<p>Broad access to healthcare services is a key factor of human development in any country. The current health care situation in South Africa can be diagnosed as critical. The hospitals are understaffed, over-occupied and the diseases like Human Immunodeficiency Virus (HIV) give health care workers additional challenges. The demand for management skills in the health sector including those for nurse managers is high. A recent World Health Organization (WHO) study of nurses working in maternal health services identified good management as more important than salary, unless the remuneration was dramatically higher. In South Africa, little empirical research exists about the management skills of nurse managers, even though proper management of human resources is vital to achieve better outcomes and access to health care around the world. In South Africa, a greater focus on human resource management in health care and more research is needed to develop new policies that will help to address the skills gap of nurse managers. The object of this research project was to identify the gaps between required and existing management skills of senior nurse managers in South Africa in private and public hospitals. Once identified, this skills gap assessment can be used by employers and policy-makers to define the management education that nurse managers require. The research is based on a survey of nurse managers in private and public hospitals using a questionnaire. The survey instrument was based on prior research of hospital managers&rsquo / competencies in South Africa, and a review of the related theoretical literature.</p>

Globally HIV and AIDS are considered to be a major health and developmental challenge facing humanity. The HIV infection of children is not only an area of great concern for families but for the future of humankind. Caring and nurturing of children generally is considered as a challenging responsibility. Caregivers of HIV infected children are faced with the added responsibility of ensuring that these children have access to life saving health care at all times. Caregivers who are responsible for the health and well being of HIV infected children face constant challenges in their care giving role and this has implications for the quality of care of the child. The needs of HIV infected children are complex and vital to their basic needs is the administration of antiretroviral therapy (ART). This study aimed to explore, describe and interpret the experiences of caregivers, caring for HIV infected children and accessing services from a public hospital in Durban. Using the ecosystems theory, this qualitative study explored the experiences of thirty caregivers caring for HIV infected children. The data was collected using semi structured interviews with the caregivers. Four main themes emerged from the data analysis; namely: The caregivers’ intrapersonal experiences, their perspectives on HIV and ART, their access to health and social services and their coping strategies. This study concludes that caregivers of HIV infected children within the public hospital setting, experience numerous psycho-social and economic challenges on a daily basis. Subsequently, these challenges impacted on the quality of care to the HIV infected child. It was evident that respondents dealt with challenges differently, as the older respondents were more equipped emotionally and psychologically than the younger respondents. Generally, all respondents were negatively affected by poor psychological and socio-economic circumstances that prevented them from ensuring the wellbeing of the child. The challenges that they faced on the micro level (economic and psycho-social experiences), the mezzo (stigma, community and family support) and exo levels (health and welfare services) together with the macro level (DOH strategic plans and childcare legislations) determined how they provided for the care of the HIV infected child. Despite these challenges respondents’ resilience and commitment to providing for the health and wellbeing of the HIV infected child was consistent and remained a priority. Multi-level intervention programmes are required to help caregivers cope with their challenges. As such social work practitioners need to take cognizance of the psycho-social, emotional and material support required by caregivers of HIV infected children. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2013.

The dualistic South African health system is divided into a private and public health care sector. The core difference between these two sectors is that private hospitals are based on a business model with a profit motive, while public hospitals offer a free service, accessible to all citizens of South Africa and is nurse-driven. The increased need towards higher quality health care is evident in the launching of the National Health Insurance system. The pilot of this system was activated in ten sub-districts in South Africa and will become the mechanism to enhance quality and safety of patient care in the private and public sectors. Registered nurses’ reporting of quality and safety of patient care is an important factor in quality-related research and has been linked with international studies on quality of care. As the registered nurses are directly involved in all the facets of patient care, this population serves as a valuable contribution in the assessment of quality care. In this research quality of care refers to quality, patient safety and adverse events. Quality of care refers to the extent to which actual care is in conformity with the present criteria for good care. Patient safety is a parameter used to monitor and enhance quality. Through enhanced patient safety, adverse events can be prevented. Adverse events refer to all the incidents that can affect a patient during hospitalisation that is not due to the patient’s illness, such as hospital acquired infections, medication safety and patient falls with injury. This research aimed to explore and describe the nurse reported differences in quality of care, patient safety and adverse events in the adult medical and surgical units of private and public hospitals in the Free State and North West Provinces. This study was conducted within the RN4CAST research programme, an international consortium of fifteen countries working together towards the formulation of nurse workforce forecasting models. A quantitative, correlational, explorative, descriptive and contextual design was followed. The population consisted of registered nurses employed for at least one year in the selected private and public hospitals in the two participating provinces. Private hospitals with more than 100 beds were included. The public hospitals had a level three status. An all-inclusive sampling was conducted (n=332) after participants gave informed consent. Data was collected through the completion of the National Nurse Survey that covered four sections of which quality of care, patient safety and adverse events was one. Field workers were utilised during data collection. Data capturing was conducted by means of EpiData 3.1. Secondary data analysis was utilised by means of SPSS 16.0. Descriptive statistics were extracted with regard to the demographic status of the participants. The descriptive statistics were congruent with the demographic profile of nursing in South Africa. The inferential statistics included the difference in quality of care, patient safety and adverse events between the private and public hospitals in the selected provinces. Both the t-test based on the quality of care and patient safety as well as the Mann-Whitney test on adverse events indicated an insignificant difference between nurse reported quality of care, patient safety and adverse events between the private and public hospitals. Reliability and validity were assured and recommendations were formulated for nursing education, practice and research. / MCur, North-West University, Potchefstroom Campus, 2013

The dualistic South African health system is divided into a private and public health care sector. The core difference between these two sectors is that private hospitals are based on a business model with a profit motive, while public hospitals offer a free service, accessible to all citizens of South Africa and is nurse-driven. The increased need towards higher quality health care is evident in the launching of the National Health Insurance system. The pilot of this system was activated in ten sub-districts in South Africa and will become the mechanism to enhance quality and safety of patient care in the private and public sectors. Registered nurses’ reporting of quality and safety of patient care is an important factor in quality-related research and has been linked with international studies on quality of care. As the registered nurses are directly involved in all the facets of patient care, this population serves as a valuable contribution in the assessment of quality care. In this research quality of care refers to quality, patient safety and adverse events. Quality of care refers to the extent to which actual care is in conformity with the present criteria for good care. Patient safety is a parameter used to monitor and enhance quality. Through enhanced patient safety, adverse events can be prevented. Adverse events refer to all the incidents that can affect a patient during hospitalisation that is not due to the patient’s illness, such as hospital acquired infections, medication safety and patient falls with injury. This research aimed to explore and describe the nurse reported differences in quality of care, patient safety and adverse events in the adult medical and surgical units of private and public hospitals in the Free State and North West Provinces. This study was conducted within the RN4CAST research programme, an international consortium of fifteen countries working together towards the formulation of nurse workforce forecasting models. A quantitative, correlational, explorative, descriptive and contextual design was followed. The population consisted of registered nurses employed for at least one year in the selected private and public hospitals in the two participating provinces. Private hospitals with more than 100 beds were included. The public hospitals had a level three status. An all-inclusive sampling was conducted (n=332) after participants gave informed consent. Data was collected through the completion of the National Nurse Survey that covered four sections of which quality of care, patient safety and adverse events was one. Field workers were utilised during data collection. Data capturing was conducted by means of EpiData 3.1. Secondary data analysis was utilised by means of SPSS 16.0. Descriptive statistics were extracted with regard to the demographic status of the participants. The descriptive statistics were congruent with the demographic profile of nursing in South Africa. The inferential statistics included the difference in quality of care, patient safety and adverse events between the private and public hospitals in the selected provinces. Both the t-test based on the quality of care and patient safety as well as the Mann-Whitney test on adverse events indicated an insignificant difference between nurse reported quality of care, patient safety and adverse events between the private and public hospitals. Reliability and validity were assured and recommendations were formulated for nursing education, practice and research. / MCur, North-West University, Potchefstroom Campus, 2013

The World Health Organization (WHO) recommends that of all the live births per year no more than 10-15% of these should be delivered by caesarean section. Despite this recommendation there has been a global increase in the percentage of caesarean section deliveries over the past few decades. In South Africa the percentage is as high as 70% in certain health care institutions which is of concern to midwives. Caesarean section deliveries are needed when the life of the baby, mother or both are at stake. However, this method of delivery bears more disadvantages than advantages to the baby and mother. Despite these disadvantages, some women request a caesarean section in their birth plans while others are influenced by health professionals to request a caesarean section. Therefore, there is a need for labouring women to be guided where possible to have vaginal birth because of its many advantages. This study sought to explore and describe the perceptions of the midwives regarding their role in facilitating the choice of delivery mode for labouring women in public hospitals and midwifery obstetric units (MOUs) of the Nelson Mandela Bay and Sarah Baartman districts. Based on the results of the study, guidelines for midwives in this role were developed. Maputle’sWoman-Centred Childbirth Model (2010) was used as the theoretical lens through which this study was viewed. The researcher selected a quantitative survey design using an explorative, descriptive and contextual research approach. The population consisted of midwives who were working in labour wards at public hospitals and midwife-led MOUs. A non-probability convenience sample was used to collect data using a structured, self-administered questionnaire. The reliability and validity of the data collection instrument were ensured by using various means including a pre-test and an expert panel. Altogether, 300 questionnaires were distributed and 288 were returned. This number excluded the pilot study. Data was collected over a period of three months using the assistance of two fieldworkers. Data was captured and analysed under the supervision of the statistician and supervisors. Analysis was done by means of descriptive analyses that involved the production of frequencies and presented using charts, figures and tables. The major findings of the study are: -The midwives perceived themselves as the main facilitators of a suitable decision by the labouring woman for a safe delivery method - The midwives emphasised the importance of the delivery position preferred by the labouring woman -The midwives indicated that a collaboration between doctors, senior midwives, midwives and midwives in management positions could assist with a decision for a suitable delivery mode option. -The midwives agreed that the culture of the labouring woman should be considered when deciding on a delivery mode and therefore midwifery curriculum should include lessons about cultural diversity. Three principal guidelines were developed, namely: 1. Create an environment that promotes acceptance of a woman’s choice of a delivery mode. 2. Create an environment promoting a collaborative health care relationship 3. Create an environment that is sensitive to cultural needs in the maternity unit Ethical considerations in this study were upheld by maintaining the principles of beneficence, maleficence, autonomy and justice.

p. 1-147 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-03-14T17:43:17Z No. of bitstreams: 2 Marques ISS, Dissertação Final1.pdf02.pdf: 914343 bytes, checksum: f2b56930aa0ce84927ef4f833d322f1f (MD5) Marques ISS, Capa Final1.pdf01.pdf: 118849 bytes, checksum: b470599993cf8feffcd3ec2ffb13aec3 (MD5) / Approved for entry into archive by Tatiana Lima(tatianasl@ufba.br) on 2013-03-14T18:26:34Z (GMT) No. of bitstreams: 2 Marques ISS, Dissertação Final1.pdf02.pdf: 914343 bytes, checksum: f2b56930aa0ce84927ef4f833d322f1f (MD5) Marques ISS, Capa Final1.pdf01.pdf: 118849 bytes, checksum: b470599993cf8feffcd3ec2ffb13aec3 (MD5) / Made available in DSpace on 2013-03-14T18:26:34Z (GMT). No. of bitstreams: 2 Marques ISS, Dissertação Final1.pdf02.pdf: 914343 bytes, checksum: f2b56930aa0ce84927ef4f833d322f1f (MD5) Marques ISS, Capa Final1.pdf01.pdf: 118849 bytes, checksum: b470599993cf8feffcd3ec2ffb13aec3 (MD5) Previous issue date: 2005 / Este trabalho tem como objetivo realizar um comparativo entre os diferentes Modelos de Gestão adotados pelos hospitais públicos do Estado da Bahia: o modelo de gestão burocrático e o terceirizado. Este trabalho de dissertação é embasado no referencial teórico da burocracia de Max Weber, adotado pelo serviço público no Brasil oficialmente na Reforma Administrativa de 1936, e na abordagem do Novo Gerencialismo no contexto da Reforma do Estado, iniciada no Brasil em 1995. Realizou-se pesquisa de campo em 19 hospitais públicos do Estado, sendo 11 (onze) destes de modelo de gestão burocrático e 8 (oito) de modelo de gestão terceirizado, bem como, pesquisa comparativa exploratória, do tipo descritiva e de abordagem quantitativa, sendo o estudo empírico desenvolvido através da coleta, da tabulação, da análise e da comparação de indicadores para caracterização dos modelos de gestão (perfil do gestor e utilização de práticas tradicionais de gestão) e de utilização de práticas contemporâneas de gestão. Observou-se que, na prática, existe correspondência entre o referencial teórico da Burocracia e os hospitais de administração direta da SESAB, e entre os hospitais com modelo de gestão terceirizado e a abordagem do Novo Gerencialismo. Os resultados revelam que a transição do modelo de gestão burocrático para o terceirizado gerou mudanças não apenas no que diz respeito ao perfil do gestor e seu grau de profissionalização, mas também na utilização de práticas tradicionais de gestão (a exemplo de ferramentas de gestão de pessoas, finanças e suprimentos) e na utilização de práticas contemporâneas de gestão. Estas últimas são as principais representantes da implementação do SUS e da perspectiva da abordagem do Novo Gerencialismo (Programas de Qualidade e Tecnologia da Informação). A pesquisa indica que para que os objetivos do SUS e da Reforma do Estado sejam atingidos não é imprescindível que haja parcerias público-privadas, sendo suficiente que haja interesse político na profissionalização da gestão de hospitais públicos de modo que estes alcancem a excelência na qualidade da oferta de serviços aliada à boa gestão dos recursos e redução de custos. / Salvador

Clinical practice is the core of nursing education during which the student is socialized into the nursing profession. During this period, there is transfer of knowledge and skill from qualified nurses and other members of the multidisciplinary team to student nurses. The purpose of this study is to describe and explore student nurse’s experiences of clinical accompaniment in a public hospital in Gauteng Province by means of a qualitative approach that included the exploratory, descriptive and contextual study. Three focus group interviews were conducted with students and one with clinical accompanists. Qualitative methods included categorizing and coding. The major findings of the research revealed that participants regarded relationships and communication as important for clinical accompaniment. Both student nurses and unit supervisors expected nurse facilitators to accompany students in clinical settings; but some hospital staff members did not perceive clinical accompaniment to be their task. / Health Studies / M.A. (Public Health)

Made available in DSpace on 2016-08-02T21:42:50Z (GMT). No. of bitstreams: 1 Almir Rangel1.pdf: 1640185 bytes, checksum: cc0b2a380aa9f47114afde386d251c3f (MD5) Previous issue date: 2008-03-31 / This study investigates the use of the Vision Based on Resources, with the aim of proposing a model for the management of people who meet the enforceability of the quality of provision of services to health. They are observed relationships of these services work in different ways, the systematization of knowledge about the elements contained in the management of people and verification of the need for Strategic and Operational Management of People for employees of the institutions of Public Health Hospital. It is empirical research and exploratory in nature, supported on multiple cases of public hospitals, interviewing and recording facts observed in the places searched, according to the Protocol of Remarks. To achieve the main objective, used the basis of works of Marras (2001, 2003 and 2005): Labor Relations in Brazil: management and strategy; Human Resources Administration: from operational to strategic and Managing People in Business Innovative, respectively. In addition to the comments participants, it is used questionnaires and interviews with users and professionals in hospitals, with instruments adapted to the context of the institution and given treatment for statistical analysis of the results, which are presented in tables for better visualization of data and analysis. The Managing People in ISHP remain in the traditional model and away from any move that could make it strategically. The level of satisfaction of patients to the health professionals is great, but on the resources and infrastructure, is low. The health care professionals in almost all its work by vocation, spirit of humanization and by feel gratifying, but the level of dissatisfaction with the pay received is high.(AU) / Este trabalho investiga a utilização da Visão Baseada em Recursos, tendo por objetivo propor um modelo de gestão de pessoas que atenda a exigibilidade da qualidade de prestação de serviços à saúde. São observadas as relações de trabalho nesses serviços nas diversas modalidades, a sistematização do conhecimento sobre os elementos que figuram na gestão de pessoas e a verificação da necessidade de Gestão Operacional e Estratégica de Pessoas para trabalhadores das Instituições de Saúde Hospitalares Públicas. Trata-se de pesquisa de natureza empírico-exploratória, apoiada em múltiplos casos de hospitais públicos, entrevistando e registrando fatos observados nos locais pesquisados, aplicando-se o Protocolo de Observações. Para atingir o objetivo principal, são utilizados os fundamentos das obras de Marras (2001; 2003 e 2005): Relações Trabalhistas no Brasil: administração e estratégia; Administração de Recursos Humanos: do operacional ao estratégico; e Gestão de Pessoas em Empresas Inovadoras, respectivamente. Além das observações participantes, utilizaram-se entrevistas e questionários com os usuários e profissionais dos hospitais, com instrumentos adaptados para o contexto da instituição e dado tratamento estatístico para análise dos resultados, que se apresentam em tabelas para melhor visualização dos dados e análise. A Gestão de Pessoas nas ISHP permanecem no modelo tradicional e longe de qualquer movimento que possa torná-la estratégica. O nível de satisfação dos pacientes para com os profissionais de saúde é ótimo, mas quanto aos recursos e infra-estrutura, é baixo. Os profissionais de saúde na quase sua totalidade trabalham por vocação, espírito de humanização e por acharem gratificante, embora o nível de insatisfação com a remuneração recebida seja elevado.(AU)

Orientador: Solange L'Abbate / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T01:40:40Z (GMT). No. of bitstreams: 1 Spagnol_CarlaAparecida_D.pdf: 6634502 bytes, checksum: 47034f29257b951227f80406fc8f54c2 (MD5) Previous issue date: 2006 / Resumo: Nessa pesquisa, investiguei os conflitos vivenciados pela equipe de enfermagem do Hospital das Clínicas-UFMG, motivada pelo fato de o enfermeiro desempenhar atividade de gerência nos serviços de saúde e freqüentemente lidar com relações conflituosas. Os objetivos delineados foram: conhecer as diferentes percepções de conflito dos enfermeiros; identificar aqueles mais comuns e os principais fatores que geram esses conflitos; compreender como o enfermeiro lida com os conflitos no trabalho; levantar facilidades e dificuldades para lidar com os conflitos e propor aos enfermeiros a construção coletiva de um dispositivo socioanalítico, a ser utilizado como espaço de análise e reflexão da prática profissional, focalizando o objeto de estudo. Por se tratar de um fenômeno processual, optei pela abordagem qualitativa, desenvolvendo uma pesquisa-intervenção em duas fases. Na primeira, realizei uma pesquisa exploratória, com o objetivo de me aproximar dos sujeitos e do objeto de estudo, utilizando um questionário, que foi aplicado, em setembro de 2003, a cento e cinco enfermeiros (105), sendo que desses, trinta e sete (37), o devolveram. Na segunda, utilizei a perspectiva da socioanálise, para construir um dispositivo, visando a criação de um espaço que permitisse à pesquisadora e às pesquisadas realizarem, conjuntamente, análises e reflexões acerca da prática profissional, focalizando situações de conflito vivenciadas no trabalho. Foram realizados cinco encontros nos meses de setembro e outubro de 2005, com duração de duas horas cada, onde participaram seis enfermeiras que, no questionário, responderam afirmativamente quanto à sua continuidade no estudo. Nessa fase, as integrantes ao elaborarem a demanda de análise do grupo, expressaram vários motivos para participarem dessa investigação, dentre eles destaco suas implicações com a pesquisadora. Para as enfermeiras conflito é: diferença de pensamentos e de posições, coisa que incomoda e algo estressante. Apresentam uma visão bipolar desse fenômeno, pois, a princípio, são percebidos como negativos, mas dependendo do ângulo que se olha também o consideram como positivo, isso se forem discutidos com todos os envolvidos e conduzidos adequadamente. Identifiquei os seguintes tipos de conflitos: intrapessoal, interpessoal, intergrupal, de poder e de interesse. As principais causas que geram esses conflitos são: duplicidade de vínculo empregatício; deficiências na estrutura organizacional e no modelo de gerência implantado; escassez de recursos; centralização do trabalho; hierarquia; autoritarismo; imaturidade; escalas de serviço; falta de respeito e compromisso profissional, trazendo conseqüências para as relações interpessoais e para a assistência prestada. As enfermeiras lidam com situações de conflito, de forma racional, apresentando desejo de fuga, ao realizarem ações imediatistas, a fim de contornarem ou amenizarem a situação, assumindo que não são preparadas para conduzirem questões problemáticas ligadas ao comportamento e relacionamento interpessoal. Sendo assim, em determinadas situações, solicitam ajuda aos psicólogos da Diretoria de Recursos Humanos do hospital. O próprio dispostivo socioanalítico se constituiu em um analisador, permitindo explicitar instituídos e instituintes, implicações e transversalidades, presentes na organização hospital que é atravessada pelas 'instituições enfermagem e medicina¿. Diante das avaliações positivas relacionadas aos encontros grupais, sugiro desenvolvermos outros trabalhos tendo o dispositivo socioanalítico como um espaço coletivo de análise e reflexão das relações e práticas profissionais / Abstract: In this research, I investigated the conflicts experienced by a nursing team at the Federal University of Minas Gerais Hospital, motivated by the fact that nurses manage health care and frequently face conflict situations. The aims of this research were: to learn about nurses different perceptions regarding conflict; to identify the most common conflicts and the main factors that generate these conflicts; to understand how nurses manage conflicts at work; to find out motivations and difficulties to manage conflicts and propose to nurses a collective construction of a socio-analytical instrument to be used as a space for analysis and reflection of professional practice, focusing on the study object. As it is a process phenomenon, I used a qualitative approach, developing an intervention research in two phases. In the first phase, I developed an exploratory research with the purpose to get closer to the subjects and study object, using a questionnaire that was applied in September 2003 to 105 nurses. Among them, 37 responded and sent it back. In the second phase, I used the socio-analysis perspective to build an instrument, aiming at creating a space that would allow the researcher and research to be developed as well as analyses and reflections regarding professional practice, focusing on conflict situations experienced at work. Five meetings happened in September and October 2005, of two hours each, with the participation of six nurses that manifested in the questionnaire their intention to continue the study. In this phase, the members of the group expressed their motivations to participate in the study, emphasized its implications regarding the researcher. According to these nurses, conflict is a difference of thoughts and positions, something that may impair the relationship. They present a bipolar view of this phenomenon as at first they are perceived as negative, but depending on the way they are seen they can be considered positive, if they are discussed with all the persons involved and managed adequately. The following types of conflict were identified: intrapersonal, interpersonal, intergroup, of power and of interest. The main causes that generate these conflicts are: work in more than one place, problems regarding the organizational structure and management, lack of resources, work centralization, hierarchy, authoritarianism, immaturity, work shifts, lack of respect and professional commitment that influence interpersonal relations and the care provided. Nurses manage conflict situations in a rational way, presenting their desire to run away when they implement immediate actions, in order to minimize the situation, assuming that they are not prepared to conduct problems related to behaviors and interpersonal relationships. Therefore, in some situations they ask for help to psychologists from the Hospital Human Resources Division. The socio-analytical instrument was a means to analyze it, enabling them to expose the situations, implications and transversal intersections that are present at the hospital organization that is crossed by other institutions such as ¿nursing and medicine¿. Considering the positive evaluation of the group meetings, I suggest the development of other works based on socio-analytical instruments as a collective space for the analysis and reflection of relationships and professional practices / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

Comment les coûts et les tarifs hospitaliers sont-ils devenus des objets politiques centraux depuis le début des années 1980, quels espaces controversés produisent-ils aujourd'hui et comment ces controverses agissent-elles sur ces instruments gestionnaires d'action publique ? C'est à ces questions que la thèse se propose de répondre en étudiant la genèse, les usages et les déplacements de plusieurs instruments d'action publique en matière hospitalière : système d'information, calcul de coûts par séjours, instruments d'ajustement budgétaire et système de tarification. En articulant sociologie politique des instruments de gouvernement et sociologie des techniques et de l'innovation, ces dispositifs sont étudiés dans les multiples sites où ils se déploient : ministère de la Santé, agence technique, centres de recherche en gestion, instances d'expertise, fédérations hospitalières, associations de malade et hôpital public. La thèse montre comment ces instruments ont profondément transformé l'hôpital en un être de gestion et de finances. La tarification à l'activité, appelée T2A, tient une place centrale dans ces transformations et est ici analysée comme un instrument de qualcul visant à quantifier et à qualifier les patients, les séjours, les maladies, voire l'hôpital public lui-même. La thèse montre comment ce processus de qualculation génère des controverses métrologiques où des acteurs se saisissent des dispositifs pour refaire les qualculs, ces controverses supposant une forme relativement nouvelle de travail critique. / How costs and tariffs have become pivotal policy instruments to govern public hospitals in France since the early 1980's? What kind of controversies do they produce and what feedback effect do these controversies have on these instruments? These are the questions I propose to answer in this PhD dissertation by analysing the genealogy, the uses and the transformations of several policy devices: information system, cost accounting, budgetary regulation instrument and pricing payment system. Combining a sociology of policy instruments and science and technology studies, these devices are analysed in the multiple sites where they spread: ministry of Health, public agency, research centres in management studies, hospital federations, patients organizations and public hospitals. The dissertation exposes how these devices have turned public hospitals into accounting and financial entities. I specially focus on the pricing payment system (called T2A) which is analysed as a qualculation instrument as it qualifies and quantifies patients, stays in hospitals, diseases, and public hospital itself. The dissertation shows how this qualculation process produces metrological controversies in which actors put into question the way things are qualculated.