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Analyse des nouvelles formes organisationelles hospitalieres en emergence au Mali.

机译：马里出现的新的医院组织形式分析。

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摘要

In Mali, a hospital law was passed in 2002 to define the institutional framework of a major reform. This law decreed substantial transformation of the internal structure, both administrative and clinical public hospitals including the involvement of local people in decision making of the establishment, administrative and financial autonomy through the delegation and the budget involvement of health professionals in the management, integration services and specialty private sector participation in the public hospital. However, the ability of hospitals to achieve the planned changes has been questioned by the majority of internal and external stakeholders. The objective of this thesis was to study how the hospital in Mali have been transformed turns under the pressure of the decentralization of state powers and to study how groups of actors are responding to these changes from two analytical frameworks. The first part incorporates the essential characteristics of hospital transformations in terms of different types of decentralization and the second part inspired by the work of Crozier and al. (1977) analysis the power games between groups of actors hospital at two levels namely strategic and systemic levels. For this, we conducted a study of two cases multiple studies we used three modes of data collection ie semi-structured interviews with key informants, document analysis, and observation during meetings.;Initially, the analyzes revealed for the changes in the structure, depending on the size of the assigned responsibilities to the public hospital, (1) several variants of decentralization. Overall, the intent was focused on a political delegation and deconcentration and devolution, the mechanisms put in place have swung more towards devolution and delegation and devolution while the transformations actually worked in public hospitals have tended to confirm a deconcentration and more particularly of a delegation in the case of the involvement of local people in hospital management. While the public hospital could make revenue from the partial recovery of costs of care among users, the state kept a strong hand on financial management and personnel management, and defined guidelines and objectives to be pursued. (2) They provide an understanding of the linkages between different elements of the reform process, the type of mechanism put in place as part of the reform seems to determine the type of processing performed according to the functions that can ensure the public hospital. The logic reflects a shift from the delegation to a devolution which is judged as the least advanced form of decentralization.;In a second step, the results confirm the presence of conflict between professional standards and recognized by health professionals and institutional and organizational standards put forward by the reform. They are defended by the majority of managers who are facing due to the authorities while the professional standards prevailing in clinical services. Both cases have highlighted the support of their general direction, there was a tension in the reactions of doctors, which was variable depending on the type of structural change aimed at, while nurses were rather accessible face of new measures introduced by the reform.;A unique feature of this thesis is that very little work on developing countries have attempted to operationalize a multidimensional concepts of decentralization before analyzing the variations that may exist between them and the strategies developed by stakeholder groups of the hospital. Furthermore, while the relevance of taking into account the characteristics of organizational context in the implementation of reforms is at the heart of care concerns, this work is one of the first to analyze the influence of the interaction between the process of hospital reform and the positions of the actors. The results of this thesis provide recommendations to policy makers and managers on the modes of structural change to favor or avoid in planning, execution and implementation of hospital reform process based on the characteristics of organizational context health. Planning reform is essential: Develop a school plan discussed and validated by all stakeholders of the hospital. This project must be compatible with the objectives of a national health organization and determine how personnel and equipment, which the hospital must have to achieve its objectives. Designing a fiscal and financial flexibility hospital (which will reduce the chain of decision making), upon which a new system of hospital management. Capacity for mobilization and execution of hospital resources should empower management. Finally, promoting a culture of evaluation and facilitate periodic evaluations of the implementation of hospital reform by agencies external and independent evaluation.;Keywords: Decentralization; hospital structure; integrating clinical, administrative; interprofessional collaboration management mechanism; hospital; role players; hospital law.
机译：在马里，2002年通过了一项医院法，以定义重大改革的体制框架。该法令禁止行政和临床公立医院内部结构的实质性转变，包括通过授权以及卫生专业人员在管理，整合服务和管理方面的预算参与，使当地人民参与建立，行政和财务自主权的决策。私营部门的专业参与公立医院。但是，大多数内部和外部利益相关者对医院实现计划变更的能力提出了质疑。本文的目的是研究在国家权力下放的压力下马里的医院如何转变，并研究行动者群体如何通过两个分析框架来应对这些变化。第一部分结合了不同类型的权力下放中医院转型的基本特征，第二部分则受到了Crozier等人的启发。 （1977年）从战略和系统两个层面分析了行动者团体之间的权力博弈。为此，我们对两个案例进行了一项研究，我们使用了三种数据收集模式，即与主要信息提供者进行半结构化访谈，文档分析以及会议期间的观察;最初，分析揭示了结构变化，具体取决于关于分配给公立医院的职责的大小，（1）权力下放的几种变体。总体而言，其意图集中在政治授权，权力下放和权力下放，已建立的机制更多地转向权力下放，权力下放和权力下放，而在公立医院中实际进行的改革倾向于确认权力下放，尤其是在权力下放中。当地人参与医院管理的案例。虽然公立医院可以通过部分收回用户的护理费用来获得收入，但国家在财务管理和人事管理方面保持了强大的实力，并确定了要遵循的指导方针和目标。 （2）他们提供了对改革过程中不同要素之间联系的理解，作为改革一部分而建立的机制的类型似乎决定了可以确保公立医院就医的职能的类型。逻辑反映了从权力下放到权力下放的转变，权力下放被认为是权力下放的最不先进形式。第二步，结果确认了专业标准之间的冲突的存在，并得到了卫生专业人员与机构和组织标准的认可通过改革。它们受到大多数管理人员的捍卫，这些管理人员由于当局而面临的挑战，而临床服务中普遍采用专业标准。两种情况都强调了他们总体方向的支持，医生的反应存在压力，取决于所针对的结构变化的类型而变化，而护士面对改革所采取的新措施相当容易。本文的独特之处在于，在分析发展中国家与医院利益相关者团体制定的策略之间可能存在的差异之前，很少有发展中国家的工作试图将权力下放的多维概念付诸实践。此外，尽管在实施医疗改革中考虑到组织环境特征的相关性是医疗服务关注的核心，但这项工作是第一个分析医院改革过程与职位之间相互作用的影响的工作之一。演员。本文的结果为决策者和管理者提供了基于组织环境健康特征的结构变革模式的建议，以偏向或避免医院改革过程的计划，执行和实施。计划改革至关重要：制定一项由医院所有利益相关者讨论并通过的学校计划。该项目必须与国家卫生组织的目标相适应，并确定医院为实现其目标必须如何配置人员和设备。设计具有财务和财务灵活性的医院（这将减少决策链），并以此为基础建立新的医院管理系统。调动和执行医院资源的能力应增强管理能力。最后，促进评价文化，并促进机构外部和独立评价对医院改革实施情况的定期评价。医院结构；整合临床， 行政的;专业间协作管理机制；医院;角色扮演者；医院法。

著录项

  • 作者

    Sanogo, Moussa.;

  • 作者单位

    Universite de Montreal (Canada).;

  • 授予单位 Universite de Montreal (Canada).;
  • 学科 Public health.;Health care management.
  • 学位 Ph.D.
  • 年度 2012
  • 页码 303 p.
  • 总页数 303
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 肿瘤学;
  • 关键词

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