Du fait des progrès scientifiques modernes dans le domaine médical, ont été soulevés de nombreux problèmes concernant la responsabilité du service public hospitalier à cause de l'utilisation des méthodes scientifiques modernes en médecine. Le juge administratif français a été et est le moteur de l'évolution des règles en matière de responsabilité du service public hospitalier. Ce n'est pas le cas de la juridiction administrative au Liban. Mais plusieurs réformes législatives ont été adoptées au Liban depuis 1996. La thèse permet de confronter les solutions du droit positif français et du droit positif libanais et de rechercher les raisons d'une responsabilité médicale rarement mise en œuvre au Liban alors que les principes juridiques posés sont proches du système français. / Because of modern scientific progress in medical field, many problems, concerning the hospital public service liability, have been established as a consequence of the use of modern scientific methods in medicine. The French administrative judge has been and is a central point of rules evolutions in the field of hospital public service liability. This is not the situation of administrative jurisdiction in Lebanon. But several legislative reforms have been enacted in Lebanon since 1996. This research permit to discuss solutions of positive French and Lebanese laws, and to know why medical liability, in Lebanon, is rarely in service. Although Lebanon has the same rules and principles of France.

A presente pesquisa tem como objetivo realizar uma analise institucional do discurso produzido em grupo por profissionais da equipe de enfermagem da Clinica Pediatrica de um hospital escola da rede publica de saude da cidade de Sao Paulo. Nossa analise foca a relacao que este profissional estabelece com o trabalho a partir do referencial metodologico conceitual da Analise Institucional do Discurso desenvolvido por Guirado (2010). Como produto desse estudo demonstramos que a relacao construida pelas profissionais no e com o trabalho e entretecida por procedimentos, sejam eles de ordem predominantemente administrativo-gerencial no caso das enfermeiras, ou da ordem do cuidado-curativo predominantemente encontrado no fazer das tecnicas e auxiliares de enfermagem. Esse entrelacamento entre procedimento e relacao acarreta indistincao entre ser e fazer no modo como as profissionais se constituem subjetivamente, abrindo, assim, caminho a producao de forte identificacao com o papel de mae, a indiferenciacao na relacao com o paciente e a dificuldade na constituicao de contornos que oferecam limites a sua pratica e a seus sentimentos. Nesse sentido, a morte se constitui como unico limite inexoravel e produz desestruturacao e reorganizacao de si e da relacao com o trabalho, mas tambem pode produzir trauma, paralisia, repeticao e panico. A mae e compreendida como o lugar-referencia por excelencia para a crianca. Quando boa e base para a vida, saude e felicidade do filho. Quando ruim ou ausente e a causa do desalinho, fragilidade, doenca e morte da crianca. As maes sao ao mesmo tempo agentes institucionais e clientela, o trabalho da enfermagem preve o da mae. A carga de trabalho da enfermagem e aliviada quando a mae e boa, e aumenta quando a mae e ma. A crianca aparece como objeto-alvo da acao da enfermagem e como sujeito-produto de sua mae. O jogo de poder/resistencia na relacao com os medicos ocorre em meio a uma polarizacao entre fazer viver e deixar morrer, na qual a resistencia implica assumir o lugar do medico, tomar conduta e fazer viver. Com os profissionais do ambito da justica esse jogo ocorre em torno da sentenca sobre o futuro da crianca, contudo, apartadas de todo o processo as profissionais resistem julgando o julgamento. Ironia, deslegitimacao, denuncia e alarde, falta de comprometimento, esgarcamento de limites e fronteiras sao as principais estrategias de resistencia das quais fazem uso. De outro lado, como manutencao do funcionamento institucional temos a rigida estrutura hierarquica, processos juridicos e administrativos, punicao e conversa, o apaziguamento, cujo papel o grupo aqui analisado cumpriu. Por fim, por meio desta pesquisa configuramos como objeto institucional da enfermagem a manutencao e controle de todos os movimentos e alteracoes do e no paciente, quer sejam motores ou fisiologicos, por meio de tecnologias de monitoramento e vigilancia, gratificacoes e punicoes / The main goal of this research is to make an institutional analysis of the discourse of a group. For this assignment a Sao Paulo\'s public teaching hospital was chosen. The focus of our analysis is the relationship the professional has with his work, using the Institutional Analysis of Discourse, developed by Guirado (2010), as a conceptual and methodological reference. This research will demonstrate that the professionals\' relationship with their work is tangled up by procedures, majorly composed by administrative and caring procedures (for nurses and auxiliary nurses, respectively). The blending of procedures and relationship disguises the differences between being and doing, leading in turn to the nurses identification with the mother\'s role, to the indiscriminateness of their relationship with the patients, and to an increased difficulty when defining the limits for their practice and their feelings. In that case, death is for them the only inexorable limit, one that promotes the disruption and reorganization of themselves and their relationship with the work. Death is also able to promote trauma, paralysis, repetition, and panic. The mother is seen, by the child, as a true and only haven. If the mother is good, she is considered the foundations for life, health and happiness of the child. When she is bad or absent, this is considered the reason for the child\'s untidiness, fragility, illness and death. The mothers are, simultaneously, institutional agents and clientele, since the nursing work presupposes the work of the mother. The amount of work attributed to that staff is lessened in the presence of a good mother and enlarged when dealing with a bad mother. The child appears as object and target of the nurses\' action and as subject and product of your mother. The dispute for power (and its resistance) in the contacts with the doctors occurs through the polarization between making the child to live or leaving the child to die, in which the resistance implies taking over the doctors job, take conduct and making the child to live. With the professionals in the domain of Justice, these games of power/resistance occur concerning the sentence about the child\'s future. Nevertheless, nurse professionals, kept away from the process, resist by judging the judgment. Irony, disqualifying, indictment and boasting, lack of commitment, and the blurring of limits and boundaries are the primary resistance strategies which they employ. On the other hand, acting as institutional functioning support maintenance we have a rigid hierarchic structure, juridical and management proceedings, punishment and discussion, and pacification (whose role was fulfilled by the group here studied). At last, the maintenance and control of all patient\'s alterations and movements (physical or physiological) was configured as the institutional object for the nursing work. This was achieved by means of monitoring and surveillance technologies, rewards and punishments

Submitted by Joana Azevedo (joanad@id.uff.br) on 2017-07-03T13:19:51Z No. of bitstreams: 1 Dissert Diego Carlos Farias.pdf: 1218138 bytes, checksum: 18e2ebc92bec79a4a4425ad12f50a8da (MD5) / Rejected by Biblioteca da Escola de Engenharia (bee@ndc.uff.br), reason: Item rejeitado, pois a ficha catalográfica está fora do padrão. Atenciosamente, Catarina Ribeiro Bibliotecária BEE - Ramal 5992/5993/5994 on 2017-07-04T16:02:19Z (GMT) / Submitted by Joana Azevedo (joanad@id.uff.br) on 2017-07-25T19:03:22Z No. of bitstreams: 1 Dissert Diego Carlos Farias.pdf: 1214965 bytes, checksum: 68e92d70d6abc1d14fa500812bf136d5 (MD5) / Rejected by Biblioteca da Escola de Engenharia (bee@ndc.uff.br), reason: Olá, Joana! Favor verificar a formatação da ficha catalográfica. Att, Catarina on 2017-07-28T15:23:36Z (GMT) / Submitted by Joana Azevedo (joanad@id.uff.br) on 2017-07-28T19:49:56Z No. of bitstreams: 1 Dissert Diego Carlos Farias.pdf: 1215785 bytes, checksum: 467b30ba7c93d1a2974329c5606468f5 (MD5) / Approved for entry into archive by Biblioteca da Escola de Engenharia (bee@ndc.uff.br) on 2017-08-03T12:50:52Z (GMT) No. of bitstreams: 1 Dissert Diego Carlos Farias.pdf: 1215785 bytes, checksum: 467b30ba7c93d1a2974329c5606468f5 (MD5) / Made available in DSpace on 2017-08-03T12:50:52Z (GMT). No. of bitstreams: 1 Dissert Diego Carlos Farias.pdf: 1215785 bytes, checksum: 467b30ba7c93d1a2974329c5606468f5 (MD5) / A complexidade da gestão hospitalar, em conjunto com um cenário de escasez de recursos financeiros, compromete as atividades desempenhadas em hospitais públicos universitários. O presente estudo tem o objetivo de analisar as práticas de gestão hospitalar no Hospital Universitário Antonio Pedro (HUAP), no sentido de identificar oportunidades de aprimoramento em seus processos administrativos, bem como os fatores críticos responsáveis, refletindo sobre a maneira como tais fatores estão inter-relacionados. Sob a perspectiva metodológica, o estudo apoia-se em uma vertente teórica, baseada na coleta de dados secundários através do levantamento bibliométrico do acervo técnico-científico referente à gestão hospitalar, relevantes para subsidiar a pesquisa empírica proposta para ser realizada junto a atores-chave do HUAP. Já em termos empíricos foram realizadas entrevistas semiestruturadas com as lideranças funcionais tanto administrativas, quanto de assistência. Os resultados obtidos evidenciam lacunas nas interfaces de trabalho, sobretudo na relação entre as equipes médica e a administrativa, o que impacta sobre o faturamento da organização. Além disso, observaram-se hiatos na definição de processos, o que compromete algumas atividades, tanto na esfera assistencial quanto administrativa, gerando conflitos entre profissionais e impactando no atendimento aos pacientes. Uma vez evidenciados os fatores críticos, elaborou-se um mapa conceitual, que apresenta o processo gerencial do HUAP como um sistema composto pelos referidos fatores, bem como a forma como estão conectados, facilitando a observação das relações de causalidade entre estes. / The complexity of hospital management, together with a scenario of scarcity of financial resources, compromises the activities performed in public university hospitals. This study aims to analyze the hospital management practices at the Hospital Universitário Antonio Pedro (HUAP), to identify opportunities for improvement in their administrative processes, as well as those responsible for critical factors, reflecting on how these factors are interrelated. Under the methodological perspective, the study relies on a theoretical, based on secondary data collection through the bibliometric survey of technical and scientific evidence related to hospital management, relevant to support the empirical proposed research to be conducted with key players of HUAP. In the empirical study were carried out semi-structured interviews with the managers of the institution. The results show flaws in the work interfaces, especially in the relationship between medical staff and administrative, which has a direct impact on revenues of the organization. In addition, there were shortcomings in the definition of processes, which undertakes some activities, both in care as administrative, generating differences between professionals and impacting on patient care. Once the critical factors were evidenced, a conceptual map was elaborated, presenting the HUAP management process as a system composed of these factors, as well as the way in which they are connected, facilitating the observation of the causal relationships between them.

Depuis les années 1990, le Nouveau Management Public a transformé l’hôpital public, on parle d’un tournant gestionnaire. L’apparition des pôles d’activité médicale en 2005, consiste en une nouvelle gouvernance hospitalière. Nous avons cherché comprendre comment les pôles d’activité médicale font-ils évoluer les processus de décisions ? Nous avons choisi de mobiliser le concept de configuration structurelle (Mintzberg, 1982) et la théorie de l’anarchie organisée (Cohen, March et Olsen, 1972). La question est désormais de savoir si le changement de configuration structurelle va accroître ou réduire l’anarchie organisée ? Pour y répondre nous avons réalisé deux phases de récolte de données dans un CHU : l’analyse de la gestion quotidienne de trois pôles et de deux projets de pôle. Notre étude de cas a permis de mettre en évidence que l’hôpital n’est pas devenu une structure divisionnalisée mais qu’il est en transition, dans une configuration structurelle hybride. Les pôles ont eu tendance à augmenter l’anarchie organisée et le slack organisationnel pour l’heure. Notamment à cause de l’influence du contexte économique, l’absence de contrats de pôle, le problème de formation des agents et une opposition constante entre gestionnaires et médicaux. Les pôles se présentent comme de nouvelles unités qui ont rendu plus complexe l’organisation interne. Cependant, l’arrivée des pôles s’est accompagnée d’une redistribution des rôles, de nouveaux outils de gestion et de nouveaux processus de gestion. Ainsi, le changement de configuration structurelle a impacté le processus de décision de l’hôpital, en modifiant les pratiques et les cadres de ces processus de décision. / Since the 1990s, the New Public Management has transformed the public hospital, we talk about a turning management. The emergence of medical activity centers in 2005, consists of a new hospital governance. We sought to understand how the poles of medical activity are changing decision-making processes? We have chosen to mobilize the concept of structural configuration (Mintzberg, 1982) and the theory of organized anarchy (Cohen, March and Olsen, 1972). The question now is whether the change in structural configuration will increase or reduce organized anarchy? To answer this question, we conducted two data collection phases in a CHU: the analysis of the daily management of three clusters and two cluster projects. Our case study revealed that the hospital has not become a divisionalized structure but is in transition, in a hybrid structural configuration. The poles tended to increase organized anarchy and organizational slack for the time being. Notably because of the influence of the economic context, the absence of pole contracts, the problem of training agents and a constant opposition between managers and medical staff. The poles are new units that have made the internal organization more complex. However, the arrival of the clusters has been accompanied by a redistribution of roles, new management tools and new management processes. Thus, the change in structural configuration has impacted the hospital's decision-making process by changing the practices and frameworks of these decision-making processes.

隨著科技的發展，帶動全球化潮流，「病人無國界」的趨勢也因而形成。醫療資訊普及流通，民眾可以在此基礎上，尋求最能滿足自我需求的醫療服務，於是出現了跨越國界的醫療型態。相較於歐美國家高昂的醫療費用與冗長的就醫等候時間，亞洲國家擁有健全之醫療服務與品質，且能享有較低廉之醫療費用，促使著歐美國家民眾紛紛前往亞洲國家就醫。其次，隨著M型化社會型態在各國發酵，經濟能力較高者，對於跨國尋求高品質、高技術醫療服務的需求就越多，加上科技發達，人類平均壽命逐漸延長，形成高齡化的社會，帶來了全球醫藥保健與健康照護產業龐大之商機。國際醫療因而成為近年來炙手可熱之新興產業，帶動龐大經濟產值，進而促使許多國家開始重視此面向，紛紛開始推動各項政策，爭取發展國際醫療之契機。台灣正式推動國際醫療發展計畫至今已經九年多，國內許多公、私立醫療院所都加入此推動行列，但成效如何，以及公私立醫院在推行國際醫療上，所建立的經營模式是否相同等，都是本研究的重點。 本研究以個案分析法，運用Mark W. Johnson, Clayton M. Christensen, 及Henning Kagermann的商業模式再創新之四大構面「顧客價值主張」、「利潤公式」、「關鍵資源」、「關鍵流程」，探討公、私立醫院發展國際醫療服務之經營模式，並分析公、私立醫院經營國際醫療的差異處、不足之處以及彼此可學習之處，藉此提供兩者未來操作國際醫療策略之建議。 研究發現，私立醫院在建構國際醫療商業模式上相對公立醫院來的完整，主要原因為，公立醫院仍受限於傳統體制約束，無法建立符合國際醫療之流程，但公立醫院因為歷史悠久，因此有品牌優勢，只是此優勢很可能會隨著競爭對手的強力曝光而慢慢消失。相反的，私立醫院在操作國際醫療上較有彈性，但仍必須積極推廣自有品牌，以強化自身競爭優勢。 / With the rise of globalization, the advancement of technology and breakthrough in healthcare, people nowadays seek the best medical care in all parts of the world. People could search and choose to get the healthcare they hope to receive without borders. In western countries where medical care is expensive and inefficient, more and more people from these nations are flocking to Asian countries like Taiwan to receive a more complete and cost-efficient health care. On the other hand, upper class people in an M society could have the privilege to seek the best medical care in countries where healthcare is more advanced. Therefore, International healthcare service has been one of the most important strategies for hospitals in countries like Taiwan. Most private and public organizations in the medical field have put their efforts to integrate the most reliable sources to join this trend. The purpose of this study is to explore how public and private hospitals in Taiwan set up their business models in regards to international healthcare, and verify if their business models are feasible. This study implemented case study methods and applied “customer value proposition”, “profit formula”, ”key resources”, and “key processes ”, four dimensions of successful business model proposed by Mark W. Johnson, Clayton M. Christensen and Henning Kagermann to discuss the different factors for public hospital and private hospital in international healthcare. This study expects to discover the key successful factors and provide suggestions to each of them. The results of this study show that public hospitals regarded as non-profit organizations are less flexible because of the limitation on traditional regulations, thus it is difficult to set up a more complete and internationalized business model. On the other hand, private hospitals are more flexible. In order to strengthen their competitive advantage, these private organizations must promote their own brand actively to achieve a competitive advantage in this globalized trend.

L'introduction de la tarification à l'activité couplée à la réorganisation en pôles d'activités, orientent l'hôpital public français vers de nouvelles logiques financières. L'obligation de moyen fait place à une obligation d'activité, les ressources de l'institution hospitalière sont désormais directement dépendantes du niveau de l'activité produite. Aussi, la mise en œuvre d'un contrôle par les résultats financiers émerge dans une organisation déjà dominée par un contrôle professionnel. L'objet de cette étude est d'étudier les effets du contrôle par les résultats financiers, plus précisément les pressions financières internes dans l'hôpital public français. Basé sur une recherche exploratoire auprès de 31 praticiens hospitaliers dans 2 CHU et sur une étude confirmatoire auprès de 578 praticiens hospitaliers répartis dans 14 CHU, ce travail révèle l'existence de pressions financières internes. Par ailleurs, il met en lumière les conséquences concernant les conflits de rôle, l'ambiguïté de rôle, l'implication des médecins et la manipulation de données en fonction de la nature et de la source des pressions financières internes. / The introduction of activity based pricing in combination with hospitals' reorganizations have recently created a new financial logic in French public hospitals. The organization has an obligation to produce certain levels of activity, since hospitals' resources are directly dependent on the activity level. These changes also imply the implementation of financial results controls in these organizations, which are traditionally dominated by professional control. The purpose of this study is to investigate the effects of financial results control in French public hospitals. The study comprises an exploratory study among 31 physicians in 2 public hospitals, and a confirmatory survey study among 578 doctors in 14 public hospitals. It documents the existence, origins and effects of internal financial pressures as a consequence of the said developments. The study documents how role conflict, role ambiguity, physicians' commitment and data manipulation depend on the nature and source of such internal financial pressures.

A presente pesquisa tem como objetivo realizar uma analise institucional do discurso produzido em grupo por profissionais da equipe de enfermagem da Clinica Pediatrica de um hospital escola da rede publica de saude da cidade de Sao Paulo. Nossa analise foca a relacao que este profissional estabelece com o trabalho a partir do referencial metodologico conceitual da Analise Institucional do Discurso desenvolvido por Guirado (2010). Como produto desse estudo demonstramos que a relacao construida pelas profissionais no e com o trabalho e entretecida por procedimentos, sejam eles de ordem predominantemente administrativo-gerencial no caso das enfermeiras, ou da ordem do cuidado-curativo predominantemente encontrado no fazer das tecnicas e auxiliares de enfermagem. Esse entrelacamento entre procedimento e relacao acarreta indistincao entre ser e fazer no modo como as profissionais se constituem subjetivamente, abrindo, assim, caminho a producao de forte identificacao com o papel de mae, a indiferenciacao na relacao com o paciente e a dificuldade na constituicao de contornos que oferecam limites a sua pratica e a seus sentimentos. Nesse sentido, a morte se constitui como unico limite inexoravel e produz desestruturacao e reorganizacao de si e da relacao com o trabalho, mas tambem pode produzir trauma, paralisia, repeticao e panico. A mae e compreendida como o lugar-referencia por excelencia para a crianca. Quando boa e base para a vida, saude e felicidade do filho. Quando ruim ou ausente e a causa do desalinho, fragilidade, doenca e morte da crianca. As maes sao ao mesmo tempo agentes institucionais e clientela, o trabalho da enfermagem preve o da mae. A carga de trabalho da enfermagem e aliviada quando a mae e boa, e aumenta quando a mae e ma. A crianca aparece como objeto-alvo da acao da enfermagem e como sujeito-produto de sua mae. O jogo de poder/resistencia na relacao com os medicos ocorre em meio a uma polarizacao entre fazer viver e deixar morrer, na qual a resistencia implica assumir o lugar do medico, tomar conduta e fazer viver. Com os profissionais do ambito da justica esse jogo ocorre em torno da sentenca sobre o futuro da crianca, contudo, apartadas de todo o processo as profissionais resistem julgando o julgamento. Ironia, deslegitimacao, denuncia e alarde, falta de comprometimento, esgarcamento de limites e fronteiras sao as principais estrategias de resistencia das quais fazem uso. De outro lado, como manutencao do funcionamento institucional temos a rigida estrutura hierarquica, processos juridicos e administrativos, punicao e conversa, o apaziguamento, cujo papel o grupo aqui analisado cumpriu. Por fim, por meio desta pesquisa configuramos como objeto institucional da enfermagem a manutencao e controle de todos os movimentos e alteracoes do e no paciente, quer sejam motores ou fisiologicos, por meio de tecnologias de monitoramento e vigilancia, gratificacoes e punicoes / The main goal of this research is to make an institutional analysis of the discourse of a group. For this assignment a Sao Paulo\'s public teaching hospital was chosen. The focus of our analysis is the relationship the professional has with his work, using the Institutional Analysis of Discourse, developed by Guirado (2010), as a conceptual and methodological reference. This research will demonstrate that the professionals\' relationship with their work is tangled up by procedures, majorly composed by administrative and caring procedures (for nurses and auxiliary nurses, respectively). The blending of procedures and relationship disguises the differences between being and doing, leading in turn to the nurses identification with the mother\'s role, to the indiscriminateness of their relationship with the patients, and to an increased difficulty when defining the limits for their practice and their feelings. In that case, death is for them the only inexorable limit, one that promotes the disruption and reorganization of themselves and their relationship with the work. Death is also able to promote trauma, paralysis, repetition, and panic. The mother is seen, by the child, as a true and only haven. If the mother is good, she is considered the foundations for life, health and happiness of the child. When she is bad or absent, this is considered the reason for the child\'s untidiness, fragility, illness and death. The mothers are, simultaneously, institutional agents and clientele, since the nursing work presupposes the work of the mother. The amount of work attributed to that staff is lessened in the presence of a good mother and enlarged when dealing with a bad mother. The child appears as object and target of the nurses\' action and as subject and product of your mother. The dispute for power (and its resistance) in the contacts with the doctors occurs through the polarization between making the child to live or leaving the child to die, in which the resistance implies taking over the doctors job, take conduct and making the child to live. With the professionals in the domain of Justice, these games of power/resistance occur concerning the sentence about the child\'s future. Nevertheless, nurse professionals, kept away from the process, resist by judging the judgment. Irony, disqualifying, indictment and boasting, lack of commitment, and the blurring of limits and boundaries are the primary resistance strategies which they employ. On the other hand, acting as institutional functioning support maintenance we have a rigid hierarchic structure, juridical and management proceedings, punishment and discussion, and pacification (whose role was fulfilled by the group here studied). At last, the maintenance and control of all patient\'s alterations and movements (physical or physiological) was configured as the institutional object for the nursing work. This was achieved by means of monitoring and surveillance technologies, rewards and punishments

Cette thèse porte sur le développement du travail « en 12 heures » des infirmières et des aides-soignantes de l’hôpital public depuis une dizaine d’années. Elle l’envisage comme un dispositif révélateur des transformations de l’action publique et du travail. Permettant à la fois de dégager des économies pour les directions et de condenser le nombre de journées travaillées pour les soignants, ce mode d’organisation du temps de travail cristallise les enjeux actuels de l’institution hospitalière, entre rationalisation gestionnaire, intensification du travail et aspiration des soignants à se réapproprier une vie « à eux » en dehors de l’hôpital. Défini en 2002 comme une dérogation à la durée maximale du travail dans les cas où « les contraintes de continuité du service public l’exigent en permanence », la normalisation du recours au dispositif vient parallèlement nourrir un écart grandissant entre droit et pratiques. Alliant sociologie du travail, sociologie de l’action publique et sociologie du droit, la thèse se présente comme une ethnographie multi-située du travail en 12 heures, interrogeant les conditions d’émergence du dispositif et les appropriations/retraductions qu’en font les différents acteurs (réformateurs, intermédiaires du droit, soignants). La thèse montre ainsi que, à côté de l’idée d’une amélioration de la qualité du service et de l’épanouissement de soignants (qui y trouvent un équilibre entre travail et vie privée), le dispositif s’accommode de l’intensification du travail et fait le jeu de la rationalisation à l’œuvre à l’hôpital. / This thesis focuses on the development of 12 hours-shift work of nurses and nurses’ aides in public hospital since a decade. It considers the program as an indicator of public policy and work transformations. Drawing savings for the administrative heads of hospital and reducing the number of working days for nurses, this working time organization crystallises current issues of public hospital : new public management, intensification of work, aspiration of work/life balance of nurses. Defined in 2002 as an express exception of the maximum legal working time (due to the necessity of public service continuity), the standardization of the use of the program contributes to increase the gap between norms and practices. At the intersection of sociology of work, sociology of public policy and sociology of law, the thesis is based on a multi-sited 12 hours-shift work ethnography. It examines the conditions of emergence of the program and the way actors appropriate it. The thesis shows that beside the idea of an improvement of the service quality and the nurses’ satisfaction, the program goes with the intensification of work and contributes to the rationalization of hospital.

Cette recherche tente de répondre à la problématique suivante : dans quelle mesure la mise en place d’un manager-hybride et d’une équipe pluridisciplinaire, peut- elle permettre la gestion de la concurrence entre des logiques institutionnelles au sein d’une organisation hybride ? Nous avons alors établi un cadre théorique développant d’abord la notion d’organisation hybride. Ensuite, nous investiguons la notion de manager-hybride en la rapprochant de celle de l’acteur-frontière. Enfin, nous nous intéressons à l’équipe pluridisciplinaire qui apparaît alors comme un espace favorable à la collaboration interprofessionnelle. Concernant notre démarche empirique, celle-ci, dans le cadre d’une étude de cas unique, s’est déroulée au sein du pôle Femme-Enfant d’un centre hospitalier intercommunal de grande taille que nous considérons comme un cas extrême et révélateur. Plus particulièrement nous avons endossé une méthodologie qualitative (entretiens semi-directifs avec analyse de contenu). Quant à nos résultats, nous avons constaté que les contextes institutionnel et organisationnel apparaissent comme empreints de tensions entre les différents groupes d'acteurs. Pour autant, le chef du pôle Femme-Enfant et le trio gestionnaire parviennent, via différents mécanismes, à agir en faveur d’une compréhension mutuelle des différents groupes et d’une hybridité équilibrée. Nous émettons alors deux principaux axes de discussion : l’un traitant des différentes habiletés du manager-hybride à soutenir la conciliation entre des logiques institutionnelles concurrentes ; et l’autre, de l’équipe pluridisciplinaire comme espace favorable à la diffusion d’une hybridité équilibrée et durable / The particular purpose of the research is to answer the following question : to what extent is the implementation of a hybrid-manager and a multidisciplinary team enables the management of competing institutional logics within a hybrid organization ? To this end, we propose a theoretical framework that develops, firstly, the concepts of hybrid organization. Next, we focus on the concept of hybrid-manager to put it closer to the boundary-actor one. Lastly, we focus on the concept of multidisciplinary team. Multidisciplinary team that appears as a favorable space for interprofessional collaboration. Our empirical approach is based on a single case study, which references a particular department in a hospital located in southern France (i.e. the « child-woman pole ») that we consider as an extreme and revelatory case. More specifically, we applied a qualitative methodology (i.e. semi-structured interviews with content analysis). Concerning our results, the data analysis shows an institutional and organizational context marked by tensions between individuals. But, the the head of the child-woman pole and the trio foster a mutual understanding between groups, and in so doing, balances competing logics. Finally, these results lead us to put foward two main themes for discussion : one centred on the skills and competencies of the hybrid-manager to support reconciliation and to balance coexistence of competing logics ; and the second one, centred on the multidisciplinary team as favorable space for the emergence of a hybrid institutional logic and for the dissemination of balanced and sustainable hybridity

Background: The Continuing Professional Development (CPD) Framework established by the South African Nursing Council (SANC) states that organisations have a responsibility to create enabling environments in which the development of nurses can take place. Aim: The aim of this study is to assess the CPD of nurses at a public hospital in KwaZulu-Natal. Method: A quantitative descriptive design was followed. Convenience sampling yielded a sample of 166 nurses consisting of the registered nurse (63.2%) and enrolled nurse categories (36.8%). Data collection was done using a self-designed questionnaire. Statistical analysis was done using the Statistical Analysis System (SAS) Version 9.4 programme. Results: The findings revealed that CPD was ranked the least important area in terms of management priorities. Key barriers to development included staff shortages, lack of funding, poor resources and competing personal responsibilities. The study found that CPD had positive outcomes for nursing practice. / Health Studies / M.A. (Nursing Science)