upheavals for which it is unprepared. Resistance to change is stronger in hospitals than elsewhere. This is due to the persistence of strong professional silos, a tradition of apprenticeship that favors replication over innovation, and a layering of powerful counterbalances capable of blocking reform. It might be tempting for public institutions to internalize expertise—and some are already doing this quite successfully.

We believe this solution is necessary but not sufficient. First, because consulting is a real profession that can’t be improvised—it’s different from auditing or project management. Second, because it is healthy for a consultant to be paid by the client in a commercial relationship, with the mutual obligations that implies.

However, in the scenarios mentioned earlier, consulting can provide real support to hospitals—under certain conditions:

• If the consultant is willing to step outside their comfort zone, adapting services, solutions, and innovative funding models from other countries or sectors to the hospital setting. This requires a new kind of relationship, closer to partnership and further from the classic client-vendor dynamic.

• If consulting contributes to a hybrid approach, combining skills from scientists, physicians, entrepreneurs, managers, and engineers—people who do not naturally share the same methods.

• If consulting teams include individuals with healthcare experience, who can leverage collegiality to defuse professional silos, and who know how to strike the right balance between abstract strategic advice and the hands-on operational guidance needed to make real change happen.

The post-COVID crisis now affecting healthcare institutions in France and abroad is unprecedented, and may prove more difficult to face than the pandemic itself. By accelerating changes that had been simmering for years, it has thrown hospitals into a historic challenge. The right consulting support at the right time and place could be one of the ways to equip hospital professionals to face, despite their exhaustion, this new chapter in their story.

François Farhi