How adapt health organization when the patient come from around the world?

How do organizations adapt when they face changes that surpass their current capacities? From this question, a study has emerged that attempts to understand how and why public health organizations decide to adapt (or not to adapt) their services to the needs and characteristics of migrant populations in their jurisdictions. Although the dynamics of the migratory process are increasingly well documented, organizational capacities for adaptation are much less established. A conceptual model of how complex adaptive governance is able to reconcile two paradoxical mechanisms of adaptation is proposed: (1) on one hand, multiple autonomous stakeholders are capable of self-organization and act in a heterogeneous manner; (2) on another hand, governance allows these heterogeneous actions, through levers of action, to converge toward a collective process that is more homogeneous and shares a common vision (schemata). To develop this framework, we rely on the literature addressing theories of complexity and governance, particularly clinical governance. Three angles of analysis were chosen that allow us to develop aspects similar to exploration and exploitation through the clinical and administrative spheres of the organization. These three angles also allow us to theoretically develop an integrated view of governance, allowing for adaptation in the support of vulnerable migrant populations through the facilitation of generative relationships and co-evolution with stakeholders in the Environment.