For sustainable healthcare systems: focus on robustness rather than optimization

The concept of performance has gradually taken hold in healthcare policy. Presented as necessary and positive, it is often reduced to efficiency, translating into policies and management methods aimed at optimization. While these practices would guarantee our healthcare systems' sustainability, they have made them fragile. As prominent professional actors, nurses, as sociopolitical leaders, must think about new concepts to fix this situation. The life sciences can help us understand why optimization fragilizes our healthcare systems. Biologists have observed that living beings do not prioritize optimization but robustness. To cope with fluctuations, a robust organism operates with redundancy and inconsistency, variation and incompleteness, apparent waste, and a penchant for slowness, delay, and heterogeneity. It functions sub-optimally. We propose a theoretical reflection and food for thought about nursing administration for more robust healthcare systems and organizations.