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Doctoral Thesis
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How do management tools take part in the building of organizational roles? The case of clinical divisions’ contracts and financial monitoring tools in a French public hospital.
Flachère, I.

"How do management tools take part in the building of organizational roles? The case of clinical divisions' contracts and financial monitoring tools in a French public hospital"

In the last few years, many professional organizations have gone through decisive managerial changes. Professionals are asked to take on new responsibilities and use management tools. At the same time, this new demand infringes on the role of classical managers. This thesis examines how management tools, as the embodiment of a new economic and managerial logic, impacts the building of organizational roles. In order to deepen our understanding of this phenomenon, we study the implantation of management accounting tools in a large French public hospital. Hospitals are currently facing growing demands for efficiency, in terms of costs and quality of care. Following the financing (prospective payment system) and governing reforms, some doctors and head nurses become responsible for a pool of services (clinical divisions). They are made responsible through a contractual engagement with the hospital management, and are encouraged to manage their division using new financial monitoring tools. Using the actor-network theory, we see the emergence of a new social-organizational phenomenon as a movement of associations between objects and humans. We thus show the joined action of management tools and individuals in the building of roles: management tools open new possibilities of thinking and actions for individuals, while individuals put in practice these tools in multiple ways. Although management tools prescribe new managerial roles, role internalization may be achieved only when tools and individuals interact. From an empirical perspective, we underline the need to fine-tune both design and objectives of the tools, as well as clarifying the missions of clinical divisions' heads and managers.

Key words: management tools, professional-manager, actor-network theory, organizational roles, hospital

 Thesis supervisor: Philippe Zarlowski (ESCP Europe)

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