Deciding in hospital : from management dialog, to collaborative decision-making frameworks. ; Décider à l'hôpital : du dialogue de gestion aux dispositifs de prescription réciproque

Abstract

Alongside increasing regulatory requirements in France, hospitals are conducting in-depth transformation programs in order to improve their performance. Groups and individuals need to organize themselves to achieve common goals and shared objectives. With this respect, having the right information systems to manage and steer performance has become, more than ever before, a major issue. By enabling wider information sharing and dissemination, dedicated tools and procedures are allowing hospitals making the right decisions at the right time. However, the key to an effective usage and adoption of those systems lies in a global approach that encapsulates three core dimensions: the design, the usage and the meaning. To illustrate this model, a study has been carried on a single case in a hospital for four years, focusing on the analysis of the adoption mechanisms during the transformation program conducted in the organization. Three major conclusions can be drawn. First of all, focusing on usage, the expansion of the stakeholders involved in decision-making to the clinical centers demonstrates both the impact of the organizational structure on the information needs and the challenge for designers to manage the diversity of the usage styles. About design, the study highlights the crucial role of a well-identified prescriber, the medico-economic observatory, which assigns the creation targets and ensures the balance between the requirements and the individual strategies of all actors involved in the transformation project. Finally, the most striking outcome affects the dual impact of the sense-making variable on usages: direct impact through leveraged engagement of the clinical centers directors to the strategic agenda, and indirect impact through the design process of the collaborative decision-making system itself. ; Les politiques de régulation menées en France ces dernières années conduisent l'hôpital à des transformations en profondeur pour améliorer sa performance. Les individus et les groupes doivent s'organiser ...