Public health organisations of today are increasingly subject to the same market forces and competition as are private enterprises, and will inevitably have to go through the same transition towards a more professional leadership as they did a couple of decades ago. The purpose of this thesis is to investigate the importance of the development of leadership competencies for leaders in professional bureaucracies, more specifically public health care organisations, and to find out if their members are prepared for the organisational change that is forcing its way to make these organisations more leadership efficient. An increasingly popular view is that there is a lot to be gained by encouraging leaders to either participate in a local leadership education program or to take a university course in leadership and administration. If clinician-leaders are to take an active part in forming their future, they will have to take leadership seriously and come to terms with the idea that leadership education is necessary in addition to academic merits.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A presente dissertação acompanha os desdobramentos e estudos realizados durante a elaboração do trabalho intitulado Entremeio: a constituição de um espaço bureaucrático individual. Nela foram destacadas três momentos temporais e textuais: o movimento de chegada a uma cidade estranha e a elaboração do conceito de artista forasteiro, bem como o momento de adaptação ao novo e as perambulações por uma cidade a se desvelar e pulsar em uma potência transbordante; o desenvolvimento de uma coleção de perguntas capturadas em meio aos escritos de diversos autores, observando o efeito de apropriação das mesmas para a constituição de um trabalho artístico que leva em conta a distribuição silenciosa e unilateral de perguntas pelo tecido social da cidade; por fim, a criação de um trabalho que transporta o espaço individual de estudos e trabalho (bureau) para o meio de circulação pública, através da livre ocupação de espaços públicos, abordando as implicações espaciais do público e do privado. Este ensaio busca, ainda, explorar o formato ensaístico de escrita levando em consideração o relato de experiência no decorrer da elaboração de um trabalho artístico / This dissertation follows the studies and its conceptual variations of the preparation of the work entitled: In between spaces: the creations of a personal bureaucratic space. It highlights three textual and temporal moments: the movement of arrival in a new and strange city and the elaboration of the concept of outsider artist, as well as as the moment to adapt to the new and to start wandering through a city to unfold and pulsate in an overflowing power; the creation of a collection of questions captured amid the writings of various authors, observing the appropiation effect in them in order to create an artwork that works as a silent ans unilateral distribution os questions through the citys social environment; Finally, the creation of a work that takes to public spaces the individual work space (bureau), through a free occupation of this spaces, adressing the implications of wich is public and wich is private. This text also intends to explore the essay writing format considering the experience report during the development of an artistic work

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A presente dissertação acompanha os desdobramentos e estudos realizados durante a elaboração do trabalho intitulado Entremeio: a constituição de um espaço bureaucrático individual. Nela foram destacadas três momentos temporais e textuais: o movimento de chegada a uma cidade estranha e a elaboração do conceito de artista forasteiro, bem como o momento de adaptação ao novo e as perambulações por uma cidade a se desvelar e pulsar em uma potência transbordante; o desenvolvimento de uma coleção de perguntas capturadas em meio aos escritos de diversos autores, observando o efeito de apropriação das mesmas para a constituição de um trabalho artístico que leva em conta a distribuição silenciosa e unilateral de perguntas pelo tecido social da cidade; por fim, a criação de um trabalho que transporta o espaço individual de estudos e trabalho (bureau) para o meio de circulação pública, através da livre ocupação de espaços públicos, abordando as implicações espaciais do público e do privado. Este ensaio busca, ainda, explorar o formato ensaístico de escrita levando em consideração o relato de experiência no decorrer da elaboração de um trabalho artístico / This dissertation follows the studies and its conceptual variations of the preparation of the work entitled: In between spaces: the creations of a personal bureaucratic space. It highlights three textual and temporal moments: the movement of arrival in a new and strange city and the elaboration of the concept of outsider artist, as well as as the moment to adapt to the new and to start wandering through a city to unfold and pulsate in an overflowing power; the creation of a collection of questions captured amid the writings of various authors, observing the appropiation effect in them in order to create an artwork that works as a silent ans unilateral distribution os questions through the citys social environment; Finally, the creation of a work that takes to public spaces the individual work space (bureau), through a free occupation of this spaces, adressing the implications of wich is public and wich is private. This text also intends to explore the essay writing format considering the experience report during the development of an artistic work

Dans ce travail de thèse, nous étudions les relations entre associations et pouvoirs publics au prisme du dispositif local d’accompagnement (DLA).Dans la première partie de la thèse, nous nous intéressons à la genèse et à la forme du DLA. Nous observons que le DLA est une politique publique de l’emploi, dont la mise en œuvre est déléguée à des structures porteuses, et que son action vise à aider les associations employeuses à pérenniser leurs emplois et consolider leur modèle économique. L’étude de la genèse de cette politique publique montre l’intérêt grandissant de l’État pour le versant économique des associations et la charge en emplois dont elles sont porteuses. Dans la seconde partie, nous nous intéressons à ceux qui la mettent en œuvre, aux agents de cette politique publique. Si nous observons que le dispositif est structuré et cadré, le métier des chargé-e-s de mission DLA est néanmoins « ouvert » ; ils disposent d’importantes marges dans la réalisation de leur travail. Cependant, malgré cette souplesse, ils partagent le souci de l’emploi, et le travail pour l’emploi se fait. Cette analyse nous amène à avancer que le dispositif étudié relève d’une forme de gouvernement par l’accompagnement. Enfin, dans la troisième partie, nous qualifions l’impact du dispositif sur ses bénéficiaires de « professionnalisation contemporaine ». Les « entreprises associatives » sont poussées à structurer l’organisation du travail, à diversifier leurs ressources, mais aussi à se mobiliser pour leurs emplois. Le DLA participe aussi à implanter des dispositifs de gestion dans les associations employeuses : ceux-ci sont aussi bien appropriés de manière stratégique par les dirigeants associatifs que par les pouvoirs publics. Enfin, l’étude des relations entre associations et pouvoirs publics montre que ces derniers sont morcelés, producteurs d’un environnement incertain et concurrentiel pour les associations.La dynamique observée nous offre des enseignements qui dépasse les effets du DLA ; en effet le dispositif ne fait qu’accélérer un processus en cours. Au final, les transformations observées à l’œuvre dans le monde associatif employeur semblent être le résultat des mutations de l’environnement des associations, lui-même grandement déterminé par les pouvoirs publics. / In this thesis, we study the relationship between not-for-profit organisations and public authorities through the lense of the local support measure (DLA, dispositif local d’accompagnement).In the first part of the thesis, we focus on the genesis and shape of the DLA. We observe that the DLA is a policy of public employment, implementation of which is delegated to supporting structures, and that its action is intended to help employing organizations to maintain the jobs they provide and consolidate their economic model. Study of the origin of this public policy shows the state's growing interest in non-govornmental organisations from an economic point of view, specifically their importance in the job market. In the second part, we focus on the people who implement the DLA, the agents of this public policy. Although we observe that the policy has structure, the job description of professionals who implement the DLA remains "open"; they have large margins in the realization of their work. Despite this flexibility, they share the concern for employment and job creation. This analysis leads us to suggest that the subject device to a form of government by the accompaniment. Finally, in the third part, we describe the impact of the DLA on its ‘modern professional’ beneficiaries. The ‘associative enterprises’ are pushed to structure their work organization and diversify their resources, but also to mobilize for their jobs. The DLA is also involved in implementing management systems in the job-providing organisations: these are both strategically appropriated by non-for-profit directors by the authorities. Finally, the study of relationships between associations and public authorities shows that they are fragmented, producing an uncertain and competitive environment for these organisations.The dynamics observed provide lessons that exceed the effects of DLA; indeed, the policy simply accelerates an ongoing process. The changes observed at work in the employing organisations appear to be the result of changes in the environment of such organisations, which is, in turn, largely determined by the government.

Made available in DSpace on 2015-09-25T12:22:42Z (GMT). No. of bitstreams: 1 PDF - Jan Marcel de Almeida Freitas Lacerda.pdf: 2367462 bytes, checksum: 30e97c7d2ed361d6a6f9bf2d836f34c8 (MD5) Previous issue date: 2013-05-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This dissertation examines the role of the Organization of American States (OAS) in the dissemination of ideas of democracy in Latin America, especially from the Post-Cold War period to the present. Thus, it is based on two central arguments: that ideas matter in international relations; and that, among the international actors that spread them, the International Organizations as International Bureaucracies are agents in the construction, protection and defense of ideas. For this purpose, initially, the reflection will be built on the contributions of the constructivist perspective of International Relations, whose thought is that ideas are fundamental for the constitution of realities, agents, interests and identities in the international context. Regarding the international organizations, the constructivist approach of international institutions as international bureaucracies stands out, providing the understanding of the logic of these organizations, both in the structural aspect and in the relevance of sectors, individuals and staff of international bureaucracies. Then, this research will discuss the evolution of the ideas of democracy, focusing especially on the procedural (or minimalist) and substantial (or participacionist) conceptions, will show the specificity and the problems of the Latin American democracy, and will observe the concept of democracy advocated by the OAS at the regional level of performance, primarily through its normative influence. Finally, the OAS behavior and its cooperation in the thematic area of defense and protection of democracy will be observed, focusing, especially, on the influences of cognitive and executive organization and congruence of ideas through the development of cooperation between institutions in order to build reports of studies and dialogue mechanisms (seminars, forums and meetings), in which ideas of democracies also be defended and disseminated. To achieve the aim of this research, literature reviews on concepts used by theorists of Political Science and International Relations will be conducted, as well as documentary and discourse of international civil servants of the OAS analysis, and interviews. / A presente dissertação analisa o papel da Organização dos Estados Americanos (OEA) na disseminação de ideias de democracia na América Latina, principalmente no período Pós-Guerra Fria até a atualidade. Assim, parte-se de dois argumentos centrais: as ideias importam nas Relações Internacionais; e, dentre os atores internacionais que as disseminam, as Organizações Internacionais como Burocracias Internacionais são agentes na construção, na proteção e na defesa das ideias. Para tanto, de início, a reflexão será construída a partir das contribuições da perspectiva construtivista das Relações Internacionais, cujo pensamento é de que as ideias são fundamentais para a constituição de realidades, agentes, interesses e identidades no contexto internacional. Já quanto às organizações internacionais, se sobressai a abordagem construtivista dessas instituições internacionais como burocracias internacionais, proporcionando a compreensão da lógica dessas organizações tanto no aspecto estrutural quanto na relevância dos setores, dos indivíduos e das equipes de servidores das burocracias internacionais. Em seguida, a pesquisa irá discutir a evolução das ideias de democracia, em especial focará nas concepções procedimentais (ou minimalistas) e substanciais (ou participacionistas), apresentará a especificidade e problemáticas da democracia latino-americana, e observará o conceito de democracia defendido pela OEA em âmbito regional de atuação, principalmente através de sua influência normativa. Por fim, será observado o comportamento e a cooperação da OEA em área temática de defesa e proteção da democracia, visualizando, sobretudo, as influências cognitivas e executivas da organização e a congruência de ideias por meio do desenvolvimento de cooperações entre instituições, com o intuito de construir relatórios de estudos e mecanismos de diálogo (seminários, fóruns e reuniões), nos quais ideias de democracias também serão defendidas e disseminadas. Para alcançar o objetivo da pesquisa, serão realizadas revisões literárias sobre conceitos utilizados por teóricos da Ciência Política e das Relações Internacionais, análises documentais e de discursos dos servidores civis internacionais da OEA, e entrevistas.

Cette thèse cherche à comprendre comment les transformations bureaucratiques influencent l’activité professionnelle des infirmières et du personnel soignant d’expérience dans le domaine des soins aux personnes âgées en perte d’autonomie depuis les années 90 au Québec. Elle s’inscrit dans une profonde remise en question de l’État-providence, de sa régulation hiérarchique, de son rapport avec le marché privé, et particulièrement des agences privées de placement du personnel. Prenant en compte le déploiement inégal des changements imposés de façon top down et promus par des considérations économiques visant une plus grande « performance » des services publics, plus près du milieu de vie de la personne, notre démarche tient aussi compte de la dimension relationnelle propre au travail infirmier, qui s’illustre par des formes différenciées tenant compte des modèles de pratique préconisés. Notre démarche s’attarde finalement aux rapports entre l’activité professionnelle et la prise de la retraite. À travers l’exploration du nouveau rôle attendu de l’infirmière, dont les habiletés de « chef » ou de « gestion d’équipe de travail » sont sollicitées à titre d’« intervenante pivot » ou de « gestionnaire de cas », et de la place importante qu’occupe la notion de compétences relationnelles dans la prescription de nouvelles modalités des services, plus près des besoins spécifiques de la personne, les données empiriques se présentent sous la forme d’un tableau hétérogène qui montre que ce ne sont pas toutes les infirmières qui souscrivent à ce type de pratique professionnelle. Leur âge, expérience et trajectoire professionnelle, le poste occupé ou encore le milieu de pratique influenceront le rapport entre leurs activités professionnelles et le cadre bureaucratique en transformation. La base empirique de la recherche est constituée d’une collecte de données réalisée entre janvier 2003 et juillet 2006 et qui comprend 9 entrevues exploratoires, 7 entrevues semi-dirigées auprès de retraité-e-s, infirmières, infirmières auxiliaires, 17 réunions incluant majoritairement des membres de la direction d’établissements, ainsi que des syndicats, 21 observations directes avec des infirmières, infirmières auxiliaires, préposées aux bénéficiaires et auxiliaires familiales et sociales, la passation de 112 questionnaires auprès de ces différentes catégories professionnelles, et 7 entrevues semi-dirigées complémentaires, réparties dans 4 établissements différents, sur deux territoires. Quatre grands constats ressortent de notre matériel empirique. Premièrement, la dimension relationnelle au sein des activités professionnelles du personnel soignant d’expérience ainsi que sa perception en ce qui concerne les compétences et l’âge présentent des formes contrastées, voire opposées. Si certains membres du personnel soignant estiment que les interactions professionnelles se sont considérablement réduites à la suite des transformations des dernières années et que la compétence n’est pas reliée à l’âge des professionnelles, les observations directes indiquent, au contraire, un rapport étroit entre ces deux derniers éléments qui s’illustre à travers de riches relations interpersonnelles. Les données quantitatives montrent, quant à elles, qu’une écrasante majorité de répondantes estiment que les compétences associées à leurs fonctions sont reconnues par l’organisation (89,3%), probablement sous l’angle de la conformité aux descriptions de travail, et qu’elles bénéficient d’une marge d’autonomie dans leur travail (83%). Deuxièmement, des résultats s’opposent également en ce qui concerne l’influence du cadre bureaucratique sur les « capacités » ou l’« intérêt » des infirmières d’expérience à maintenir un lien à l’emploi à la date d’éligibilité à la retraite. La majorité des répondantes s’estiment « incapables » de conserver un tel lien alors qu’une minorité d’entre elles exprime un intérêt face au nouveau rôle souhaité chez l’infirmière. Quantitativement, la prise de la retraite à bas âge est toutefois marquante, surtout pour celles qui occupent une fonction et possèdent une rémunération élevée (ex. cadres). Troisièmement, des contrastes apparaissent aussi en ce qui concerne les formes que prennent les rivalités entre les infirmières d’expérience et d’autres catégories professionnelles ainsi que dans les rapports intergénérationnels. Même si les trois quarts (76,2%) des répondantes d’expérience estiment que la répartition du travail devrait être le fruit d’une discussion entre elles et les plus jeunes, et non une imposition de la direction, près de la totalité (92,6%) veulent garder leurs acquis sociaux même si elles savent que la prochaine génération de travailleuses n’aura pas les mêmes avantages. Leur rapport face aux professionnelles d’agences privées de placement est également paradoxal. Huit répondantes sur dix (78,6%) perçoivent le fait que l’établissement recourt aux agences de placement contribue à alourdir leur travail, alors qu’une partie envisage de poursuivre leur activité professionnelle après leur date d’éligibilité à la retraite, par l’intermédiaire de ces mêmes agences. Finalement, il ressort de ce portrait hétérogène que la confrontation des changements du cadre bureaucratique sur l’activité professionnelle se manifestera différemment selon la vision paradigmatique qu’aura le personnel soignant de sa pratique. Les résultats quantitatifs et qualitatifs soulignent que ce paradigme sera influencé par trois dimensions : le territoire de pratique, le type d’établissement de services et l’unité spécifique de travail. Le style de gestion (traditionnel ou intégrateur) influencera également l’impact de ces changements. L’analyse et l’interprétation de l’influence différenciée des transformations bureaucratiques sur l’activité professionnelle s’illustrent par la manifestation de rapports plus conflictuels avec les autorités administrative et professionnelle, ainsi que dans les relations interprofessionnelles. Ces conflits ont émergé lors du passage d’un cadre bureaucratique historiquement construit sur un modèle médical (cure) qui considère la personne comme un « malade chronique » et associé à un style de gestion traditionnel, voire autoritaire, surtout dans certains CHSLD, à une approche « milieu de vie » privilégiant un modèle d’accompagnement (care) favorisant des services associés aux besoins spécifiques de la personne en perte d’autonomie, à titre de « partenaire actif ». Le style de gestion intégrateur de ce dernier modèle rapproche les domaines administratif et de soins de santé, approche que nous retrouvons davantage, mais non exclusivement, dans le cadre de soins à domicile. Une des conclusions majeures de cette thèse est la possibilité d’« enrichir les qualifications de base » (Le Boterf, 2005) des professionnelles lorsque le cadre bureaucratique et le style de gestion institués tendent vers un modèle care/intégrateur, ce qui constitue une forme de « compromis social » (Oiry, 2004). La « surutilisation » des effectifs (O’Brian-Pallas et al., 2005) qui en résulte peut expliquer, en partie, l’incontournable force d’attraction vers la retraite, dès la date d’admissibilité, du personnel soignant, quitte à ce qu’il poursuive ensuite ses activités professionnelles, selon des exigences personnelles, par le biais d’agences privées de placement. Les « fissures » (Laville, 2005) de la frontière entre les services publics et ceux du marché privé ne peuvent alors que s’accentuer, surtout lorsqu’on constate que le cinquième des effectifs, soit 14, 000 infirmières de 55 ans et plus, est potentiellement admissible à la retraite dès maintenant (OIIQ, 2008a). / This thesis aims to understand how bureaucratic transformations influence professional activity of experienced nurses since the 90s in Quebec in the field of elderly care who dealing with the lost of autonomy. It falls into a deep questioning of the Welfare state, its hierarchic regulation, and its relationship with the private market, particularly the private nursing agencies. Taking into account the unequal deployment of changes implemented in a top down manner, and promoted by economic considerations for a greater “performance” of public services, closer to the living environment of the individual, our approach takes also into account the specific relational dimension of nursing work, which is illustrated by differentiated forms that reflect practice models. Our research finally focuses on the relationship between professional activity and time of retirement. While taking into account the new nursing role expectations, in which “leadership” and “management team work” abilities are in demand as a “pivot professional” or “case management”, and of the important place of the concept of relational skills in the prescription of new modalities of service, closer to the specific needs of the individual, empirical data is presented in the form of a heterogeneous picture which shows that not all nurses subscribe to this type of professional practice. Age, experience and professional career, position or the practice environment will influence the relationship between their professional activities and bureaucratic framework in transformation. The empirical basis of this research consists of a data collection conducted between January 2003 and July 2006 and includes: 9 exploratory interviews; 7 semi-structured interviews with retirees, nurses, and nursing assistants; 17 meetings attended by management and unions; 21 direct observations with nurses, nursing assistants, orderlies, and home and social aids; 112 questionnaires distributed to the aforementioned professional groups; and 7 semi-structured interviews, in 4 different organizations from two territories. Four major findings emerged from the empirical findings. First, the relational dimension in the professional activities of experienced nursing staff and their perceptions regarding skills and ages have contrasting and even opposite forms: while some believe that professional interactions have greatly reduced following the transformations of recent years and that skills are not related to the age of the professional, direct observations rather indicate a close relationship between these two elements, and which is illustrated through rich interpersonal relationship. The quantitative data shows, in turn, that an overwhelming majority of respondents believe that the skills associated with their functions are recognized by the organization (89.3%), probably in terms of compliance with the job description, and that they enjoy a degree of autonomy in their work (83%). Second, results are also opposed in regards to the influence of the bureaucratic framework under the "capacities" or "interest" of experienced nurses to maintain a link to the employment at the date of eligibility retirement: the majority of respondents consider themselves "unable" to maintain such a link while a minority express an interest in facing the new expectation. Quantitatively, taking retirement at an early age is oustanding, especially for those who hold high position and pay (ex. managers). Third, contrasts also appear regarding the forms taken by the rivalries between experienced nurses, other professional groups and in intergenerational relationships. Even if three quarters (76.2%) of respondents believe that the division of labor should be the result of a discussion between themselves and younger staff, and not an imposition of the direction, almost all (92.6%) want to keep their social benefits even if they know that the next generation of workers will not have the same benefits. Their relationship with professionals working for private nursing agencies is also paradoxical: eight in ten respondents (78.6%) perceive that using their services contributes to increase their work, while continuing professional activities at the date of eligibility for retirement is planned through these same agencies. Finally, this heterogeneous picture underlines confrontational changes in the bureaucratic framework concerning professional activity that will manifest itself differently depending on the paradigmatic vision of the nursing staff of their practice. The quantitative and qualitative results emphasize that this paradigm is influenced by three dimensions: the territory of practice, the type of service establishments and the specific unit of work. Management style (traditional or integrator) will also influence the impact of these changes. The analysis and interpretation of the differentiated influence of bureaucratic changes on professional activity are illustrated by more conflicting reports with administrative and professional authorities, as well as with inter-professional’s relationships. These conflicts have emerged during the transition from a historically bureaucratic framework built on a medical model (cure), which considers the individual as a "chronically ill", and associated with a traditional management style, even authoritarian, especially in some nursing homes, to an approach that emphasizes living environment, a model of support (care) that favors related services to the specific needs of the individual in loss of autonomy, as an "active partner". The integrator’s management style of this latter model will bring the administrative and health care closer, that we find more, but not exclusively, through home care. A major conclusion of this thesis is the ability to "enrich the basic skills" (Le Boterf, 2005) of professionals when the bureaucratic framework and management style tend to set up a care/integrator’s model, which is a form of "social compromise" (Oiry, 2004). However, the "overuse" of the workforce (O'Brien-Pallas et al., 2005) that may result can explain, partially, the inescapable pull of retirement, from the date of eligibility of nursing staff, even if they then continues then their professional activities, according to their personal requirements, through private agencies. The "cracks" (Laville, 2005) in the border between public services and private market can then only increase, especially as the fifth of the workforce, 14 000 nurses aged 55 and over, are potentially eligible to retired now (OIIQ, 2008a).

This study explores and assesses the attitudes of the personnel of welfare-oriented governmental bureaucracies toward the poor. To fulfill these goals, a treatment and a control group were selected to compare their attitudes toward this group. They were measured by a disguised-structured instrument using the survey approach. It was found that the majority of respondents in both groups have a pro-poor attitude but it is more prevalent among the bureaucrats than among the students. In light of the knowledge we have of the effect of attitudes on the execution of policies, these results suggest that the policies governing the different programs studied are being executed to the advantage of the client.

O objetivo geral deste trabalho é compreender as razões da autonomia burocrática das organizações financeiras internacionais. O objetivo específico é entender porque o Banco Mundial alcançou um grau maior de autonomia do que o Fundo Monetário Internacional a despeito de possuírem estruturas de governança parecidas e terem sido criados no mesmo contexto histórico. Acreditamos que as razões desta diferença residem na burocracia com expertise mais diversificada do Banco Mundial em contraste a burocracia com expertise mais rígida do FMI. Uma burocracia mais diversificada aumenta as possibilidades de formação de coalizões com ONGs em torno de policies de interesse da burocracia. Estas coalizões aumentam os custos de intervenção dos Estados para alterar ou barrar as policies defendidas pelo corpo burocrático. Assim, nossa hipótese é a seguinte: quanto maior a diversidade de expertise da burocracia internacional maior será a possibilidade de formação de coalizões com ONGs em torno de policies de seu interesse e, conseqüentemente, maior será sua autonomia burocrática. Do ponto de vista teórico utilizamos a teoria agente-principal para discutir burocracias internacionais. Do ponto de vista metodológico utilizamos o método comparativo com base em instrumentos qualitativos de análise e estatística descritiva. / The main goal of this dissertation is to understand the building of bureaucratic autonomy among international financial organizations. The specific goal is to understand why the World Bank has reached more bureaucratic autonomy than the International Monetary Fund regardless the fact that both have similar institutional structures. We believe that the reason for such difference is a more diverse expertise of the World Bank compared to the IMF. We claim that a more diverse bureaucracy increases the likelihood of coalition formation with NGOs. Such coalitions aim to support policies that are important for both the bureaucracy and the NGOs. Consequently, they increase the costs for both State intervention and State control over the organization. The higher costs of intervention and control allow bureaucrats to act more freely according to their interests. Hence, our hypothesis is the following: the more diverse the bureaucratic expertise, the more likely is the formation of coalitions between bureaucracy and NGOs, and the greater the costs for State control and intervention. Higher intervention and control costs, in turn, increase bureaucratic autonomy. We use mainly qualitative research methods with some descriptive statistics.

A presente tese analisa a influência da Organização das Nações Unidas (ONU), da Organização dos Estados Americanos (OEA), de suas burocracias internacionais e de suas relações administrativas intra e extraorganizacionais na promoção e na defesa da democracia na América Latina. A partir das contribuições teóricas do construtivismo social e dos estudos de administração, é possível observar os corpos burocráticos das organizações internacionais como Administrações Públicas Internacionais (APIs) que influenciam a governança global ao distribuir níveis de governo e mudar as condutas dos Estados. A singularidade da América Latina alerta as Organizações Internacionais (OIs) e suas burocracias internacionais quanto às constantes crises democráticas na região, dos problemas econômicos e sociais e das distorções dos princípios democráticos nas sociedades latino-americanas. O objetivo desta tese, então, é investigar a influência das OIs, de suas burocracias e de suas interações administrativas na democracia latino-americana. É defendida a hipótese de que a cooperação entre a ONU e a OEA impacta nas democracias latino-americanas, por meio de suas atuações conjuntas em missões eleitorais, publicações e eventos. Para tanto, adotou o método de análise misto, com técnicas de pesquisa qualitativa e quantitativa combinadas para melhor explicar o fenômeno estudado. Qualitativamente, fez-se revisões literárias e análises documentais sobre as OIs, as burocracias internacionais e as relações interoganizacionais como atores externos nos processos de democratização da América Latina. Já na etapa quantitativa, realizou-se uma análise descritiva aprofundada do banco de dados inédito e foram empregadas as estimações por Mínimos Quadrados Generalizados (MQG) para dados organizados em painel, para 20 países latino-americanos, no período de 2000 a 2015. A estruturação do banco de dados inovador utilizou as atividades dessas organizações na área da democracia, incluindo os eventos, as publicações e as missões políticas e de assistência eleitoral entre os anos selecionados. Os resultados encontrados confirmaram a hipótese de que a cooperação entre ONU e OEA em suas atividades aumenta o nível de democracia latino-americana. / The present thesis analyzes the influence of the United Nations (UN), the Organization of American States (OAS), their international bureaucracies and their administrative intra and extra-organizational relations in the promotion and defense of democracy in Latin America. By combining the theoretical contributions of social constructivism and management studies, it is observed that the bureaucratic bodies of international organizations such as International Public Administrations (IPAs) influence global governance by distributing the level of government and changing the conduct of States. The singularity of Latin America alerts the International Organizations (IOs) and their international bureaucracies about the constant democratic crisis in the region, the economic and social problems and the distortions of democratic principles in Latin American societies. In this sense, the purpose of this thesis is to investigate the influence of IOs, their bureaucracies and their administrative interactions in Latin American democracy. The working hypothesis is that cooperation between the UN and the OAS impact on Latin American democracies through their joint actions in electoral missions, publications and events. In order to do so, the mixed analysis method was adopted, with qualitative and quantitative research techniques combined to better explain the investigated phenomena. Qualitatively, the thesis uses literary reviews and documentary analysis about the IOs, the international bureaucracies and the inter-organizational relations as external actors in the processes of democratization in Latin America. The quantitative stage of the research included an in-depth descriptive analysis of the database and the usage of estimates by Generalized Least Squares (GLS) for panel data for 20 Latin American countries, from 2000 to 2015. The structuration of the innovative database of this thesis used the organizations’ activities in democracy including events, publications and political and electoral assistance missions during the selected years. The results confirm the initial hypothesis that cooperation between the UN and the OAS in their activities increases the level of democracy in Latin American.

Cette thèse cherche à comprendre comment les transformations bureaucratiques influencent l’activité professionnelle des infirmières et du personnel soignant d’expérience dans le domaine des soins aux personnes âgées en perte d’autonomie depuis les années 90 au Québec. Elle s’inscrit dans une profonde remise en question de l’État-providence, de sa régulation hiérarchique, de son rapport avec le marché privé, et particulièrement des agences privées de placement du personnel. Prenant en compte le déploiement inégal des changements imposés de façon top down et promus par des considérations économiques visant une plus grande « performance » des services publics, plus près du milieu de vie de la personne, notre démarche tient aussi compte de la dimension relationnelle propre au travail infirmier, qui s’illustre par des formes différenciées tenant compte des modèles de pratique préconisés. Notre démarche s’attarde finalement aux rapports entre l’activité professionnelle et la prise de la retraite. À travers l’exploration du nouveau rôle attendu de l’infirmière, dont les habiletés de « chef » ou de « gestion d’équipe de travail » sont sollicitées à titre d’« intervenante pivot » ou de « gestionnaire de cas », et de la place importante qu’occupe la notion de compétences relationnelles dans la prescription de nouvelles modalités des services, plus près des besoins spécifiques de la personne, les données empiriques se présentent sous la forme d’un tableau hétérogène qui montre que ce ne sont pas toutes les infirmières qui souscrivent à ce type de pratique professionnelle. Leur âge, expérience et trajectoire professionnelle, le poste occupé ou encore le milieu de pratique influenceront le rapport entre leurs activités professionnelles et le cadre bureaucratique en transformation. La base empirique de la recherche est constituée d’une collecte de données réalisée entre janvier 2003 et juillet 2006 et qui comprend 9 entrevues exploratoires, 7 entrevues semi-dirigées auprès de retraité-e-s, infirmières, infirmières auxiliaires, 17 réunions incluant majoritairement des membres de la direction d’établissements, ainsi que des syndicats, 21 observations directes avec des infirmières, infirmières auxiliaires, préposées aux bénéficiaires et auxiliaires familiales et sociales, la passation de 112 questionnaires auprès de ces différentes catégories professionnelles, et 7 entrevues semi-dirigées complémentaires, réparties dans 4 établissements différents, sur deux territoires. Quatre grands constats ressortent de notre matériel empirique. Premièrement, la dimension relationnelle au sein des activités professionnelles du personnel soignant d’expérience ainsi que sa perception en ce qui concerne les compétences et l’âge présentent des formes contrastées, voire opposées. Si certains membres du personnel soignant estiment que les interactions professionnelles se sont considérablement réduites à la suite des transformations des dernières années et que la compétence n’est pas reliée à l’âge des professionnelles, les observations directes indiquent, au contraire, un rapport étroit entre ces deux derniers éléments qui s’illustre à travers de riches relations interpersonnelles. Les données quantitatives montrent, quant à elles, qu’une écrasante majorité de répondantes estiment que les compétences associées à leurs fonctions sont reconnues par l’organisation (89,3%), probablement sous l’angle de la conformité aux descriptions de travail, et qu’elles bénéficient d’une marge d’autonomie dans leur travail (83%). Deuxièmement, des résultats s’opposent également en ce qui concerne l’influence du cadre bureaucratique sur les « capacités » ou l’« intérêt » des infirmières d’expérience à maintenir un lien à l’emploi à la date d’éligibilité à la retraite. La majorité des répondantes s’estiment « incapables » de conserver un tel lien alors qu’une minorité d’entre elles exprime un intérêt face au nouveau rôle souhaité chez l’infirmière. Quantitativement, la prise de la retraite à bas âge est toutefois marquante, surtout pour celles qui occupent une fonction et possèdent une rémunération élevée (ex. cadres). Troisièmement, des contrastes apparaissent aussi en ce qui concerne les formes que prennent les rivalités entre les infirmières d’expérience et d’autres catégories professionnelles ainsi que dans les rapports intergénérationnels. Même si les trois quarts (76,2%) des répondantes d’expérience estiment que la répartition du travail devrait être le fruit d’une discussion entre elles et les plus jeunes, et non une imposition de la direction, près de la totalité (92,6%) veulent garder leurs acquis sociaux même si elles savent que la prochaine génération de travailleuses n’aura pas les mêmes avantages. Leur rapport face aux professionnelles d’agences privées de placement est également paradoxal. Huit répondantes sur dix (78,6%) perçoivent le fait que l’établissement recourt aux agences de placement contribue à alourdir leur travail, alors qu’une partie envisage de poursuivre leur activité professionnelle après leur date d’éligibilité à la retraite, par l’intermédiaire de ces mêmes agences. Finalement, il ressort de ce portrait hétérogène que la confrontation des changements du cadre bureaucratique sur l’activité professionnelle se manifestera différemment selon la vision paradigmatique qu’aura le personnel soignant de sa pratique. Les résultats quantitatifs et qualitatifs soulignent que ce paradigme sera influencé par trois dimensions : le territoire de pratique, le type d’établissement de services et l’unité spécifique de travail. Le style de gestion (traditionnel ou intégrateur) influencera également l’impact de ces changements. L’analyse et l’interprétation de l’influence différenciée des transformations bureaucratiques sur l’activité professionnelle s’illustrent par la manifestation de rapports plus conflictuels avec les autorités administrative et professionnelle, ainsi que dans les relations interprofessionnelles. Ces conflits ont émergé lors du passage d’un cadre bureaucratique historiquement construit sur un modèle médical (cure) qui considère la personne comme un « malade chronique » et associé à un style de gestion traditionnel, voire autoritaire, surtout dans certains CHSLD, à une approche « milieu de vie » privilégiant un modèle d’accompagnement (care) favorisant des services associés aux besoins spécifiques de la personne en perte d’autonomie, à titre de « partenaire actif ». Le style de gestion intégrateur de ce dernier modèle rapproche les domaines administratif et de soins de santé, approche que nous retrouvons davantage, mais non exclusivement, dans le cadre de soins à domicile. Une des conclusions majeures de cette thèse est la possibilité d’« enrichir les qualifications de base » (Le Boterf, 2005) des professionnelles lorsque le cadre bureaucratique et le style de gestion institués tendent vers un modèle care/intégrateur, ce qui constitue une forme de « compromis social » (Oiry, 2004). La « surutilisation » des effectifs (O’Brian-Pallas et al., 2005) qui en résulte peut expliquer, en partie, l’incontournable force d’attraction vers la retraite, dès la date d’admissibilité, du personnel soignant, quitte à ce qu’il poursuive ensuite ses activités professionnelles, selon des exigences personnelles, par le biais d’agences privées de placement. Les « fissures » (Laville, 2005) de la frontière entre les services publics et ceux du marché privé ne peuvent alors que s’accentuer, surtout lorsqu’on constate que le cinquième des effectifs, soit 14, 000 infirmières de 55 ans et plus, est potentiellement admissible à la retraite dès maintenant (OIIQ, 2008a). / This thesis aims to understand how bureaucratic transformations influence professional activity of experienced nurses since the 90s in Quebec in the field of elderly care who dealing with the lost of autonomy. It falls into a deep questioning of the Welfare state, its hierarchic regulation, and its relationship with the private market, particularly the private nursing agencies. Taking into account the unequal deployment of changes implemented in a top down manner, and promoted by economic considerations for a greater “performance” of public services, closer to the living environment of the individual, our approach takes also into account the specific relational dimension of nursing work, which is illustrated by differentiated forms that reflect practice models. Our research finally focuses on the relationship between professional activity and time of retirement. While taking into account the new nursing role expectations, in which “leadership” and “management team work” abilities are in demand as a “pivot professional” or “case management”, and of the important place of the concept of relational skills in the prescription of new modalities of service, closer to the specific needs of the individual, empirical data is presented in the form of a heterogeneous picture which shows that not all nurses subscribe to this type of professional practice. Age, experience and professional career, position or the practice environment will influence the relationship between their professional activities and bureaucratic framework in transformation. The empirical basis of this research consists of a data collection conducted between January 2003 and July 2006 and includes: 9 exploratory interviews; 7 semi-structured interviews with retirees, nurses, and nursing assistants; 17 meetings attended by management and unions; 21 direct observations with nurses, nursing assistants, orderlies, and home and social aids; 112 questionnaires distributed to the aforementioned professional groups; and 7 semi-structured interviews, in 4 different organizations from two territories. Four major findings emerged from the empirical findings. First, the relational dimension in the professional activities of experienced nursing staff and their perceptions regarding skills and ages have contrasting and even opposite forms: while some believe that professional interactions have greatly reduced following the transformations of recent years and that skills are not related to the age of the professional, direct observations rather indicate a close relationship between these two elements, and which is illustrated through rich interpersonal relationship. The quantitative data shows, in turn, that an overwhelming majority of respondents believe that the skills associated with their functions are recognized by the organization (89.3%), probably in terms of compliance with the job description, and that they enjoy a degree of autonomy in their work (83%). Second, results are also opposed in regards to the influence of the bureaucratic framework under the "capacities" or "interest" of experienced nurses to maintain a link to the employment at the date of eligibility retirement: the majority of respondents consider themselves "unable" to maintain such a link while a minority express an interest in facing the new expectation. Quantitatively, taking retirement at an early age is oustanding, especially for those who hold high position and pay (ex. managers). Third, contrasts also appear regarding the forms taken by the rivalries between experienced nurses, other professional groups and in intergenerational relationships. Even if three quarters (76.2%) of respondents believe that the division of labor should be the result of a discussion between themselves and younger staff, and not an imposition of the direction, almost all (92.6%) want to keep their social benefits even if they know that the next generation of workers will not have the same benefits. Their relationship with professionals working for private nursing agencies is also paradoxical: eight in ten respondents (78.6%) perceive that using their services contributes to increase their work, while continuing professional activities at the date of eligibility for retirement is planned through these same agencies. Finally, this heterogeneous picture underlines confrontational changes in the bureaucratic framework concerning professional activity that will manifest itself differently depending on the paradigmatic vision of the nursing staff of their practice. The quantitative and qualitative results emphasize that this paradigm is influenced by three dimensions: the territory of practice, the type of service establishments and the specific unit of work. Management style (traditional or integrator) will also influence the impact of these changes. The analysis and interpretation of the differentiated influence of bureaucratic changes on professional activity are illustrated by more conflicting reports with administrative and professional authorities, as well as with inter-professional’s relationships. These conflicts have emerged during the transition from a historically bureaucratic framework built on a medical model (cure), which considers the individual as a "chronically ill", and associated with a traditional management style, even authoritarian, especially in some nursing homes, to an approach that emphasizes living environment, a model of support (care) that favors related services to the specific needs of the individual in loss of autonomy, as an "active partner". The integrator’s management style of this latter model will bring the administrative and health care closer, that we find more, but not exclusively, through home care. A major conclusion of this thesis is the ability to "enrich the basic skills" (Le Boterf, 2005) of professionals when the bureaucratic framework and management style tend to set up a care/integrator’s model, which is a form of "social compromise" (Oiry, 2004). However, the "overuse" of the workforce (O'Brien-Pallas et al., 2005) that may result can explain, partially, the inescapable pull of retirement, from the date of eligibility of nursing staff, even if they then continues then their professional activities, according to their personal requirements, through private agencies. The "cracks" (Laville, 2005) in the border between public services and private market can then only increase, especially as the fifth of the workforce, 14 000 nurses aged 55 and over, are potentially eligible to retired now (OIIQ, 2008a).