Du système industriel. T. 3 (French Edition)
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Why have they organized collectively to act on the health system?
What kind of actions do they use? What are the effects of their actions on the work relations regions in the hospital sector? Adopting structuration theory requires that the researcher choose between two research schemes, namely analyzing strategic behaviours or analyzing institutions Giddens, , since structures are actualized through human activity. In accordance with Giddens, research must therefore consider the conditions and knowledge that have enabled and constrained the action that actualizes and transforms work relations.
Thus, this research is based on a dual methodology used to illustrate the analytical model presented above. To analyze the organizational and worksite regions, we conducted a new analysis of data collected for an exploratory case study carried out in a French hospital. Exploratory case studies offer the advantages of exploring phenomena that are multidimensional and difficult to understand Yin, Moreover, they facilitate the understanding of research goals, allow for questions to be adjusted, and can reveal complementary or new dimensions of a social reality Miles and Huberman, ; Strauss and Corbin, The data were collected in a University Hospital in France Havard and Naschberger, between and All interviewees had a high level of seniority and a good knowledge of the hospital surveyed.
All the data were analyzed using content analysis techniques, in three phases Creswell, : 1- a pre-analysis aimed at identifying the different topics related to the structurationist model; 2- categorization of the data; and 3- interpretation by crossing the analyses of two of the researchers. The internal validity of the information presented below is limited by the small number of interviews conducted Miles and Huberman, The external validity of this illustrative study can be assessed in the light of other research Miles and Huberman, ; Johnson, , however the results produced for the organizational region cannot be generalized.
The results will be presented by region, as they emerged through the data analysis. It should be noted that there is no a priori causal hierarchy between the regions identified, in accordance with the precepts of structuration theory. The order of presentation also follows a temporal logic, considering that:. Patients began individually contesting patient-medical staff relations in the s;. In France, the rise of demands and the mobilization of users in the field of health grew out of associations formed by patients with rare diseases.
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End users are invited as individuals, as members of focus groups, or in a more political capacity pressure groups, end user representatives to participate in the definition of their needs or of the product and methods of production. They are also frequently called upon to evaluate the quality of the product, its price and how it should be marketed. The action of users is multi-scalar and transforms the boundaries between patients and caregivers, and between expert and lay knowledge:.
At the same time, the rise of AIDS and the crisis that ensued, favoured the emergence of a new model of organization. HIV patients, feeling very much abandoned, became active, informed and organized, thus deconstructing the image of the passive patient who is ignorant and in need of the expertise provided by the medical elite.
In turn, these developments were followed by legislative changes in France.
A second part strengthens the individual rights of each patient information, conditions of access to medical records and freedom of expression, particularly with regard to the quality of care. For instance, through its effective fundraising campaigns, the French Association against Myopathies has taken an active role in the direction of genetic research. They have also been able to influence the national research orientations such that orphan drugs and diseases are now covered by the French health system.
New multi-discipline hospitals, acting as reference centres, have been created Chalamon, The Law provides opportunities for action by local actors in hospitals, individually and collectively, to assert their interests and needs.
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Indeed, Tabuteau showed the limits of health care democracy. This extension of state power over the health system can limit democratization within the regional agencies and hospitals.
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These representatives have succeeded in developing strong medical and organizational expertise generated by their communications networks with their members and the networks of expertise they have managed to mobilize. It has also led to the creation of new positions in the health system, those of mediators Compagnon et al. Political and economic actions fundraising campaigns that have subsequently made it possible to steer research have been taken in the national region.
As brought out in our literature review, the work of health researchers has been transformed by the co-design of research protocols and the choice of research priorities. Their actions in the worksite and governance regions had an effect on the work of care personnel and supervisors, more so in the worksite region than in the governance region, as will be seen in the following sections.
These changes in behaviour have led to a significant transformation in the work practices of nursing staff, whose work has come under pressure. Their access to information has also been facilitated by the widespread distribution of information and the use of new technologies specialist medical reviews, hospital ratings in the press, the internet, blogs, forums, etc. This development also reflects new types of behaviour that are evolving outside the hospital environment, in the broader society.
They grant themselves the right to contest medical diagnoses, as well as the way they are treated in the hospital process. This phenomenon reveals one of the tensions experienced by the nursing staff.
Fiabilité et performances supérieures
In fact, paradoxically, while patients have high expectations in terms of personal relations, it appears that the relationship aspect is not always given priority. For the nursing staff, this conundrum challenges their image of their work and the meaning it holds for them. The nursing staff have to make arbitrary judgements and prioritize their actions. These judgements are made individually, within the nursing teams Ruiller, or with the help of supervisors. Faced with these developments in the workload of the nursing staff, one nursing staff supervisor that we interviewed felt that she should play more of a supporting role for them.
In the absence of help from supervisors, the pressure perceived by the nursing staff can be a source of frustration and even pain. The board defines the general hospital policy and decides on the main actions to be implemented hospital development plan, social projects, medical projects, investment programs, budget, etc. They can be asked to participate in disciplinary committees to share their point of view on the reintegration or dismissal of employees found to be at fault. However, while their participation in the hospital governing body is seen by management representatives as being legitimate, it has met with some reluctance on the part of union representatives.
Thus, the two types of representatives limit their actions to their own interests and do not engage in any real dialogue. This has helped transform the national and organizational work relations regions by opening them up to issues other than those of modernity working conditions, pay, etc.
Within the infranational regions, our results are more contrasted. Through their involvement in joint committees evaluation, disciplinary committees, etc. They are actors as individuals, as a group and as an institution Bellemare, Their actions have led to changes in the national and infranational organizational and worksite regions. They have had an impact on work relations in different regions and have reduced the distinction between expert and lay knowledge.
Up until the s, the work relations regions involved managerial at the state and hospital levels and union actors, tasked with determining working conditions and the organization of work.
Manual Du système industriel. T. 3 (French Edition)
In the worksite region, their involvement in labour relations and the work of the nursing staff was limited. The most notable features of the "bioclimatic facade" facing the park are Les Serres — three greenhouse spaces each 32 metres high, 32 metres wide and 8 metres deep. The facades of Les Serres were the first structural glass walls to be constructed without framing or supporting fins. The building is constructed around the vast steel trusses of an abattoir sales hall on which construction had halted in The tramway 3b was opened in December .
From Wikipedia, the free encyclopedia. Science museum in Paris, France. The Daily Telegraph. Archived from the original on 25 January Retrieved 6 September