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Le déploiement d'outils financiers dans le cadre de la réforme du système de soins : quand les acteurs les utilisent parce que c'est ce qu'il convient de faire [The implementation of financial tools in the context of healthcare reform: when organisational members use tools because that is the proper thing to do]
Bonnier, C., Flachère, I., Saulpic, O.

BONNIER, C., FLACHERE, I., SAULPIC, O. (2014). "The implementation of financial tools in the context of healthcare reform: when organisational members use tools because that is the proper thing to do" Politiques et Management Public, 2014, 31(4), 443-463

Abstract

Numerous reforms have recently impacted French hospitals leading to the diffusion of new management control devices. Few empirical studies have analyzed the implementation of these reforms and they do not explain how these devices are used nor how they impact administrative or medical actors' practices. We propose a contribution to this question based on a case study. Our observations exhibit strong commitment of actors in the implementation and use of these devices despite them having limited impact on these actors' operational practices and little strategic behavior of medical actors regarding these devices. They are thus different from previous observations. Our analysis leads us to propose that actors do not use these devices because they are useful and efficient, but because it is appropriate to do so, what March & Olsen (1976, 2004) call the "logic of appropriateness". This logic would thus apply to doctors' attitude towards managerial devices and not only towards their medical activities. These observations can lead to adaptations in the way management devices are implemented in hospitals.

Keywords: management tools, hospitals, appropriateness, consequentiality

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