L'évolution de la fonction contrôle de gestion à l'hôpital

Lartigau, Jérôme

doi:10.3917/jgem.097.0371

Cited by 10 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Expert control is no longer limited to physicians but shared with centrally appointed bureaucrats (three representatives of the state sit at the RHA board of directors and each of them has three voting bulletins) and powerful management controllers. Representatives of the Social Security form the largest group within the board of the Regional Health Agency and double up as “political coordinator.” These high‐level bureaucrats capitalize on novel management tools such as prospective hospital payment, performance management tools (eg, patient volume targets, benchmarking, guidelines, and penalties for hospitals and premiums for physicians who participate in public prevention programs), agreements defining activity volume and financing needs, and novel activity‐based accounting mechanism such as DRGs to align public providers on private care providers and restore fiscal discipline. Out of the 50 billion dollars in savings pledged by the government Hollande in its 2014‐2017 economic stabilization program, 10 billion were expected to come from the health sector…”

Section: The French Welfare Elitementioning

confidence: 99%

Technocratic recentralization in the French health care system: A critical evaluation

Simonet

2019

Health Planning & Management

View full text Add to dashboard Cite

Summary The French health care system implemented several corporate management recipes such as diagnostic‐related groups (DRGs), benchmarking, and activity‐based management in a bid to restore fiscal discipline and to “reassert the center.” The government also regrouped health policy decisions with the Regional Health Agencies and opted for a top‐down line of command to ensure policy implementation. Though reforms emphasized evidenced‐based policy and outputs measurement, outcomes were below expectations in many areas and led to a shift in values. Professional autonomy and patient engagement receded. This leads us to a critical evaluation of the French audit society.

show abstract

Section: The French Welfare Elitementioning

confidence: 99%

Technocratic recentralization in the French health care system: A critical evaluation

Simonet

2019

Health Planning & Management

View full text Add to dashboard Cite

show abstract

“…These reforms led to a shift in accountability from professional (physicians are primarily accountable to their peers) to managerial (the professionalization of hospital managers, “doctors as managers”) and legal forms (for instance, via a regulation of quasi‐market; Mattei, Christensen, & Pilaar, ). By law, every hospital in France has a Medical Information Unit that provides the central government with exhaustive activity data (Lartigau, ). Professional values have become plurals (Dahan, ), as exemplified by the hybridization of economic performance and professional values (Routelous, ).…”

Section: Shifting Accountability Professional Values and Central Gomentioning

confidence: 99%

Recentralization and vertical alignment in the French health‐care system

Simonet

2017

Journal of Public Affairs

View full text Add to dashboard Cite

In foreign exemplars, key new public management (NPM) features such as decentralization and devolution of health-care responsibilities had outcomes below expectations. Other NPM traits such as the patient as overseer of reforms or the empowerment of patient remained elusive. In France, the integration of public values such as greater participation of patients and local actors (NGOs and elected officials) and NPM-driven private values such as performance evaluation has yet to be seen. Taking advantage of NPM's failings and austerity agenda, a French welfare elite regained control over health-care policy decisions at the expense of regions and other local actors. NPM outcomes were below expectations. Austerity cures led to weakening of the regional decision spaces, which can be explained under the principal-agent relationship. Accountability shifted to managerial (the professionalization of hospital managers) and legal (governance via regulations) forms in a bid to restore central government control. A democratic recess results from the lack of public engagement in recent health reforms.

show abstract

“…The term "New Governance" (in French: "Nouvelle Gouverance") was coined to designate this more decentralized form of hospitals' governance in which medical departments were endowed with more autonomous decision power (Bérard, 2013). This regulatory change prompted the development of management control systems in French hospitals (Lartigau, 2009;Pépin & Moisdon, 2010). By contrast with the American managed care logic (Scott, Ruef, Mendel, & Caronna, 2000), the French "managerial approach in hospitals" (Engel, Kletz, Moisdon, & Tonneau, 2000: 1), which culminated with the adoption of the "New Governance" frame, was therefore grounded on the political will to involve healthcare professionals in the management of hospitals, which until then had been the exclusive realm of administrative directors (De Pouvourville & Tedesco, 2003).…”

Section: Research Settingmentioning

confidence: 99%

Collective Sensemaking: The Cave within the Cage

Baly

Kletz

Sardas

2016

AMPROC

View full text Add to dashboard Cite

Situated cognition and neo-institutional theory have revived two fruitful allegories of collective sensemaking within organizations: Plato's Simile of the Cave and Max Weber's Iron Cage. Scholarly efforts to combine these two approaches have converged towards a shared vision of collective sensemaking as an interaction between institutionalized cognitive schemas and contextual grounding. Nevertheless, the mechanisms framing and shaping the outcome of this contextual cognitive interaction, i.e. the collective meanings actually produced and institutionalized, have remained largely unexplored. We aim to address this common gap by examining how the interplay of institutional and contextual factors determined the collective sensemaking of an emergent occupational group, namely, management controllers in French hospitals. Comparing the results from a two-year focus group study held in a community of practice and survey data from 163 respondents, we draw consistent findings indicating that a similar position within supervision micro-structures, which we label isothetism, contributed to shaping the group's transactive memory and to framing the institutionalization of its cognitive schemas. We conclude by discussing the implications of isothetism for future research on the meaningfulness of organizations.

show abstract

L'évolution de la fonction contrôle de gestion à l'hôpital

Cited by 10 publications

References 0 publications

Technocratic recentralization in the French health care system: A critical evaluation

Technocratic recentralization in the French health care system: A critical evaluation

Recentralization and vertical alignment in the French health‐care system

Collective Sensemaking: The Cave within the Cage

Contact Info

Product

Resources

About