Regrouper pour mieux gouverner ? : Le cas des hôpitaux publics français

Abstract : As in most of developed countries, French public hospitals are facing several challenges: shortage of medical resources, development of new care practices, 
as well as recurrent reforms introducing new financing or governance rules. The fragmented organization of the hospital network, which is made up of nearly a thousand public institutions, makes it difficult to implement a large-scale transformation that would meet these multiple constraints.In such a context, the latest healthcare law (2016) now requires all public hospitals in France to join a Territorial Hospital Group (THG). THGs come after a series of instruments that aimed at reorganizing the territorial hospital organisation, with mixed results up to now. This new reform has aroused many questions regarding its objectives and implementation conditions. Indeed, it contrasts with the strong state-control trend that had prevailed so far, by giving local actors a large amount of autonomy.The thesis is based on the analysis of this reform through a multiple case study. The main ambition of this work is to question the inclusion of the THG law in a new public action paradigm.Despite its apparently relatively vague objectives, I show that this reform is a real break in public action, as it aims at initiating local exploration dynamics around new territorial organizations. This approach corresponds to a new governmentality regime, providing actors with specific objects of government, such as care pathways, capable of triggering collective learning through the creation of exploration partnerships. However, due to remaining inconsistencies in the government’s action, the trajectories of these THGs appear to be very heterogeneous. Therefore, I suggest several recommendations for the management of these exploration dynamics, as well as for consistent public action engineering, in order to carry out such new orientations.
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Léo Cazin. Regrouper pour mieux gouverner ? : Le cas des hôpitaux publics français. Gestion et management. PSL Research University, 2017. Français. ⟨NNT : 2017PSLEM013⟩. ⟨tel-01743929⟩

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