La question principale de cette thèse peut être formulée ainsi : Comment les discours, normes et pratiques spatiales peuvent, dans le cadre d’une relation inter-organisationnelle, produire un bon comportement spatial des agents dans une relation de délégation ? Ancré en management stratégique, notre cadre théorique mobilise des approches issues de la géographie et le concept foucaldien de dispositif. La méthodologie de recherche déployée repose sur une étude de cas unique portant sur la gestion de la santé en région Centre-Val-de-Loire. L’analyse du matériau empirique fait ressortir la création d’une chaîne d’auto-régulation inter-organisationnelle permettant de propager ce dispositif reposant sur trois types d’espace, absolu, relatif et relationnel en donnant l’illusion à chacun des maillons qu’il est responsable de ses actions. Nous mettons aussi en évidence le caractère autonome du dispositif qui produit à la fois des marges de manœuvres pour les acteurs et des résultats parfois contre-productifs vis-à-vis de la politique initialement portée par le mandant. / The main question of this thesis can be formulated as follows: How can discourses, norms and spatial practices, in the context of inter-organisational relations, produce good spatial conduct of agents in a relation of delegation? Rooted in strategic management, our theoretical framework mobilise approaches from the domain of geography and the Foucauldian notion of dispositif. The methodology we used is based on a unique case study: the health system in the region of Centre-Valde- Loire. The analysis of the empirical material shows the creation of an inter-organisational self-regulation chain, enabling the dissemination of this dispositif based on three types of space (absolute, relative and relational) by giving the illusion to each one of these links that he is responsible for his actions. We also highlight the independent nature of the dispositif that can create room for manoeuvre for actors as well as results that are sometimes counter-productive with regard to the original policies of the mandator.

Care of the elderly is frequently debated in the Swedish media. Pensioners, who are often ill and lonely, need help with social care, such as cleaning and cooking, and health care, such as taking medicine and treatment of injuries and wounds. They are aided by home helpers from the home helper unit and assistant nurses and nurses from the health centre. How does control operate in this intimate and private situation, and what influences the home helpers? What is the relation between control and the delivery of care to the pensioners? These are the questions explored in this dissertation, based on an empirical study of domestic elderly care in a large city in Sweden. The thesis explores the conflict between the productification of care, manifested in administrative controls, and the needs and desires of the pensioners in specific care giving situations, manifested in self controls. It is seen that even during periods of high financial pressure, the home helpers are influenced by the pensioners. The home helpers are flexible and do extra things not included in the pre-specified social care contract for some pensioners. Flexibility is shown to be important for the pensioners, but the increased financial pressure makes it harder and harder for the home helpers to be flexible. It is therefore suggested in the thesis for social care service purchasers to put in some unspecified time in the social care decisions and not just pre-specified operational activities. In this way some flexibility will be built into the administrative system. The importance of cooperation between the health centre and the home helper unit is also stressed in the thesis. There is a need to issue administrative controls for cooperation. A joint task group, with members from the health centres and the home helper units, meetings between the home helpers and the nurses and specified guidelines for cooperation tasks can act as controls which would sustain significant and positive effects on the cooperation. Finally, a problematic underlying financial process for the home helper units is identified. The home helper units are not often compensated for yearly salary increases. The problems of the moment receive significantly more attention, but this thesis points to the need for discussing the ongoing, underlying and problematic financial process in the elderly care. / <p>Diss. Stockholm : Handelshögskolan, 2007</p>