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Les effets de la régulation souple intermédiée : le cas du virage ambulatoire des établissements de santé français

Abstract : This dissertation addresses the effects of modes of regulation relying on intermediaries in order to promote soft organizational frameworks. For that purpose, I analyze a case of intermediation taking place in the French healthcare field : the participation of the National Agency for the Performance of Healthcare Facilities (NAPHF) in the outpatient shift programmed by the 2015-2017 Transformation Plan of the healthcare system. My approach, which draws on the work of Michel Foucault, consists in examining the regime of governmentality that has been implemented in that case. Having used that inductive approach during a three-year research intervention in partnership with the NAPHF, I unveil the specific features that have enabled the regulatory regime of the Transformation Plan to operate at the national, regional and intra-hospital levels. Furthermore, that approach leads beyond measuring the efficacy of intermediation to explaining its effectiveness and to questioning its usefulness for answering the needs of the different stakeholders of the healthcare system. As a whole, this doctoral thesis bears methodological, theoretical, and practical implications. On the methodological side, I propose a method for evaluating the effects of regulatory tools aimed at fostering organizational change. On the theoretical side, I supplement existing models for understanding intermediation by identifying three effects of that organizational activity, which is currently expanding. Those effect are namely: contingent capacity-building, conjoined truth-telling, and alethurgic learning. On the practical side, my work suggests that management scholars may use the conceptual apparatus inherited from Michel Foucault in a constructive manner. I illustrate the potential benefits of that constructive stance by providing six recommendations for improving the regulation of the French healthcare system as well as five possible orientations for researchers who are seeking to help the actors of that system in the future.
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Submitted on : Tuesday, July 23, 2019 - 3:34:27 PM
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  • HAL Id : tel-02191673, version 1


Olivier Baly. Les effets de la régulation souple intermédiée : le cas du virage ambulatoire des établissements de santé français. Gestion et management. Université Paris sciences et lettres, 2019. Français. ⟨NNT : 2019PSLEM006⟩. ⟨tel-02191673⟩



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