Résumé En se basant sur le courant « Reliance on Accounting Performance Measures » (RAPM) cet article a pour objectif de proposer une réflexion sur les effets du contrôle des résultats introduit à l’hôpital public. Ce travail exploratoire, réalisé à partir de 31 entretiens semi-directifs, tente de comprendre la problématique du RAPM ainsi que ses effets sur les attitudes et les comportements des professionnels du secteur hospitalier public. Les résultats révèlent l’existence d’une pression budgétaire qui s’accompagne de conflits de rôle, des résistances et une tendance à la manipulation de données. En soulignant le caractère réducteur des précédents travaux menés dans le champ du RAPM, l’étude propose d’intégrer dans la compréhension du phénomène, les dimensions organisationnelles et institutionnelles de l’hôpital.

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PurposeThis study aims to understand whether and how the use of performance measures in the context of healthcare organizations facilitates the dynamics of compromise or whether it creates moral struggles among a wide variety of actors. It offers novel insights into the concept of hybridity by investigating its underlying moral dimension. Drawing upon the sociology of worth theory (Boltanski and Thévenot, 1991, 2006), this paper examines how actors negotiate and compromise over time concerning issues of justice, involving the use of performance measures on a day-to-day basis.Design/methodology/approachThe article presents a single case study of a medical unit in a French public hospital. Data were obtained through the ethnographic method, semi-structured interviews and internal financial and accounting documents.FindingsUnlike earlier accounting studies, the authors analyze whether, and how, accounting, on one hand, contributes to the dynamics of compromise between actors with divergent values that characterize hybrid organizations, and, on the other hand, increases tensions among actors with convergent values involved in caregiving. This offers practical insights into three relational mechanisms underlying the dynamics of compromise and their limits through the time dimension.Research limitations/implicationsThe authors use a single case study in a country-specific context.Practical implicationsThis study helps managers of healthcare organizations to understand the relationships between the use of performance measures and their impact on the evaluation of worth in practice.Originality/valueIn terms of theoretical contribution, the authors show how the sociology of worth (Boltanski and Thévenot, 1991, 2006) complements the analysis of hybridity and develop an original approach to understanding the ambivalent role of performance measures in bringing together divergent values within French public hospitals.

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