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At the clinical, management, and policy levels, the use of knowledge and evidence in health care has become a worldwide priority. The contributors to Using Knowledge and Evidence in Health Care seek to broaden our understanding of the complexity involved in health care decision-making by integrating social science knowledge and exploring some of the challenges and limits of evidence in different health care contexts. Louise Lemieux-Charles and François Champagne have brought together an esteemed group of scholars to provide a conceptual framework that illustrates the factors critical to analysing and optimizing the use of knowledge and evidence. Previous studies have focused primarily on the medical literature without acknowledging the social sciences tradition. With its integration of works from political science, public policy, informatics, and other disciplines, Using Knowledge and Evidence in Health Care provides a bridge between both worlds. By bringing together different views on the topic, the volume goes beyond strict disciplinary boundaries to provide the fullest exploration of knowledge and evidence in health care

In recent decades, there has been a growing interest in the design and implementation of systems using public reporting of performance measures to improve performance. In their simplest form, such interventions rest on the market-based logic of consumers using publicly released information to modify their behavior, thereby penalizing poor performers. However, evidence from large-scale efforts to use public reporting of performance measures as an instrumental performance improvement tool suggests that the causal mechanisms involved are much more complex. This article offers a typology of four different plausible causal pathways linking public reporting of performance measures and performance improvement. This typology rests on a variety of conceptual models and a review of available empirical evidence. We then use this typology to discuss the core elements that need to be taken into account in efforts to use public reporting of performance measures as a performance improvement tool.

Cet article présente un cadre conceptuel pour l'analyse des stimulants rattachés aux modalités de paiement des professionnels de la santé, notamment des médecins. Dans une première partie, la dynamique du système de soins est exposée et les particularités fondamentales des services de santé sont décrites. Dans une deuxième partie, une typologie des modalités de paiement est proposée qui prend en compte, non seulement l'objet de la rémunération, mais aussi les mécanismes de détermination du niveau de la rémunération et l'organisation du paiement.

À l'aide des propos théoriques apportés par Giddens (1994) et Beck (2001) sur la modernisation réflexive, cet article explore les transformations expansionnistes inhérentes à la mondialisation institutionnelle des sociétés modernes et leur influence sur l'intégration organisationnelle de la participation des communautés locales aux décisions d'intérêt collectif concernant la santé des populations.
La complexité et la diversité culturelle des conseils locaux de santé (CLS) mis en place lors des stratégies de décentralisation du « Sistema Único de Saúde » (SUS) au Brésil nous serviront d'appui pour illustrer les enjeux qui découlent de la confluence des lignes de tensions paradoxales inhérentes à ce processus d'intégration organisationnelle de la participation communautaire. Ces forces divergentes, mais potentiellement complémentaires, constituent un élément clé du renouvellement démocratique des pratiques participatives dans le champ complexe de la santé publique.

L'évolution des structures et des connaissances pousse les systèmes sociosanitaires à modifier leurs régulations; aussi, mieux comprendre les processus favorisant ou contrant les changements planifiés est-il important. Cet article vise à intégrer la notion de champ à l'analyse institutionnelle du changement. Cette notion définie par Pierre Bourdeau est particulièrement utile pour cerner la dynamique de l'implantation d'une réforme, comme l'illustre une étude de cas concernant le traitement du sida. À l'intérieur de ce secteur, trois champs sont identifiés et la dynamique de modification de leurs régulations est présentée. Cette recherche souligne l'importance d'accorder une attention particulière aux champs les plus institutionnalisés dans un secteur d'intervention et à leurs principaux acteurs, qui tendent à adopter des stratégies de conservation. Pour mettre en place des changements importants, le développement de stratégies autoritaires et formalisées est préconisé.

Based on the example of the evaluation of service organization models, this article shows how a configurational approach overcomes the limits of traditional methods which for the most part have studied the individual components of various models considered independently of one another. These traditional methods have led to results (observed effects) that are difficult to interpret. The configurational approach, in contrast, is based on the hypothesis that effects are associated with a set of internally coherent model features that form various configurations. These configurations, like their effects, are context-dependent. We explore the theoretical basis of the configuration approach in order to emphasize its relevance, and discuss the methodological challenges inherent in the application of this approach through an in-depth analysis of the scientific literature. We also propose methodological solutions to these challenges. We illustrate from an example how a configurational approach has been used to evaluate primary care models. Finally, we begin a discussion on the implications of this new evaluation approach for the scientific and decision-making communities.

International audience ; Objective To find out which are the emerging views on hospital performance and to analyze how these views vary among hospital stakeholders.Methods Study setting: Three hospital stakeholder groups (physicians, caregivers, and administrative staff) in a large Paris teaching hospital.Study design: A case study combining a qualitative (interviews of 80 key hospital stakeholders and a survey of hospital staff), and a quantitative analysis (a questionnaire composed of 4 theoretical dimensions, 13 sub-dimensions, 66 items) with triangulation of the results.Results Hospital stakeholders assign greatest importance to the human relations dimension, i.e., organizational climate (professional and public service values) and quality of work life. These values attract a high degree of consensus among stakeholders (no statistical difference between physicians, caregivers and administrative staff).Conclusions Our findings challenge the mainstream view that competing values underlie hospital performance. Currently, views are to some extent shared among different stakeholder groups. A reason for this could be the need to form a more united front in the face of recent reforms. This common emphasis on professional and public service values could be the basis for formulating management priorities in teaching hospitals in order to improve performance.

International audience ; Objective To find out which are the emerging views on hospital performance and to analyze how these views vary among hospital stakeholders.Methods Study setting: Three hospital stakeholder groups (physicians, caregivers, and administrative staff) in a large Paris teaching hospital.Study design: A case study combining a qualitative (interviews of 80 key hospital stakeholders and a survey of hospital staff), and a quantitative analysis (a questionnaire composed of 4 theoretical dimensions, 13 sub-dimensions, 66 items) with triangulation of the results.Results Hospital stakeholders assign greatest importance to the human relations dimension, i.e., organizational climate (professional and public service values) and quality of work life. These values attract a high degree of consensus among stakeholders (no statistical difference between physicians, caregivers and administrative staff).Conclusions Our findings challenge the mainstream view that competing values underlie hospital performance. Currently, views are to some extent shared among different stakeholder groups. A reason for this could be the need to form a more united front in the face of recent reforms. This common emphasis on professional and public service values could be the basis for formulating management priorities in teaching hospitals in order to improve performance.

International audience ; Objective To find out which are the emerging views on hospital performance and to analyze how these views vary among hospital stakeholders.Methods Study setting: Three hospital stakeholder groups (physicians, caregivers, and administrative staff) in a large Paris teaching hospital.Study design: A case study combining a qualitative (interviews of 80 key hospital stakeholders and a survey of hospital staff), and a quantitative analysis (a questionnaire composed of 4 theoretical dimensions, 13 sub-dimensions, 66 items) with triangulation of the results.Results Hospital stakeholders assign greatest importance to the human relations dimension, i.e., organizational climate (professional and public service values) and quality of work life. These values attract a high degree of consensus among stakeholders (no statistical difference between physicians, caregivers and administrative staff).Conclusions Our findings challenge the mainstream view that competing values underlie hospital performance. Currently, views are to some extent shared among different stakeholder groups. A reason for this could be the need to form a more united front in the face of recent reforms. This common emphasis on professional and public service values could be the basis for formulating management priorities in teaching hospitals in order to improve performance.