Gestion de crise et production de l’information médicale dans un service hospitalier. Mise en place d’une démarche d’assurance qualité par une collaboration DIM/service de gynécologie/pôle (Trousseau)

Recentralization and vertical alignment in the French health‐care system

“…Though not a core “demand” of the public, NPM made inroads into the French health system thanks to a weakening of French physician unions; a lack of politicization of health affairs, despite their potential to slow reforms (Meadowcroft, ); the use of low‐profile instruments that offers limited visibility to external actors (Bezes, ); and the rise of a programmatic elite (Genieys & Hassenteufel, ). The French NPM toolbox includes novel compensation mechanisms such as activity‐based payments via diagnostic‐related groups (known in France, as “homogenous groups of patients”) that triggers yardstick competition for patients and seeks to align all payments made to hospitals on an average fee calculated on a sample of participating hospitals; total quality management and management by objective, as in the corporate sector; outsourcing and competitive bidding for the construction of public hospitals, despite no evidence of improved efficiency or convenience (Torchia, Calabrò, & Morner, ); hospital league tables; premiums for General Practitioners who comply with quality‐enhancement programs in the treatment of chronic diseases or for providers that reach certain patient volume targets to ensure that efficiency goals meet a quality imperative; evidence‐based policy‐making, efforts at quantification, as demonstrated by the rise of costs–benefits analysis and epidemiological studies (Gaudin, Bonnardel, Pellegrin, & Chaudet, ; Serfaty et al, ), or the benchmarking of care providers that send doctors to chase a “dizzying array of metrics” (Bérard, Gloanec, & Minvielle, ), though professional judgment and autonomy are more critical than data collection skills in a highly uncertain and complex environment. Predictability diminishes as medical decisions become more complex (McFarlane & Prado, ).…”