In the past few decades, accountability has become a key concept to assess the role and place of a wide range of trasnational institutions. Such trend can be partially explained by the widespread sense of unaccountability that permeates the legal realm beyond the state. The aim of this thesis is to investigate three particular institutional actors of the Climate Change Regime: the Intergovernmental Panel on Climate Change (IPCC), the Compliance Committee of the Kyoto Protocol (CCKP), and the Clean Development Mechanism (CDM). This investigation is carried out through the descriptive and critical lenses of accountability. It resorts to the Global Administrative Law (GAL) project in order to pursue that task. Along the way, the thesis asks four interrelated research questions. The first is conceptual: what is accountability? The second is an abstract normative question: what is regarded as a desirable accountability relationship at the national and the global level? The third is purely descriptive: how accountable are the three institutions? The fourth, finally, is a contextualised normative question: how appropriate are their three accountability arrangements? The two former questions are instrumental and ancillary to the two latter. That is to say, they respectively provide the analytical and evaluative frameworks on the basis of which a concrete description and a concrete normative assessment will be done.

La recherche en contrôle a montré que le champ hospitalier français a subi de profonds changements, notamment à travers l’introduction de l’accountability. La conformité aux pressions institutionnelles pousse les organisations à s’orienter vers de nouveaux outils et principes pour renfoncer leur légitimité externe (Power, 2003). Cette même littérature a montré que l’accountability s’infiltre dans la sphère médicale et démontre des phénomènes d’hybridation de rôle chez les médecins hospitaliers, qui sont ainsi sensibilisés aux contraintes financières (Kurunmäki, 1999). La sphère administrative ne fait pas exception et subit également des pressions coercitives. L’objectif de notre thèse est de contribuer à cette littérature en analysant les effets et les rôles de l’accountability dans le secteur hospitalier public français sur la sphère médicale. Pour analyser ces effets, nous nous ciblons sur les dispositifs d’accountability tels que le reporting d’informations (audit financier, pratique budgétaire). Pour répondre à cette problématique, notre terrain s’est focalisé sur des entretiens semi-directifs et une approche ethnographique dans un CHU de grande taille. Premièrement, à travers une étude exploratoire qualitative menée auprès de 19 directeurs administratifs financiers (représentant 19 CHU/CH), nous montrons que l’accountability au travers de l’exemple de l’audit financier amène à des changements organisationnels et sert également à « rendre des comptes » aux parties prenantes externes (Agence Régionale de Santé, banques) mais aussi internes des organisations hospitalières. Nos résultats soulignent notamment que l’audit financier renforce la légitimité de la sphère administrative vis-à-vis de la sphère médicale. Deuxièmement, nous identifions à partir d’une approche ethnographique (observation non-participante et entretiens) menée dans un CHU des acteurs administratifs spécifiques, servant de vecteurs pour l’infiltration de l’accountability dans la sphère médicale : les Techniciens d’Information Médicale. Ces acteurs administratifs ont un rôle essentiel dans l’hybridation des médecins aux compétences gestionnaires, et les sensibilisent aux logiques financières. A travers le reporting de leur activité médicale, nos résultats mettent en lumière une atténuation du clivage traditionnel observé dans la littérature entre acteurs administratifs et corps médical. Nous montrons également que l’infiltration de l’accountability par d’autres agents administratifs spécialisés, tend à sensibiliser les médecins à la réduction de surplus, de slack présent dans la prise en charge des patients. Il s’avère que cette organisation hospitalière privilégie des dispositifs d’accompagnements afin de solliciter les médecins à intégrer de nouvelles responsabilités dans l’efficience de leur rôle. Notre étude montre que les médecins tentent désormais de trouver un équilibre afin d’articuler « logique patient » et logique gestionnaire. Pour cela, nos résultats soulignent une modification des protocoles de soins, du raisonnement ainsi que des valeurs des professionnels de santé qui concilient et promeuvent désormais le médico-économique. / How are accountability measures used by actors in the administrative field? Consequently, which are the associated effects on workers in the health sector?Research in control has shown that the French hospital has undergone profound changes, notably through the introduction of accountability. Compliance with institutional pressure drives organizations to move towards new tools and principles that reinforce their external legitimacy (Power, 2003). The same literature has shown that accountability infiltrates the medical sphere and that a new phenomenon occurs: doctors adopt hybridization role in hospital. This hybridization creates doctors who are aware of financial constraints (Kurunmäki, 1999). The administrative sphere is no exception and is also subject to coercive pressure.The aim of our thesis is to contribute to this literature by analyzing the intra-organizational effects and roles of accountability on the medical logic in the French public hospital sector. To analyze these effects, we focus on accountability mechanisms such as information reporting (i.e. financial audit, budget practice). To answer this problematic, we use semi-structured interviews into French hospitals and we adopt an ethnographic approach of one large university hospital.Firstly, from a series of exploratory interviews with 19 financial administrative directors (in 19 public hospitals), we show that accountability through financial audit leads to organizational changes and also use to “give account” not only to external stakeholders (Regional Health Agency, banks) but also internal hospital organizations. Our results show that the financial audit reinforces the legitimacy of the administrative sphere towards the medical sphere.Secondly, we identify with an ethnographic approach (non-participant observation and interviews) in a UHC of specific administrative actors called “Medical coders” (i.e. actors serving as vectors for the infiltration of accountability in the medical sphere). These administrative members have a key role in hybridization of health professionals to management skills, and sensitize them to financial logics.Through the reporting of their medical activity, our results highlight an attenuation of the traditional cleavage observed in the literature between administrative members and the medical profession.Moreover, we show that the infiltration of accountability by others specialized administrative agents tends to sensitize doctors to the reduction of surplus, and the slack in the care of patients. It turns out that, the hospital organization favors support systems to make physicians integrate efficiency in their health role.Our result show that physicians are now trying to find a balance in order to articulate medical logic and managerial logic. For this, our study highlights a modification of care protocols as well as the reasoning and values of health professionals who reconcile and promote medico-economic logic.This thesis argues that the introduction of accountability within the French public hospital sector has intra-organizational effects on both the administrative and medical spheres and emphasizes that on the basis of the reduction of the organizational slack, the conflicts between medical and managerial logic are lessened.