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Theses

La rationalisation en douceur Sociologie des indicateurs qualité à l’hôpital

Abstract : Since the late 1990s, the French hospital sector faces neomanagerial reforms aiming at strengthening state control over care organizations and medical activities. The thesis examines these contemporary transformations through the deployment of quality indicators measuring the quality of medical care, in order to enhance transparency and improve quality. How do these evaluation devices affect the institutional regulation of healthcare, the organization of hospitals and the professional autonomy of medical practitioners? The thesis describes the organized, instrumental and cognitive dimensions of public action, through a qualitative methodology crossing interviews with institutional leaders, analysis of written sources and investigations in four hospitals. It traces the career of these instruments, analyzes their technical and cognitive properties and characterizes their diverse social uses. These indicators have emerged in an institutional context deeply affected by nosocomial infections and hospital rankings. They are made of hybrid knowledge. Multiple intermediaries between state and professional actors shaped and legitimized them. They have been carefully but massively disseminated in the 2000s. Through their institutionalization, they instill formalization, control, traceability and auditability in hospitals. By moving the focus from the visible and constraining effects of payment instruments to these more discrete mechanisms, the thesis shows how quality evaluation softly rationalizes professional bureaucracies.
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Hugo Bertillot. La rationalisation en douceur Sociologie des indicateurs qualité à l’hôpital. Sociologie. Institut d'Etudes Politiques de Paris, 2014. Français. ⟨tel-02896060⟩

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