Abstracts
Résumé
L’objectif général de la thèse était de comprendre le processus d’appropriation des salles de pilotage (outils de gestion intégrée de la performance) mandatées en contexte de réforme (2015) du système de santé au Québec. Nous présentons le développement d’un nouveau devis méthodologique qualitatif, soit celui d’une étude de cas ethnographique organisationnelle multisite, et son application empirique pour reconstruire l’histoire de l’appropriation des salles de pilotage (2016-2019), à la fois comme processus et comme travail sociomatériel. L’appropriation comme processus se décuple en trois phases (implantation, test, adaptation) et selon trois trajectoires appropriatives (cognitive, structurelle, technique). L’appropriation comme travail sociomatériel permet de reformuler la recherche de performance, de perturber le travail d’imputabilité et d’effectuer une gestion intégrée de la performance en santé. L’analyse processuelle narrative multiniveau des données révèle entre autres comment l’appropriation des salles de pilotage permet de renforcer la pertinence clinique et managériale en contexte de gestion intégrée.
Mots-clés :
- Appropriation,
- outils de gestion de la performance,
- systèmes de santé,
- recherche ethnographique organisationnelle,
- sociomatérialité
Abstract
The general objective of the thesis was to understand the appropriation process of control rooms (integrated performance management tools) mandated in the context of the 2015 health system reform in Quebec, Canada. We present the development of a new qualitative methodological design - a multisite ethnographic case study – and its empirical application to reconstruct the story appropriating control rooms (2016-2019), both as an organizational process and as a form sociomaterial work. Appropriation as a process unfolds into three phases (implementation, test, adaptation) and follows three trajectories (cognitive, structural, technical). Appropriation as a sociomaterial work sequentially allows to reformulating performance management work, disrupting accountability work, and effecting value-based integrated performance management. A multi-level narrative process analysis of the data reveals how the appropriation of control rooms can strengthen the relationship between managerial and clinical relevance in the context of integrated performance management.
Keywords:
- Appropriation,
- performance management tools,
- health systems,
- organisational ethnographic research,
- sociomateriality
Appendices
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