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Hôpital, Territoire, Santé : l'émergence d'un contrôle de gestion médicalisé ?

Abstract : A lot of research has dealt with the emergence of an hospital management control function since the elaboration of the activity-based payment model. However, management control seems to suffer from a certain number of issues such as the proliferation of budgetary tools without link with actors' logics and without impact on the organizational behavior. This view of management control seems to us reducing since the creation of Health Care Delivery Head Office and the new governance of health system linked with the creation of Regional Agencies of Health. It shows the will asserted having a global approach of health care delivery joining as well ambulatory care and hospital. Studies in management outline a management control from resource allocation to performance management linked with strategy. This PhD thesis analyzes the deficiencies of traditional tools stemming from hospital cost accounting in the context of a destabilization of the object "hospital". It bases on the hypothesis according to which emergence of a medical management control is similar to an eco-design approach which connects the construction of the instrumentation with that of the level of the organization. The proposition is led around three grounds on the model of intervention research classified according to two variables: the degree of organizational innovation on the one hand, characterized by new coordination methods, and the distance with regard to the traditional instrumentation of management control on the other hand. However, even if we adopt a more ambitious approach linked with organizational dynamics which is more and more complicated because of the opening outside of the hospital, we don't claim to question the development and the use of the cost accounting system in hospital. The tools which ensue from it don't have to be considered in a prescription and judgment approach ; it allows exploration and discussion within the framework of imperfect tools which are based on simplified modelling and cost accounting which are necessarily conventional. By positioning our reflection around knowledge for the construction of management tools on one hand, and the training of the structures and dependence relations between actors on the other hand, we focus on an approach aiming at collective action and moving closer two conflicting disciplines that are medicine and management. We so confirm our intuition of a medical management control as process of innovative conception which crosses construction of knowledge and relations. This question is all the more relevant as we approach various levels of the organization, the hospital in the strict sense at a "vast hospital".
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Sophie Colasse. Hôpital, Territoire, Santé : l'émergence d'un contrôle de gestion médicalisé ?. Gestion et management. École Nationale Supérieure des Mines de Paris, 2011. Français. ⟨NNT : 2011ENMP0105⟩. ⟨pastel-00732241⟩

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