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L’hôpital en restructuration : Regards croisés sur la France et le Québec (2021)

Damien Contandriopoulos ; Annick Valette ; André-Pierre Contandriopoulos ; [et al.]

Presses de l’Université de Montréal

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Publication Date: 2023-12-20

Description: Les besoins de la population en matière de soins de santé et les pratiques cliniques évoluent dans un contexte hospitalier que d’aucuns jugent en pleine restructuration. Au cœur de toutes les grandes réformes politiques, en France comme au Québec, la réorganisation du système de santé est annoncée partout comme la priorité qui devrait permettre de résoudre tous les maux. Pourtant, si cette volonté politique de changement est clairement affichée, il reste que les stratégies de mise en œuvre sont souvent mal accueillies par les médecins et le personnel soignant qui doivent composer au quotidien avec un manque flagrant de ressources. Dans cet ouvrage, les restructurations ne sont pas considérées comme une simple solution miraculeuse apportée par les gestionnaires ou une réponse rationnelle imposée par les exigences de la pratique clinique. En présentant le paysage institutionnel de la France et du Québec, les auteurs adoptent résolument une approche qui enrichit notre compréhension des changements structurels. Les transformations y sont analysées sur le plan national et celui des dynamiques locales, pointant les singularités et les problèmes spécifiques de ressources, les initiatives individuelles et collectives, les logiques professionnelles qui déterminent le déclenchement et les trajectoires de restructuration. Avec cette réflexion rigoureuse et approfondie sur le dispositif hospitalier, une nouvelle étape est franchie qui permet l’émergence de nouveaux modèles pour penser les restructurations.

Keywords: H1-99 ; hôpitaux ; services de santé ; restructuration hospitalière ; télémédecine ; bic Book Industry Communication::H Humanities

Language: French

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Governance Structures and Political Processes in a Public System: Lessons from Quebec (2004)

Contandriopoulos, Damien ; Denis, Jean-Louis ; Langley, Ann ; [et al.]

Oxford, UK; Malden, USA : Blackwell Publishing Ltd/Inc.

Public administration 82 (2004), S. 0

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ISSN: 1467-9299

Source: Blackwell Publishing Journal Backfiles 1879-2005

Topics: Political Science , Economics

Notes: Debates about the form and nature of changes in the management of public systems have for some time now been articulated under the theme of governance. All definitions of governance are related to the problems of securing convergence among a diversity of actors and organizations, of redistributing power in an organizational or social field characterized by a high level of heterogeneity and of gaining sufficient legitimacy to act in the name of the collectivity. This paper concentrates on the dynamics involved in the emergence of new governing capabilities in public systems. More precisely we study the implementation of regionalization policies in the health care field (in this case of Canada) conceived as one major attempt to renew the governance structures in a large public system.Our study draws on the comparative analysis of empirical regulation in three health regions as contrasted with three ideal type models of governance in regionalized systems. The first model is inspired by an economic approach to organizational behaviour and focuses on mandate-giving, execution and control. The second model is based on a political interpretation of behaviours and focuses on negotiation processes between actors. Finally, the third model is based on the theory of deliberation as well as the institutional school of policy analysis and focuses on direct public participation in public affairs. Evidence for this article is primarily derived from interviews with key informants and documentary analysis.Our analysis shows that none of the three models is sufficient in itself to grant regional structures the authority and legitimacy they need to create added value in terms of regulation that could ensure their survival. Regional Boards are thus forced by environmental constraints to conceive and implement original mixes of these models. The two predominant logics in regional action are inspired by the first two models although the last one also has an influence. Overall, our study also suggests that the implementation of new sources of governing authorities in a public system is rather fragile because of dependence on existing institutions. Clearly, the attempt to modify the dynamics of governance in a given system must be conceived as a political exercise and not just as a technical problem consisting of the rational adjustment of policy instruments.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1111/j.0033-3298.2004.00410.x

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Becoming A Leader In A Complex Organization (2000)

Denis, Jean-Louis ; Langley, Ann ; Pineault, Marc

Boston, USA and Oxford, UK : Blackwell Publishers Inc.

Journal of management studies 37 (2000), S. 0

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ISSN: 1467-6486

Source: Blackwell Publishing Journal Backfiles 1879-2005

Topics: Economics

Notes: For a new leader, the process of entering and establishing a position of leadership in a complex organization presents a major challenge. This challenge seems particularly acute when authority, goals and technology are ambiguous, as in many professional service organizations. In this paper, we integrate ideas from the literature on socialization and role theory as well as that on executive succession processes to view new leader integration as a mutual adjustment process between two trajectories – that of the organization and that of the new leader. It is argued that this may lead to four possible types of integration outcomes: assimilation, transformation, accommodation and parallelism. Drawing on a case study of a large hospital, the paper identifies several mechanisms that can be mobilized by the new leader to enhance his or her room for manœuvre as the integration process evolves. The mechanisms can be classified as collaborative or affirmative, with each type having different risks and advantages. The case analysis further reveals that leader integration processes may be differentiated between different activity domains, dynamic over time (as the use of one type of integration approach alters the potential for another later), and interactive across different activity domains (as events in one part of the organization have consequences for those occurring in another).

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1111/1467-6486.00217

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