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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
21

Les facteurs de succès et de frein d'une démarche de prévention des risques psychosociaux à l'hôpital public : une lecture au regard de la sociologie de la traduction / The factors of success and brake of a practical approach to psychosocial risks in the public hospital : a reading with regard to the sociology of translation

Durand, Sandra 11 September 2017 (has links)
Notre recherche-intervention produit des enseignements sur les modalités qui favorisent le déploiement de projets de prévention des risques psychosociaux (RPS) dans des centres hospitaliers publics. Compte tenu de la forte exposition des agents aux facteurs de RPS, les hôpitaux sont encouragés à s’engager dans ce type de démarche et se confrontent alors à un défi de taille. En effet, de par leur nature Ressource Humaine, ces démarches transverses subissent l’influence défavorable d’éléments de contexte externes et internes qui les ralentissent voire les annihilent. Face à cette problématique, la littérature reste relativement muette sur les modalités concrètes qui permettent de décliner opérationnellement des pistes préventives. Notre recherche repose sur trois études de cas longitudinales réalisées dans deux Centres Hospitaliers publics des régions PACA et Languedoc-Roussillon. Nous nous sommes appuyés sur la sociologie de la traduction, dans sa version normative et analytique, pour aider et analyser la conduite des démarches préventives. Nous mettons en évidence les facteurs de succès et de freins relatifs au trois projets étudiés. Ainsi, nous formulons des préconisations managériales et proposons des pistes de recherche visant à outiller davantage les gestionnaires qui souhaitent conduire des projets de prévention des RPS dans les structures hospitalières publiques. L’étude met en évidence qu’un guide normatif de la sociologie de la traduction enrichi et appliqué à l’échelle locale d’un service semblerait être la voie privilégiée pour prévenir efficacement les risques psychosociaux à l’hôpital. / Our research-intervention provides lessons on modalities supporting the deployment of psychosocial risk prevention projects in public hospitals. Given the agents’ high exposure to psychosocial risk factors, hospitals are encouraged to engage in this type of approach but also face important challenges. Indeed, due to their human resource nature, these transversal approaches suffer from the negative influence of external elements and internal ones that slow down or annihilate them. Thus, psychosocial risk prevention is considered unsatisfactory, despite some steps taken. Literature remains relatively silent on what modalities allow to operationally decline preventive leads. Our research is based on three longitudinal case studies carried out in two public hospitals in the ProvenceAlpes-Côte d'Azur and Languedoc-Roussillon regions. We based our research on the sociology of translation, in its normative and analytical version, to help analyze the conduct of preventive approaches. We highlight the success factors and constraints related to each stage of the three projects studied (initiation and establishment of the diagnosis, development and implementation of the action plan). Our transformative posture allows us to enrich the normative guide of the theoretical framework. Thus, we formulate managerial recommendations and propose research tracks aimed at better equipping managers who wish to conduct psychosocial risk prevention projects in public hospitals. The study shows that a normative guide to the sociology of translation enriched and applied at the local level of a service appears to be the most effective way to prevent psychosocial risks in hospitals.
22

La création d’un « climat d’accountability » dans les hôpitaux publics français, entre légitimité(s) et influence(s) : une approche par la théorie néo-institutionnelle / The climate of accountability in french public hospitals, between legitimacy and influence : an approach using neo-institutional theory

Barreda, Marlène 04 December 2018 (has links)
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.
23

Equipe de enfermagem: análise do clima organizacional no centro cirúrgico do Hospital Universitário Getúlio Vargas

Chaves, Jaqueline Alves 14 February 2012 (has links)
Made available in DSpace on 2015-04-22T22:11:18Z (GMT). No. of bitstreams: 1 Jaqueline_A_Chaves.pdf: 529789 bytes, checksum: eaedfe8199c705c0d7721caf47d6c597 (MD5) Previous issue date: 2012-02-14 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The quality of the organizational environment increasingly influence the behavior of employees in the institutions, thus interfering in performance, expanding the potential of people and results. The objective of this research is to understand what factors are conducive to a good organizational climate within the nursing team of the surgical center at a university hospital in view of this, we seek to have the views of nurses, technicians and nursing assistants in total of 37 professionals, about the ten dimensions considered relevant to a healthy organizational environment. The theoretical findings found on the subject were used to develop a questionnaire, self-administered, containing 60 closed questions and distributed in ten dimensions. The quantitative analyzes were developed from the SPSS software according to the rules of the instrument. In short, we intend to observe the opinion of the servers about the current situation and desired situation. The results showed that the servers are not satisfied with the dimensions of safety and working conditions, indicated that the training is limited, moreover, there is no recognition when the job is well done, however there is satisfaction concerning the salary received. According to these conditions, it is possible to understand and specify measures that allow a good organizational climate. / A qualidade do ambiente organizacional influencia cada vez mais o comportamento dos colaboradores nas Instituições, interferindo, assim, na performance, na ampliação do potencial das pessoas e nos resultados. O objetivo desta pesquisa consistiu em conhecer quais são os fatores favoráveis a um bom Clima Organizacional na equipe de enfermagem do centro cirúrgico de um hospital universitário. Em vista disso, buscou-se obter a opinião dos enfermeiros, técnicos e auxiliares de enfermagem num total de 37 profissionais, a respeito das dez dimensões consideradas relevantes a um ambiente organizacional saudável. Os achados teóricos encontrados a respeito do tema foram aplicados no desenvolvimento de um questionário, autoadministrado, contendo 60 questões fechadas e distribuídas em dez dimensões. As análises foram quantitativas, desenvolvidas a partir do software SPSS de acordo com as normas do instrumento. Em suma, pretendeu-se observar a opinião dos servidores acerca da situação vigente e situação desejada. Os resultados demonstraram que os servidores não estão satisfeitos com as dimensões: segurança e condições do trabalho, indicaram que os treinamentos são escassos, além disso, não existe reconhecimento quando o trabalho é bem feito, todavia existe satisfação em relação ao salário recebido. Desta forma, tornou-se possível compreender e indicar medidas que viabilizem um bom Clima Organizacional.
24

Rädsla, attityd, miljö och okunkskap : Faktorer som kan påverka sjuksköterskors bemötande av patienter med psykisk sjukdom / Fear, attitude, environment and ignorance : Factors that may affect nurses' response concerning patients with a mental disorder

Hedström, Sofie, Finn, Therese January 2011 (has links)
Bakgrund: Sjuksköterskor kommer ofta i kontakt med personer med psykisk sjukdom oavsett var de arbetar. Det är allmänt känt att psykisk sjukdom ökar bland befolkningen i hela världen. Den allmänna attityden i samhället gentemot personer med psykisk sjukdom är oftast negativ och att känna rädsla är vanligt. Syfte: Syftet var att belysa faktorer som påverkar den grundutbildade sjuksköterskans bemötande av patienter med psykisk sjukdom inom somatisk vård på allmänsjukhus. Metod: En allmän litteraturstudie har genomförts på ett systematiskt sätt där tio vetenskapliga artiklar sex kvalitativa och fyra kvantitativa, som granskats, värderats och analyserats. Resultat: Stigmatisering, undvikande och särbehandling vid vård av psykiskt sjuka patienter var vanligt på somatiska vårdavdelningar. Faktorerna som påverkade sjuksköterskornas bemötande var rädsla, okunskap och brister i den vårdande miljön som patienterna vistades i. Diskussion: De flesta sjuksköterskor hade en negativ attityd till patienter med psykisk sjukdom och de själva ansåg att de inte hade tillräckligt med kunskap och erfarenhet att vårda de här patienterna. Slutsats: Sjuksköterskan bör ha tillräckligt med kunskap, stöd från omgivningen och en medvetenhet om hur förförståelse och attityd kan påverka bemötandet vid vård av patienter med psykisk sjukdom. Sjuksköterskor måste också få mer psykiatriutbildning för att minska den negativa attityden och rädslan. / Background: Nurses are in daily contact with people that has a mental illness regardless of where they work. It is commonly known that mental illness is increasing among the populations throughout the world. The general attitude in our society towards people with a mental illness is often negative and with fear. Objective: The aim is to highlight factors that will affect a basic trained nurse in somatic care, and the treatment of patients with a mental disorder. Method: A general literature review is conducted in a systematic way, where ten scientific articles are requested, reviewed, evaluated and then analyzed. There are six qualitative and four quantitative reviews. Results: Stigma, discrimination, and a tendency of treating mentally ill patients differently then other patients, is found to be common in somatic wards. Factors that influence nurses’ response, in addition to a general weakness in the caring environment, are fear and ignorance. Discussion: Most nurses have a negative attitude towards patients with a mental illness. Many of these nurses also feel they lack the necessary knowledge and skill that is required to properly care for these patients. Conclusion: Nurses require sufficient knowledge through education. In addition, they also benefit greatly from the caring environments support. It has to be brought forward that an awareness regarding the nurses’ attitudes and interest in understanding a patient may affect the outcome of how one is being perceived. There is a need for more psychiatric training to battle this negative attitude and fear.
25

Custeio dos gastos no serviço público de saúde: estudo de caso no Hospital Nelson Salles / Costing spending on public health care: a case study in Nelson Hospital Salles

Warley Francisco de Araújo Pereira 11 March 2014 (has links)
A dissertação tem como objetivo aplicar um método de custeio aos gastos atribuídos, pelo Hospital Nelson Salles, na execução do serviço público de saúde, em apoio ao Município Engenheiro Paulo de Frontin. Para a realização deste trabalho, o estudo utilizou-se da pesquisa bibliográfica para fundamentar e ilustrar o tema proposto, bem como, do método exploratório descritivo para reconhecer a situação da instituição e identificar uma metodologia de controle dos custos adequada à realidade da organização estudada. A apuração de custos em organizações hospitalares justifica-se: pelo aumento na demanda de clientes; pelo crescimento dos gastos na área da saúde e pelas limitações decorrentes dos orçamentos das entidades públicas, onde as organizações necessitam adotar um sistema que forneça informações úteis referentes aos custos, em especial ao hospital, objeto de estudo, por não dispor de um sistema de custos. Um sistema de apuração de custos pode trazer aos gestores hospitalares informações relevantes ao planejamento, controle e tomada de decisão com vistas à otimizar os recursos limitados e a manutenção da qualidade no atendimento ao paciente. Neste contexto, foram apresentados os principais métodos de custeio utilizados para a implementação do sistema de gestão de custos hospitalares, que são custeio por absorção; com apropriação por centro de custos, o custeio variado e o custeio baseado em atividades (ABC).Como resultado alcançado foi aplicado o tradicional método de custeio adotado para implementar um sistema de gestão de custos hospitalar, que é o custeio por absorção, pois o hospital em estudo não apresenta controle de custos e, portanto, o sistema tradicional é o mais adequado para uma primeira avaliação dos custos; para melhor visualização dos custos executados na atividade de saúde foi aplicado o critério de rateio por departamentalização dos custos indireto. Depende de cada hospital identificar qual o método mais adequado a sua estrutura organizacional. Em relação às considerações finais, sugeriu-se a utilização da departamentalização, que proporcionará ao Hospital Nelson Salles importantes informações gerenciais. No atual contexto organizacional, identificou-se que o recomendável é o método de custeio por absorção, por ser o mais tradicional, atender a legislação fiscal e demanda menores investimentos para sua implementação. / The dissertation aims to apply a method of funding allocated to spending at Nelson Salles Hospital, in the implementation of public health services support of the Country Engineer Paulo de Frontin. For this work, the study used the literature to substantiate and illustrate the theme, as well as a descriptive exploratory method to recognize the institutions situation and identify a control methodology appropriate to the reality of the studied organization costs. The calculation of costs for hospital organizations is justified: the increase in customer demand, the growth in spending on health and the limitations arising from the budgets of public entities, where organizations need to adopt a system that provides useful information regarding costs in particular the hospital object of study due to lack system cost. A system of calculation of costs for hospital managers can bring relevant information to the planning, control and decision making in order to optimize the limited resources and the maintenance of quality in patient care. With ownership cost center, costing the varied and activity-based costing (ABC), in this context, the main costing methods used for the implementation of the management system the hospital costs, which are absorption costing were presented. As a result achieved was applied the traditional costing method adopted to implement a management system for hospital cost, which is the absorption costing, because the study hospital has no cost control and therefore, the traditional system is the most suitable for a first assessment of the costs, for better visualization of the costs carried on the activity of the health assessment criteria for departmentalization of indirect costs was applied. It depends on each hospital to identify the most appropriate method to its organizational structure. Regarding the final considerations it was suggested that the use of departmentalization, which will give the Nelson SallesHospital important management information. In the current organizational context, it was identified that the recommended method is the absorption costing, to be the most traditional, meet the tax laws and lower investment demand for its implementation.
26

Custeio dos gastos no serviço público de saúde: estudo de caso no Hospital Nelson Salles / Costing spending on public health care: a case study in Nelson Hospital Salles

Warley Francisco de Araújo Pereira 11 March 2014 (has links)
A dissertação tem como objetivo aplicar um método de custeio aos gastos atribuídos, pelo Hospital Nelson Salles, na execução do serviço público de saúde, em apoio ao Município Engenheiro Paulo de Frontin. Para a realização deste trabalho, o estudo utilizou-se da pesquisa bibliográfica para fundamentar e ilustrar o tema proposto, bem como, do método exploratório descritivo para reconhecer a situação da instituição e identificar uma metodologia de controle dos custos adequada à realidade da organização estudada. A apuração de custos em organizações hospitalares justifica-se: pelo aumento na demanda de clientes; pelo crescimento dos gastos na área da saúde e pelas limitações decorrentes dos orçamentos das entidades públicas, onde as organizações necessitam adotar um sistema que forneça informações úteis referentes aos custos, em especial ao hospital, objeto de estudo, por não dispor de um sistema de custos. Um sistema de apuração de custos pode trazer aos gestores hospitalares informações relevantes ao planejamento, controle e tomada de decisão com vistas à otimizar os recursos limitados e a manutenção da qualidade no atendimento ao paciente. Neste contexto, foram apresentados os principais métodos de custeio utilizados para a implementação do sistema de gestão de custos hospitalares, que são custeio por absorção; com apropriação por centro de custos, o custeio variado e o custeio baseado em atividades (ABC).Como resultado alcançado foi aplicado o tradicional método de custeio adotado para implementar um sistema de gestão de custos hospitalar, que é o custeio por absorção, pois o hospital em estudo não apresenta controle de custos e, portanto, o sistema tradicional é o mais adequado para uma primeira avaliação dos custos; para melhor visualização dos custos executados na atividade de saúde foi aplicado o critério de rateio por departamentalização dos custos indireto. Depende de cada hospital identificar qual o método mais adequado a sua estrutura organizacional. Em relação às considerações finais, sugeriu-se a utilização da departamentalização, que proporcionará ao Hospital Nelson Salles importantes informações gerenciais. No atual contexto organizacional, identificou-se que o recomendável é o método de custeio por absorção, por ser o mais tradicional, atender a legislação fiscal e demanda menores investimentos para sua implementação. / The dissertation aims to apply a method of funding allocated to spending at Nelson Salles Hospital, in the implementation of public health services support of the Country Engineer Paulo de Frontin. For this work, the study used the literature to substantiate and illustrate the theme, as well as a descriptive exploratory method to recognize the institutions situation and identify a control methodology appropriate to the reality of the studied organization costs. The calculation of costs for hospital organizations is justified: the increase in customer demand, the growth in spending on health and the limitations arising from the budgets of public entities, where organizations need to adopt a system that provides useful information regarding costs in particular the hospital object of study due to lack system cost. A system of calculation of costs for hospital managers can bring relevant information to the planning, control and decision making in order to optimize the limited resources and the maintenance of quality in patient care. With ownership cost center, costing the varied and activity-based costing (ABC), in this context, the main costing methods used for the implementation of the management system the hospital costs, which are absorption costing were presented. As a result achieved was applied the traditional costing method adopted to implement a management system for hospital cost, which is the absorption costing, because the study hospital has no cost control and therefore, the traditional system is the most suitable for a first assessment of the costs, for better visualization of the costs carried on the activity of the health assessment criteria for departmentalization of indirect costs was applied. It depends on each hospital to identify the most appropriate method to its organizational structure. Regarding the final considerations it was suggested that the use of departmentalization, which will give the Nelson SallesHospital important management information. In the current organizational context, it was identified that the recommended method is the absorption costing, to be the most traditional, meet the tax laws and lower investment demand for its implementation.
27

Valores organizacionais e bem-estar no trabalho: um estudo de caso em um hospital público de ensino / Organizational values and the well being at work: a study at a teaching public hospital

Rissi, Liane Terezinha Braga 24 June 2014 (has links)
The aim of this study was to identify the relation between organizational values and well being at work according to the employees‟ perception of a public health institution. It was a quantitative research approach, descriptive character, held in a Public Teaching Hospital of Federal University. The measure instruments used were: The inventory of Organizational Value Profiles IPVO from Oliveira and Tamayo (2004) and the Scale of Personal Well Being Perception in Organizations- EPBO from Dessen and Paz (2010). The personal variables analyzed were: age, sex, schooling, marital status, and the ones related to occupation: time worded in the institution, the position held, class, actual sector, the time worked in this sector and work shift. With the aim of presenting the institution contributions, an action plan to improve the employees‟ satisfaction and organizational commitment is proposed to the management. The data were analyzed in a quantitative way by the use of software SPSS, version 18.0. To analyze the data, the descriptive statistics, factor analyses, Cronbach‟s alpha, measure, test t, ANOVA and Pearson‟s correlation were analyzed.. Theoretical references in values used were: Human Value Theory from Schwartz (1992, 2005) and Tamayo and his collaborators studies (1996, 2000, 2005, 2006. In relation to well being at work, concepts developed by Paschoal (2008); Paz (2004) and Dessen and Paz (2010) were used, which express both approaches of general well being, the subjective well being and psychological well being, because in this concept, the affective aspects (emotions and humor) as well as cognitive aspects (fulfillment) are considered. This research will be applied to technical-administrative staff on education, who work at UFSM, specifically at a Public Hospital in a Federal University, pursuing the maximum number of returns. However, the minimum sample has been calculated. The research presents major results as a strong identification with the institution of the servers and the important role of leadership in the context of health production. The low scores assigned to some variables of well-being, characterized the importance of the hedonic dimension of well-being in the perception of the servers, thus demonstrating that congruence between personal and organizational values can generate greater welfare organization. / O presente estudo têm como objetivo geral estabelecer a relação entre valores organizacionais e o bem-estar no trabalho segundo a percepção dos servidores de uma instituição pública de saúde. Trata-se de uma pesquisa de abordagem quantitativa, de caráter descritivo, realizada em um Hospital Público de Ensino de uma Universidade Federal, com todos os Servidores Técnico-Administrativos em educação, ativos, lotados e em exercício no hospital, buscando-se obter o número máximo de retornos. No entanto, foi calculado para o estudo o tamanho da amostra mínima. Os instrumentos de medida utilizados foram: O Inventário de Perfis de Valores Organizacionais IPVO de Oliveira e Tamayo (2004) e a Escala de Percepção do Bem-Estar Pessoal nas Organizações EPBO de Dessen e Paz (2010). As variáveis pessoais analisadas foram: idade, sexo, escolaridade, estado civil, e as profissionais: tempo na instituição, cargo ocupado, classe, setor atual de trabalho e o tempo que trabalha no setor e turno de trabalho. A fim de apresentar contribuições à instituição para melhorar a compreensão do bem-estar dos trabalhadores em função dos valores organizacionais e, assim, propor à gestão de pessoas sugestões para elaboração de plano de ação que resulte no aumento da satisfação dos servidores e no comprometimento organizacional. O dados foram analisados quantitativamente por meio da utilização do software SPSS versão18.0. Para fins de análise foram utilizadas estatística descritiva, análise fatorial, alpha de Cronbach, médias, teste t, ANOVA e correlação de Pearson, sendo o estudo de caso a estratégia de pesquisa escolhida. Como referências teóricas em valores foram utilizadas a Teoria de Valores Humanos de Schwartz (1992, 2005) e os estudos de Tamayo e seus colaboradores (1996, 2000, 2005, 2006). Em relação ao bem-estar no trabalho foram utilizados os conceitos desenvolvidos por Paschoal (2008); Paz (2004) e Dessen e Paz (2010) que expressam as duas correntes do bem-estar geral: a do bem estar subjetivo e a do bem-estar psicológico, pois, nesta conceituação são visíveis tanto os aspectos afetivos (emoções e humores) quanto os aspectos cognitivos (realização). A pesquisa apresentou como principais resultados a forte identificação dos servidores com a instituição e a importância do papel da chefia no contexto da produção em saúde. As baixas médias atribuídas à algumas varáveis do bem-estar, caracterizou a importância da dimensão hedônica do bem-estar na percepção dos servidores, demonstrando assim que a congruência entre os valores pessoais e organizacionais poderá gerar um maior bem-estar organizacional.
28

Le statut des médecins libéraux dans les hôpitaux publics / The status of the private doctors in the public hospitals

Salameh, Joseph 02 December 2013 (has links)
De longue date, l’hôpital public a voulu faire fonctionner un service public autonome avec ses propres moyens et ses personnels.Cependant, il s’est trouvé dans l’obligation d’ouvrir ses portes à des opérateurs privés (l’intervention des médecins libéraux l’illustre) pour répondre à ses besoins de fonctionnement et d’organisation, dont les voies ont été ouvertes par la dernière loi hospitalière. Ainsi, la loi HPST a créé des dispositifs contractuels via notamment le « contrat d’exercice libéral » et le contrat de « clinicien hospitalier » pour que l’hôpital public propose des conditions statutaires plus attractives à l’attention de ces nouveaux opérateurs.Ce besoin nouveau qui s’impose, sans être véritablement souhaité, entraîne le recours à des solutions juridiques trop diversifiées.De ce fait, une cohabitation et un foisonnement de statuts s’est créé au sein de l’hôpital public. Cette situation apporte une vraie contradiction de règles statutaires, un véritable fatras qui met à mal sa cohérence.Un rapprochement des statuts des praticiens hospitaliers et des praticiens libéraux paraît inévitable pour clarifier et donner une lisibilité à l’hôpital public avec le souci unique d’apporter des soins de qualité aux usagers du service public. / The public hospital has long been willing to operate an independent public service with its own means and own staff.However, it was forced to open its doors to some private operators (the intervention of private doctors illustrates it) to satisfy its needs for operating and organization, the path of which has been opened by the last Hopsital Act. Thus, the HPST Law has created some contractual arrangements mainly with the “private practice contract”and the contract of “hospital clinical practitioner” in order that the public hospital offers more attractive statutory conditions to these new operators.This new major need, not being really desired, requires legal solutions which are too diverse.Consecuently, a coexistence and a lot of statuses have emerged within the public hospital. This situation causes a real contradiction of the statutory rules, a real hackneyed nonsense which undermines its consistency.An harmonization of the hospital and private practitioners statuses seems to be inevitable in order to clarify and make the public hospital more transparent with the sole concern to improve the quality of the health care provided to the public service users.
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Permanences, mutations et renouveau du service public hospitalier / Permanencies, mutations and revival of hospital public utilities

Romanens, Jean-Louis 02 June 2014 (has links)
Le corpus législatif initié le 21 juillet 2009 par la loi portant réforme de l’hôpital et relative aux patients, à la santé et aux territoires, a posé un nouveau paradigme juridique de service public hospitalier. Aussi avons-nous interrogé ce concept, ses servitudes, sa permanence mais aussi ses mutations et apparent renouveau. Le concept de service public hospitalier, sans doute le premier service public de notre histoire, est issu d’une lente maturation. Celle de la règle-précepte « Servir l’Autre », apparue canoniquement dès le Concile d’Orléans de 511. Depuis mille cinq cents ans, il a souvent muté mais a conservé ce contenu mental, sur lequel s’est greffée l’expérimentation hospitalière. Deux nouvelles mutations se sont développées dans la dernière décennie. Dans une rupture juridique formelle qui distingue mission de service public ouverte à tout acteur de santé, et garanties de service public d’égalité, permanence, mutabilité, le service public d’origine hospitalière s’est construit une euro-compatibilité. En retour, essentiellement porté par l’hôpital français et ses neuf millions d’hospitalisations par an, il a modelé le concept de service d’intérêt économique général de l’Union européenne. Par une autre mutation de sa gestion autonome, il a trouvé l’éthique d’une nouvelle synergie entre qualité médicale systémique, et management économique fondé sur l’activité. Cependant, pèsent sur son avenir d’autres impératifs. D’une part, les coopérations entre établissements nécessitent leur élévation au rang de missions de service public. Et une gestion des représentants des usagers et des différents personnels hospitaliers doit être intégrée au management. D’autre part, les lourds enjeux actuels de santé publique aggravant les déficits sociaux, paralysés par le corporatisme, exigent rapidement des prises en charge personnalisées en parcours de santé des affections chroniques, de la dépendance et des populations en fracture sanitaire. L’essor d’une mission de service public de santé de territoire, ouverte à tout acteur de santé, dont nous proposons la législation, permettrait de mieux contribuer à la coordination inter professionnelle et à la pertinence du système de santé. En prolongement, nous proposons des modalités législatives et organisationnelles de création d’entités spécifiques par les établissements de santé, dans des territoires d’exception convenus avec l’Agence régionale de santé. Il s’agirait de pôles hospitaliers interprofessionnels de santé de médecine ambulatoire de prévention, éducation thérapeutique, soins organiques, de santé mentale, de suivi de rééducation-réadaptation et médico-social. Ces PHIS, centres de santé inclus dans des pôles de santé, permettraient aux établissements de rétablir des accessibilités populationnelles adaptées à chaque problématique territoriale, d’améliorer la relation ville-hôpital, et un enseignement-recherche valorisant la médecine générale. Dans sa société et pour le citoyen, le service public hospitalier se doit de rester l’expérience de l’avenir. / Permanencies, mutations and revival of hospital public utilities : The legislative corpus initiated on July, 21st, 2009, by the law reforming the hospital and relative to the patients, health and territories, put a new legal paradigm concerning the hospital public utilities. So we have questioned this concept, its constraints, its permanencies but also mutations and apparent revival. The concept of a public hospital service, may be the first public service created in our history, emerged from a slow maturation, based on that rule: ''serve the other one'', canonically appeared during the Orleans Council, 511. Since one thousand and five hundred years, it has often mutate but has kept this mental content, on which transplanted the hospital experiment. Two new mutations were developed during the last decade. In a formal legal break-off, distinguishing public services missions opened to any health actor, and the public utilities' guaranties of equality, continuity, mutability, the public utilities originating from hospital, leaving its organicity, built for itself a euro-compatibility. In return, mainly supported by the French hospital and its nine million hospitalizations a year, it shaped the concept of general economic interest service of the European Union. Through another mutation of its autonomous management, it has found the ethic of a new synergy between systemic medical quality and economic management grounded on activeness. However, it weighs on its future, other imperatives. On one hand, the cooperations between establishments require their elevation into a public utilities mission rank. And a management of the user's representatives and the various hospital staff must be integrated to the strategy. On the other hand, the heavy current stakes in public health, worsening the social deficits, paralyzed by the corporatism and sanitary powerlessness, would quickly require a personalized coverage in health routes of chronic diseases, and of populations in social dislocation. The rise of a territory health public utilities mission opened to any health actor whose legislation we propose, would contribute to the inter-professional coordination and the relevance of the health system. In continuation, we propose legislative and organizational modalities of creation of specific entities by the health establishments, in territories of exception agreed with the Regional Health Agency (Agence Régionale de Santé). It would be a matter of Inter professional hospital poles of health (PHIS) on ambulatory medicine of prevention, therapeutic education, organic care, mental care, reeducation and rehabilitation follow-up. Health centers included into health poles, they would allow restoring population accessibilities adapted to each territory, bettering the town-hospital relationship, and a research-teaching valuing the general medicine. In its society and for the citizen, the public hospital utilities have to stay the experiment of future.
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Évolutions de l’hôpital public français : une approche interprétative par la culture organisationnelle : le cas de deux centres hospitaliers universitaires / French public hospital evolutions : an interpretative analysis based on the organizational culture : the case study of two university hospitals

Olivaux, Marc 24 November 2016 (has links)
Les hôpitaux publics français subissent, au gré des alternances politiques, de très nombreux changements qui interrogent aujourd’hui tant les procédés de gestion que les reconfigurations structurelles nécessaires pour faire face aux défis que leur lancent les restrictions budgétaires successives, le vieillissement de la population ou l’apparition de nouvelles pathologies. Cette recherche vise, sur la base d’un cadrage conceptuel analysant les réformes du secteur sanitaire à l’aune du paradigme de l’action publique qu’est le « new public management » d’une part, et d’une seconde analyse relative à la métamorphose des hôpitaux que l’on peut qualifier de bureaucraties professionnelles pluralistes en évolution d’autre part, à proposer une lecture de ces institutions par le prisme culturel dans une démarche exploratoire aux fondements ethnographiques et interprétativistes. Une étude de cas multiples enchâssée portant sur deux centres hospitaliers universitaires a donc été menée. S’appuyant sur 47 entretiens analysés dans une démarche inductive et triangulés avec les résultats d’une observation flottante et de nombreuses données secondaires, elle offre une analyse transversale et comparée des structures étudiées au regard d’un modèle narratif de présentation des résultats reconstruit pour une meilleure compréhension des déterminants hiérarchiques, prospectifs, interactionnistes, sociaux et stratégiques qui caractérisent les cultures des institutions étudiées. Les résultats permettent de faire émerger, au regard d’une discussion basée sur l’application de divers cadres conceptuels, de nombreuses implications managériales applicables au contexte actuel des deux structures étudiées / French public hospitals are currently affected by many changes due to political alternation. These changes raise questions on management processes and structural reconfigurations required by the new challenges they’re facing such as budgets cuts, the aging of the population and the increase of chronical pathologies. This research aims, on one hand to analyze the reforms of the health sector according to the « new public management » paradigm based on a conceptual approach, and secondly to analyze the gradual metamorphosis of hospitals (or evolving pluralistic professional bureaucracies) and finally, to propose a reading of these institutions by the cultural prism following an exploratory methodology based on an ethnographic and interpretivist approach. As a result, multiple case studies were conducted in two hospitals. Based on 47 semi-directive interviews which were analyzed with an inductive approach and then triangulated with the results of a floating observation and additional secondary data, it provides a transversal and compared analysis of the studied structures. Presented by a narrative model therefore rebuilt, these results aims to understand the hierarchical, prospective, interactionist, social and strategic cultures criteria that describes the studied institutions and organizations. A discussion of the results based on the application of various conceptual frameworks, allows to highlight numerous managerial implications applicable to both studied structures

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