The aim of the study was to realise a strategic analysis of the feasibility of implementing a health care network for the management of severely head-injured patients in the Alpine region. We conducted face-to-face semi-structured interviews. Manual and computerized analysis of interviews was realized. Textual analysis was performed using the ALCESTE software package. A strategic analysis according to Crozier and Friedberg was performed. Eighteen interviews were realised: 13 physicians, 3 hospital directors and 2 head nurses. We identified 5 types of problems in the management of severely head-injured patients: the lack of human and material resources (33.1% of the variance), problems of communication (12.2%) and surgical competence (24.00), trajectory of care influenced by the concurrence between hospitals (18.0%) and relationship between professionals (12.6%). The stabilisation of process of cooperation was expected by all the professionals and a health care network seemed to be adapted as a coordination tool. Its implementation needed to take into account 3 individual representations: the will for collaboration--cooperation (23.3%), the negotiation (48.4%) and the contracts of the cooperation (28.3%). This study confirms that actors noted the need for improving the management of severely head-injured patients in the Alpine region. However, negotiation to express and solve controversies appears being a precondition to prevent from the blocking of the network by resistances to change.
IV 3?Drlrovt. fcl)cn, wk mfyUA bic »craditctcii, überall verfolgten ediletdicn für bie Sanbn.Mrtl)fcbaft fmb, unb wie fte trof)! i^crbieiien, fennen gelernt jn un-rben.^t cnfo ober no* in I)öf)erem @rabe nn^Ii* ifi bie fi^tlig unfctäblictê Ringelnatter. gomit glaubte idi ein SSerf ber 9Jienfcf)lidifeit unb bcr Sarnitjersigteit^u üben, ivenn i* bie gcber ergriff }u ©unften biefeö fo fc^r miffanuten unb »erfolgten 2^icrgef*Iedit6; wenn i* auf biefe 9(rt rietlcic^t S^aufcnben bicfcr 3:i)iere baS Sebcn rette; wenn icfi bie 3ugcnb burd) 58e[el)rung ba[)in bringe, S?arml)erjigfcit ju üben gegen ganj unfdiäblidie, roo^I aber I}unbcrtfad) uü^lid^e Ütiiere^t renn i* inelkicbt ein gropeS (Stücf Slbcrglauben unb 3fIo[)f)eit auö bem Solf verbannen I)elfc. iffienbct mir bennodi^e manb ein: e6 gibt aber bod) aud) gefä()r[idie unb giftige ©ditangen in unferem SSatcr* lanbe, fo entgegne idi il)m: (5benbc^l)alb umü id) bir biefelbcn fo befdireibeu, tafi bu fte fennen unb unterfcbeiben lernft, unb bn ni*t bie nü^lidH'u tcbtfd)Iägft ftatt ber fd)äb(id)en, ober bicfc an einer giftigen iH'rgreifft, wie jener Slpot^cfer, bcr auS Untenntni^e ine f^nmvje jlrenjotter einftng unb bafür fdiivcr bilden mu^te; ober wie im »origen 3al)r jener junge g-orftmanu in SfJürnberg, ber, ebeufad'J au6 Unfenntnif;, eine Jireujotter einftng ftatt einer 9?atter, von il)r gebiffen würbe unb feine Unfenntnif mit bem 5obc bcjablen mufte. .f-^ätte^e manb biefcn beuten bie J()iere gejeigt unb befdiriebcn, fte lebten no*^e utc unb mit ibneu ncd) tiele, bie i^re Unfenntiti^m it bem 2obe ober mit Siec^t^um büfen mußten. So l)ätteft bu nun bie ©vünbe biefer Sc^langenfdirift. SBenn ict) babur* ben unfdiulbigen unb iiü^Iidien Sfjieren ber SIrt ba § Scben rette, unfere Sugcnfc i^i"' 9iot}f)eit unb 2:f)icrquä(erei abhalte, ober eublicfc aud) nur (Sinem 5)?enfd)eu^' cbeu unb ©efunb^eit rette, fo ift ii)r^wcd erreidjt. 2Sou SOJaunern, rocidje mir bd btefem 95ud} mit 9Iat^u nb %i)at beigeftaitbcn ftnb unb benen icf) f)ier cffentti* meinen innigen 5)anf auöjnfvred)en mid) gebrungen fü^(e, will id) fjier nur nennen bie .^errcn *)3ro= feffor Dr. Strang, Sonfernator am Ä. 9iaturalienfabinet, Äanjteiratl)-o. 9J?artenö uub Wahr (5. 9)iaier in Stuttgart. 2lud) bem^e rrit Sit^ogravl) 5B. ®. SSaifd) bin id) für bie in fed)g S^afcln beigegebeuen Slbbtlbuugen, welcfcc er nad) ber 9iatur gejeidinet, (it[)ograp[)irt unb in gifbenbrucf au^gefül^rt f)at, ju grij^tem 2)anf unb Slncrfcnnitng tjcrpfliditet. Jreuc Slbbitaingen von Sd)Iangcn ju geben, ift auferorbent(id) fcbwierig.^err Saifc^f)at jebocb biefe Slufgabe fo glüdlidi gclöät, ta^biefe feine iBitber an 9(aturtreue aÜe mir befanitten, feibft in ben foftbarftcn naturl)iftorifd)en SBerten entl;a[teucn Jlbbilbungen cntf*iebcn übertreffen. Sßenn aud^bie in ffiürttcnibcrg nid)t voifommeube "Sleöculavfc^langc" hier aufgenommer worben, fo ift bieö ber 3>ellftänbigfeit tDcgcn gefc^eben. 2)urd^bie 3!ufnal)ine berfelben umfaßt nun bie vortiegenbe Schrift bie fammtli*cn (gelangen, weldie in 'I)cutfdiU"iut »orgefunbcn nn-iben. Bn tJerfiiircr.
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