Teses / dissertações sobre o tema "Services de santé – France – Gestion"
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Rimbert-Pirot, Anne-Gaëlle. "Analyse du processus de territorialisation de l'action publique : construction d'un territoire et appropriation d'un outil pour agir collectivement : cas des programmes territoriaux de santé". Electronic Thesis or Diss., Aix-Marseille, 2015. http://www.theses.fr/2015AIXM1099.
Texto completo da fonteThis research focuses on public policy territorialisation. While administrative territories, such as health territories, are imposed via a top-down process, a bottom-up approach is also recognised as being necessary. Here, local stakeholder and user needs are identified and understood meaning that territory specificities are recognised, local public actions are adapted, social inequalities are tackled and access to care is facilitated. This work focuses on the construction process of one such territory by public and local actors. In order to increase knowledge the objective is to study this process in relation to the procedure of territory building by local stakeholders and the ownership of a public policy tool which will lead to collective action. The first section is theoretical and presents the links between the three research areas: territrialisation, territory construction and appropriation of a tool. The second part presents the epistemological and methodological choices and the case study. Focus is placed on the deployment of a public policy tool, in this case a territorial health programme, in two health territories. The third part presents an analysis of the results which include interviews and observation. Finally, the fourth section places the results in perspective. The dimensions of constructed territory are reconsidered so as to offer a model articulating the dichotomy between prescribed territory and emergent territory while taking into consideration the specificities of a public tool for regionalisation
Rimbert-Pirot, Anne-Gaëlle. "Analyse du processus de territorialisation de l'action publique : construction d'un territoire et appropriation d'un outil pour agir collectivement : cas des programmes territoriaux de santé". Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM1099/document.
Texto completo da fonteThis research focuses on public policy territorialisation. While administrative territories, such as health territories, are imposed via a top-down process, a bottom-up approach is also recognised as being necessary. Here, local stakeholder and user needs are identified and understood meaning that territory specificities are recognised, local public actions are adapted, social inequalities are tackled and access to care is facilitated. This work focuses on the construction process of one such territory by public and local actors. In order to increase knowledge the objective is to study this process in relation to the procedure of territory building by local stakeholders and the ownership of a public policy tool which will lead to collective action. The first section is theoretical and presents the links between the three research areas: territrialisation, territory construction and appropriation of a tool. The second part presents the epistemological and methodological choices and the case study. Focus is placed on the deployment of a public policy tool, in this case a territorial health programme, in two health territories. The third part presents an analysis of the results which include interviews and observation. Finally, the fourth section places the results in perspective. The dimensions of constructed territory are reconsidered so as to offer a model articulating the dichotomy between prescribed territory and emergent territory while taking into consideration the specificities of a public tool for regionalisation
Martin, Pascal. "Les métamorphoses de l'État social : la réforme managériale de l'assurance maladie et le nouveau gouvernement des pauvres". Paris, EHESS, 2012. http://www.theses.fr/2012EHES0077.
Texto completo da fonteBetween 1995 and 2008 the reform of the health insurance system in France deeply transformed the social state. From the apex of the state downwards various apparatuses (institutional structures, training programs, work organization) induced new (or renewed) thought categories and practices that penetrated the representations and work of institutional agents. The role of the state was reinforced and managerial policies incorporating a new governance system were introduced. In the course of this transformation, the training programs aimed at different categories of agents were reformatted to fit both the new political orientations of the health system and the discourse of "quality service" with its managerial tools. The implementation in January 2000 of a universal health coverage programme called CMU (Couverture Maladie Universelle), the aim of wich was to protect precarious populations, has been empirically observed. The influx of "assisted" population groups claiming CMU or AME (state medical aid for certain foreign populations) benefits led to a reorganisation of the system, evidence in the way in wich users of the health system are treated at the reception at local level. The managerial rationalisation allowed a classification of users ranging from "good" insured clients to the "assisted" and the imposition of strictly quantitative objectives (norms of "quality"), rationalised work time and work organisation measuring such items as "client" time spent in waiting lines on the length of interviews. At the same time, however, arbitration over the attribution of conditional CMU or AME coverage was left to the discretionary appreciation of health service employees
Eckenschwiller, Maud. "Etude de l’émergence de la collaboration interprofessionnelle au sein du système hospitalier français". Electronic Thesis or Diss., Bourgogne Franche-Comté, 2023. http://www.theses.fr/2023UBFCF009.
Texto completo da fonteInterprofessional collaboration (CIP) is at the heart of hospital practices in France. In view of a complex and constantly changing environment, it brings many benefits for patients (Ben Maaouia, 2018; D'Amour & al., 2005), professionals (Brunelle, 2009; Lemieux-Charles & McGuire, 2006) and the organization (Aumais & al., 2012; Nielsen, 2004). However, the mechanisms of its implementation need to be further identified, explored and understood, mainly at the organizational and interactive levels (Dumas & al., 2016; Gheorghiu & Moatty, 2005; Nobre, 2013; Vallejo, 2018). This research work based on the literature’s recommendations to address IPC. These include addressing IPC as a process (Humphrey & Aime, 2014; Kosremelli Asmar and Wacheux, 2007), considering interactions (Lemieux & McGuire, 2006; Ben Maaouia, 2017) and prioritizing its organizational factors (Jacob, 2015; Nolte & Tremblay, 2005; Robidoux, 2007; Sicotte & al., 2002) and its emerging states (Marks & al., 2001; Seeber & al., 2014; Waller & al., 2016).Based on these findings, our research work, articulated in three studies, is based on the following problem: “How to promote the emergence of interprofessional collaboration within the French hospital system?”.To address this problem, we are conducting a literature review that allows us to identify and mobilize two complementary theoretical frameworks. The first is the theoretical framework of the Interdisciplinary Training for Collaborative Practice in Oandasan, D'Amour & al. (2004), which deals in particular with organizational factors. Second, it is the Bedwell & al. (2008) collaborative performance framework dealing with emerging states. On the other hand, we are conducting a qualitative and abductive study with agents of a French hospital group.The main results of our research work is about the identification of the issues of the CIP within French hospitals, about the interactions between organizational factors and the main emerging states of the CIP (trust, cohesion, mutual recognition, willingness to collaborate and leadership) and the contextualization of these different elements.The study opens up new managerial perspectives based on the development of shared mental models for the emergence of IPC.Future perspectives are directed towards the further application of our theoretical framework and our proposal for a framework for managerial reflection to new empirical research
Guan, Wei. "Le rôle de l'intégration de la supply chain et de la modularité de prestation de services dans le développement de la capacité de personnalisation de masse en santé : le cas de la MAIA". Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0519/document.
Texto completo da fonteThis research is conducted in the French healthcare context, in which the care of the growing population of health service users with chronic diseases, requires a coherent coordination of multidisciplinary interventions from multiple providers. This personalized care is resource consuming. In a context of resource scarcity, the cost-quality dilemma arises in the care of this growing population. The search for an answer to this dilemma has led us to focus on the concept of Mass Customization (MC), widely studied in Supply Chain Management (SCM) and Operations Management (OM), as well as its implementation in the healthcare context. According to these two fields of literature, MC can be achieved by developing Mass Customization Capability (MCC). Moreover, Supply Chain Integration (SCI) and Modularity-based practices have been identified as the two most important factors facilitating its development. Therefore, this research aims to study the role of SCI and modularity, as well as their relationship in the development of MCC in the healthcare context. Based on the relationships studied and those insufficiently investigated between these three concepts in SCM and OM literature (general context), a conceptual model has been established, and we seek to test this model in the healthcare context. For this purpose, an exemplary/critical case has been identified: MAIA Marseille. Through this case study, our research enabled us to test and refine the pre-established conceptual model, and to highlight the lessons to be learned in the development of MCC in the healthcare context
Dionko, Maoundé. "Contractualisation et performance du système de santé au Tchad". Lyon 3, 2007. https://scd-resnum.univ-lyon3.fr/in/theses/2007_in_dionko_m.pdf.
Texto completo da fonteAfter several years of civil war and economic recession and despite the implementation of various strategies related to healthcare, the improvement of Chadian healthcare system remains one of the weakest in Africa. There are four main causing factors: insufficient healthcare infrastructures, poor healthcare organization as well as quantitative and qualitative insufficiency in healthcare staffing and lack of equipment. Vis-à-vis this incapacity of the public healthcare system to meet the needs of the populations, the government has decided to implement contracting as an instrument in order to improve the performance of the healthcare system. However, the contractual process has some backdrops that the partners believe to know exactly what is in store. Yet, in reality, they generally don't "find out” what they signed until there is a disagreement. That is why this new healthcare policy seems an excellent factor for the improvement of the performance of the healthcare system if only some legal issues are addressed. Because, if the contractual process has been until now considered as a management instrument in order to improve the performance of the healthcare system in Chad, this one could not be freed of some fundamental provisions which define the public character of its action. It can only improve in an already set legal framework that has structured the institutions, and by the same token distributed the tasks and roles, structured the authority, improved possibilities of control as well as of protection
Lu, Angang. "Le maire en tant que gestionnaire d'une ville : gestion publique, gestion privée". Paris 1, 1997. http://www.theses.fr/1997PA010039.
Texto completo da fonteHe mayor is the unique, symbolic representative of the town. He plays two roles : firstly, as local magistrate and secondly, as agent of the state. His administrative and legal duties are strictly regulated. The mayor has freedom with respect to town management, but each mayor has to deal with different, often special situations and has his own method of government. The town's future is in his hands right from the time of his election. Private sector management methods, known for their efficiency, can be employed and are more and more popular in the public sector. Moreover, this tendency is not just a passing fashion. "the town is an enterprise" and the purpose of its activity is to produce services and assets for its "clients", who are the local residents. However, the town hall has its own structure and culture and cannot be compared to any other type of organisation. Its aim is not to make money. The town cannot therefore be considered as a simple company and company management methods cannot be applied to it as such. In his role as town manager, the mayor must define objectives and draw up a strategy for public policy. However, town budgets are not inexhaustible and all action taken must be evaluated from a financial point of view. Whatever the objectives of public policy and improvement in management, a project can only be carried out if financing is available. Since financing comes, in principle, from local sources, particular attention must be given to the financial analysis of the locality. Contracting with private firms enables great savings to be made in areas where the municipality is limited in its scope of action. The very size of a town encourages it to seek partners capable of operating on a large scale so as to provide services as cheaply as possible. As a general rule, marriage between the public and private sectors is thought to stimulate greater flexibility of action than if the activity were performed by public bodies only. In the future, for an action to be considered viable in local government, the mayor must prove that the methods he is using are sound. In other words, by demonstrating the logic and efficiency behind his management, the mayor can obtain the endorsement of his decisions in matters of finance, staffing and town planning
Ravoux, Vincent. "Le panier de biens et de services de santé : une approche managériale pour la France". Dijon, 2001. http://www.theses.fr/2001DIJOE002.
Texto completo da fonteVillerabel, Gustave. "Le service de santé des armées". Aix-Marseille 3, 1991. http://www.theses.fr/1991AIX32010.
Texto completo da fonteLe, Goff Erwan. "Les Villes-Santé en Bretagne : quels choix de gestion et d'aménagement des espaces ?" Phd thesis, Université Rennes 2, 2012. http://tel.archives-ouvertes.fr/tel-00772443.
Texto completo da fonteJover, André-Franck. "Les métamorphoses des services de santé au travail - entre santé au travail et santé publique". Thesis, Paris 2, 2015. http://www.theses.fr/2015PA020011.
Texto completo da fonteHealth and security at work, occupational risk prevention (road risk, psychosocial risks), intensification of labor conditions… A number of questions that the enterprise has to take into account. Answering them assumes a variety of points of view and skills. Occupational health services, that have the exclusive mission to prevent any worker health alteration occurring from their work, contribute to this debate. Due to their unique position, as a field actor, they should be the master piece of the occupational health system ; these services are, however, victim of a collective disaffection. The delicate combination of the “medical fitness for work” concept and the occupational risk prevention concept contributes to this disaffection. Since 1942, the institution has seen deep metamorphoses, a number of them appearing from the combination (sometimes being a cause for tension) of the labor law and the public health law. After the Liberation, the incorporation of the institution to the Ministry of Labor, sealed a long domination of the Labor law. The growing power of the Public Health has been jeopardizing progressively this domination. The reform dated 20th July 2011 illustrates this change of balance. The analysis of the links between the Labor Law and the Public Health Law suggests to propose a new paradigm for the sake of the workers’ health, based upon the idea – which is also a fact – that the occupational health service cannot be compared to other providers : this service contributes to the general interest
Andrieu, Pierre. "Les marchés à l'épreuve des nouveaux modes de gestion du secteur hospitalier public". Bordeaux 4, 1996. http://www.theses.fr/1996BOR40044.
Texto completo da fonteIndependent administration added to devolution allowed growth of innovating operations that irritate the orthodox of market overt. To authorize creativity shows without breeding corruption, such are the news challenges of tursteeship. Evry "exotic" deal is not inevitably more efficient. But to give up innovating in administration on account of presumed risks and costs should be quite as suicidal as to get rid of research and development. The author draws the shapes of possible advancement of market overt code that valuation should clear. Health public service organization in network calls new rules of public accountancy. To break new ground is not always compatible with public law rules orthodoxy. The writer suggests ways of answers to leave this paradox. An experimentation visa for a limited length of time, specific to each experimentation matched necessarly to a valuation frame the keystone. Expansion of experimental method to administration sciences thanks to valuation should turn observation-deduction into experimentation-deduction
Berrivin, Renaud. "Les contrats centre-périphérie comme levier de modernisation du management public : analyse comparée des stratégies de changement et du pilotage de deux grands réseaux de services publics, Ministère de l'équipement, EDF GDF Services". Paris, Institut d'études politiques, 1995. http://www.theses.fr/1995IEPP0015.
Texto completo da fonteThis thesis in sociology deals with the implementation of managerial contracts between center and periphery of public organizations. These contracts should improve the quality of the internal relationship between center and periphery and stimulate on the one hand the engagement of actors and on the other the efficency of these organizations. This thesis is based on the empirical analysis of two comparable processes of managerial change which promote the contractual philosophy or model, and the evaluation of their impact : the policy of modernization of the ministry of equipement and the reform of EDF GDF services (distribution of electricity and gas). With the comparison of these two programs, two models of center-periphery regulation emerge. This thesis demonstrates that the impact of center-periphery contracts is contingent. There is no automatic positive consequence and contracts can be in certain cases counterproductive. Nevertheless, this study emphasizes that these kinds of contracts can be, under certain conditions, an efficient tool to reform French public management. But, this change depends on the capacity of the center, as a real leader, to drive strategically a program of change which is extremely complex. It also means an important investment in knowledge and. .
Brunat, Marion. "Analyse économique de l'accessibilité des soins primaires en France : la question de l'organisation de l'offre de services de santé ambulatoires". Grenoble, 2010. http://www.theses.fr/2010GRENE008.
Texto completo da fonteThe objective of this work is to bring to bear a critical reflection on the choices of public policy in the fight against health inequalities, through the utilisation of the concept of " real possibilities for access " as applied to both preventive and curative care. In a neo-institutional economic approach, we develop an analysis of the accessibility of medical care recognising the importance of the financial aspect and integrating the structural characteristics of cane supply and professional practice. We stress the limits of the CMU-C provision in an unchanged institutional and organisational system. An econometric study of logistical regression on the bases of medical consumption in 2007 by beneficiaries of CMU-C supports the position we take. Thus we stress the need for a reflection on the benefits and ways of developing an integrated and pluri-professional supply of health services (health centres and " maisons de santé "). We make use of documentation provided by semi-directive interviews with several persons of the whole health sector. These differing forms of organisation are a fruitful avenue to explore to improve coordination, continuity and global healthcare service. Nevertheless, their development depends on internal choices of organisations to achieve an economic gain in terms of the cooperation of professionals. It depends also on the rules and perceptions pertaining to the system at the institutional level. Their emergence as structured ways of supplying primary health care as a means of reducing health inequalities depends on the development of new organisational forms of outpatient healthcare supply as well as their adequate institutional recognition
Capgras, Jean-Baptiste. "Le programme de médicalisation des systèmes d'information (1982-2009) : anamorphose et métamorphoses d'un dispositif de gestion". Lyon 3, 2009. https://scd-resnum.univ-lyon3.fr/in/theses/2009_in_capgras_j-b.pdf.
Texto completo da fonteThe “programme de medicalisation des systemes d’information” (PMSI) is the information system tracking the inpatient activity of the French hospitals. It is used by the Health Ministry to allocate budget for short inpatient stay only. The allocation of this budget, corresponding to nearly 50 billion euros today (equivalent to nearly 3% of France’s GDP), is tightly connected to the historical development, tribulation and evolution of the PMSI. Based on the “theory of activity” developed by Y. Engestrom and the concept of “situation de gestion” (managerial context) defined by J. Girin, we develop a comprehensive understanding of this “management system”. This study was conducted looking at the implementation of the PMSI both within hospitals and regulatory agencies. Our study demonstrates that the PMSI is first a true “management system” tool. Second our study develops a new concept called “management system” that relies on a grid framework to analyze activity systems with instruments. The PMSI is the results of an anamorphosis whose final aim was to allocate financial budgets (design for use). This achievement led to a main application (“forme pivot”): the “Tarification à l’activité” (DRG payment). This resulted in improving the completeness of the data/information collected. It has now evolved (metamorphosed) for multiple applications (design by use)
Díaz-Romeral, Gomez Alberto. "La responsabilidad por asistencia sanitaria en los ordenamientos español y francés". Bordeaux 4, 2009. http://www.theses.fr/2009BOR40072.
Texto completo da fonteA comparative research on Spanish and French public health care liability systems and on their national health systems. These two systems are built on different basis; however, throught different ways, they both provide a similar level of protection to national health system's users. The most difficult issues are those related to risk in health care. It is not possible to separate health care and risk, -l'aléa médical-, and this means that dammages may occur even though no fault has caused them. That's why it is imperative to draw a clear borderline between liability and other forms of social protection that only the parliament may grant
Pierru, Frédéric. "Genèse et usages d'un problème public : la "crise" du "système de santé" français, 1980-2004". Amiens, 2005. http://www.theses.fr/2005AMIE0055.
Texto completo da fonteGlavany-Godet, Isabelle. "Le concept de système sanitaire est-il cohérent à un niveau infranational? : un terrain d'étude : la Bretagne". Paris 1, 1986. http://www.theses.fr/1986PA010036.
Texto completo da fontePélissier, Fanny. "Le réseau en santé et l'assurance maladie". Dijon, 2003. http://www.theses.fr/2003DIJOE002.
Texto completo da fonteThe recent increase in the number of health-care networks calls for appropriate funding and allocation based on a meaningful evaluation of this new form of organization. The incipient restructuring of France's health-care system into networks is seeing funds decentralized and managed by regional bodies such as regional union of health insurance funds (URCAM). The creation in 1998 of the FAQSV fund for the improvement of ambulatory care to finance, inter alia, networks connecting free-market practitioners and health-care establishments, was a step down this road. But is this instrument adapted to what a "good" network should be? Beyond the issue of the FAQSV the wider question is raised of the suitability of the tools employed for restructuring the health system on a regional basis. It is the funding of the network as a whole that needs to be rethought in the light of the theoretical foundations of "managed care" as adapted to the institutional arrangements in France
Lacaze, Delphine. "Le rôle de l'individu dans la socialisation organisationnelle : le cas des employés dans les services de restauration rapide et de grande distribution". Aix-Marseille 3, 2001. http://www.theses.fr/2001AIX32063.
Texto completo da fonteOrganizational entry is a determinant phase for newcomers. It refers to the larger concept of organizational socialization, imported from sociology. Defined as the process of "learning the ropes" of a new job, organizational socialization was first considered an instrument of control over individuals (Van Maanen and Schein, 1979). Later, the proactive role of newcomers, trough cognitive (Louis, 1980) and information seeking activities (Morrison, 1993 ; Ashforth and Saks, 1996), was recognized. In service firms where turnover is high, it is important that customer contact workers, representing their organization, be quickly socialized to insure a good quality of service. The role of the individual in organizational socialization is explored in a population of cashiers in the retailing industry and in fast-food operations. .
Bichon, Marie-Claude. "La fonction « coordination » dans le réseau de santé : Etude des principales conditions de performance de la fonction". Corte, 2008. http://www.theses.fr/2008CORT1049.
Texto completo da fonteThe purpose of health networks is the compleat and coordinated care of patients by professionals from health and social sectors in a specific area and, most often, for a specific pathology or population. The government expects that these networks will also control health expenses throught a more rational system of care. In order to meet these challenges and assure their continuitiy, the networks should become agents of change, in terms of both continuity and quality of care, in the midst of changing practices. At the center of the system is the coordinator, on whom the success of the entire system largely depends. Nevertheless, professional literature has little to say about this new profession of coordinators, and managers lack sources of information required for its successful realization. This doctoral research seeks to examine the main requirements of the performance of the coordination in the health network. It provide for Public Health a research directed to Human Resources (RH) that will provide a keener understanding of its function, its challenges and its requirements. Finally, it propose to network managers and their associates ways to improve the performance of the coordinator and therefore contribute to the efficiency of the entire network
Couroux, Bernard. "De la faculté d'adaptation d'un établissement public à son milieu : l'exemple d'EDF". Nice, 1991. http://www.theses.fr/1991NICE0001.
Texto completo da fonteFoures, Franck. "De l'urgentisation des routines à la routinisation des urgences : vieilles maladies, nouvelles crises, simples alertes". Paris, Institut d'études politiques, 2011. http://www.theses.fr/2011IEPP0061.
Texto completo da fonteBeyond the major sanitary crises, at the turn of the 21st century a multiple of more reduced and barely politicized crises have appeared, affecting this time the regular and usual activities of the services in charge of Public Health. Rabies and meningitis are two such diseases managed routinely in an almost autonomous way by specialized administrations throughout the second half of the 20th century and which appear suddenly in the form of crises, as from 2000s. These diseases and their various episodes acquire at first a new status and appear as crises because of a redefining of the stakes which they convey by new actors on the sanitary scene or by brutal renegotiations of their property/suitability between these same actors. The very clear increase of files so made visible at the national level is accompanied by a standardization of their practices of management connected to a coverage taken on by structures and specialized actors (InVS, missions and the department of sanitary emergencies). This work studies the impact of the changes of the sanitary scene which were decided after the major crises concerning the taking on and the management of the sanitary files. It concludes in a shape of everyday acceptance or in a global dynamic of the taming of certain forms of crises by a process "of urgentisation of the routines" accompanied by a progressive "routinisation of urgencies”
Oganesyan, Ani. "Les réformes du système de santé en France et leurs impacts". Thesis, Nice, 2016. http://www.theses.fr/2016NICE0005/document.
Texto completo da fonteThe thesis provides an overview of theoretical approaches to health care systems reforming. It is aimed to solve the contradictions in the reduction and optimization of total expenditure on health and the increase in life expectancy and also the quality of life with an comprehensive analysis of main tools of reforming in health care system in France, as welle as to make the proposals using constructive French experience in reforming teh economic ans asministrative mechanisms of teh health care system in Russia
Vergnenègre, Alain. "Indicateurs explicatifs de la durée de séjour chez les personnes agées admises dans une unité de court séjour pneumologique". Toulouse 3, 1994. http://www.theses.fr/1994TOU30235.
Texto completo da fonteAit, Haddadene Syrine Roufaida. "Modèles et méthodes pour la gestion logistique optimisée dans le domaine des services et de la santé". Thesis, Troyes, 2016. http://www.theses.fr/2016TROY0027/document.
Texto completo da fonteThis work addresses the vehicle routing problem (VRP) including timing constraints: time windows (TW), synchronization (S) and precedence (P), applied in Home Health Care sector; giving the VRPTW-SP. This problem consists in establishing a daily caregivers planning to patients' homes asking for one or several services. We have started by considering the problem as a single objective case. Then, a bi-objective version of the problem is introduced. For solving the single-objective problem, a Mixed Integer Linear Program (MILP), two constructive heuristics, local search procedures and three local search based metaheuristics are proposed : a Greedy Randomized Adaptive Search procedure (GRASP), an Iterated Local Search (ILS) and a hybrid approach (GRASP × ILS). Regarding the bi-objective VRPTW-SP, different versions of multi-objective evolutionary algorithm, including various local research strategies are proposed: the Non-dominated Sorting Genetic Algorithm version 2 (NSGAII), a generalized version of this latter with multiple restarts (MS-NSGAII) and an Iterated Local Search combined with the Non-dominated Sorting concept (NSILS). All these algorithms have been tested and validated on appropriate instances adapted from the literature. Finally, we extended the VRPTW-SP on a multi-period planning horizon and then proposed a MILP and a matheuristic approach
Mouillac-Delage, Agathe-Marianne. "Les établissements de santé à l'épreuve de la Gestion Prévisionnelle des Emplois et des Compétences". Thesis, Montpellier 1, 2014. http://www.theses.fr/2014MON10033/document.
Texto completo da fonteHuman resources represent the most important and most expensive part of health care. Anticipating the need for human resources through a forward planning of jobs and skills (FPJS), represents, today, a fundamental challenge in a health, social and medico-social context undergoing profound mutation. Established by the « law Borloo », «FPJS » is often seen as a paradoxical notion with a double face, of which the unclear contours, confer on it, multiple interpretations Often considered as a simple obligatory mechanism, source of sanction and jurisprudence litigation, nevertheless, « FPJS » has to be seen « differently ». If it's true that it's sometimes the first sign of restructuring, it is, above all, a real predictive and operational « approach » to anticipate and manage the human resource needs, in order to develop activities of health facilities and ensure the quality of patients care
Lenay, Olivier. "Régulation, planification et organisation du système hospitalier : la place des outils de gestion dans la conception des politiques publiques". Paris, ENMP, 2001. http://www.theses.fr/2001ENMP1018.
Texto completo da fonteSuberchicot, Jean-Luc. "Le service de santé de la Marine Royale (1661-1793)". Paris 4, 1998. http://www.theses.fr/1998PA040010.
Texto completo da fonteMonnet, Marlène. "L'intermédiation du prestataire de services logistiques dans une "supply chain" en contexte de développement durable". Aix-Marseille 2, 2007. http://www.theses.fr/2007AIX24011.
Texto completo da fonteThe purpose of the present research is to find out the conditions which enable a logistics service provider to act as a middleman in a supply chain in the context of sustainable development. Face with regulation pressures concerning electric and electronic equipment waste and the various reactions of the actors responsible for recycling, the research develops two phases : the first, in Norway, provides a reading guide of the general context ; the second, in France, consists in a typical case study which involves many interacting actors and emphasizes the intermediary role of the provider. The results depend on the mobilization of skills in the field of thinking, organizing and relating to one another, and also imply the smooth implication of the stakeholders. These results should demonstrate that the logistics service provider who offers help in the field of global responsability can actually act as an intermediary in the context of sustainable development. Provided he or she takes into account all the parties involved and brings together the required abilities for coordinate management of the supply chain
Tort, Éric. "Contribution à la connaissance des systèmes comptables des grandes entreprises en France : approches organisationnelles, managériales et pratiques de gestion : bilan et perspectives". Paris 1, 2001. http://www.theses.fr/2001PA01A001.
Texto completo da fonteCourbis, Thierry. "Économie de la santé et gestion de la vieillesse : le système de prise en charge des personnes agées dans les alpes-maritimes". Nice, 1988. http://www.theses.fr/1988NICE0022.
Texto completo da fonteThe problem of elderly persons recognized in france in the 1960's has been integrated in a old age policy. But the economic crisis, the increase of numbers of elderly (problem of the old age pensions, medical coasts etc) and the changes in the social image of the old age, has imposed a necessary management of the old age. That one want giving an answer to medical care and assistance needs, requiered by the elderly (study of morbidity and disability) by using a complex system (study of different institutions, services and centers constituting the overall system of distributing assistance). To measure the real efficacity of these institutional answers, we have analysed the different factors of this problem into a specific department : the maritime-alps. The study of the local demography by using existing statistics, and some projections (use of p. R. U. D. E. N. T. Evaluations c. F. I. N. S. E. E), the social and economic factors (study of incomes, housing conditions, loneliness etc) and also the elderly state of heath, explain the being of a population caracterized by important risk factors of coming in institution. Such a population cannot be taken into account by the social or sanitary system. . .
Gerbaud, Laurent. "Financement des services de soins hospitaliers et développement de l'évaluation de la qualité des soins". Dijon, 1999. http://www.theses.fr/1999DIJOE020.
Texto completo da fonteLeclerc, François. "Approche contingente des structures et activités de gestion du personnel". Bordeaux 1, 1987. http://www.theses.fr/1987BOR1D302.
Texto completo da fonteWhile tackling the various functions of personnel from a contingent perspective, the aim of this survey is to study the structure, the activity and the functions of the management of personnel. The survey is based on the analysis of facts gathered from questionnaires which were completed by 50 compagnies in the south west of france. The procedure followed here consists in trying to authenticate the hypothesis of different contingent factors, mainly the size and the field of the activity concerning the formal structure, the roles and functions of the various personnel departments. Taken as a whole it would seem that the organizational size has a direct influence on the formal structures and the activities of the service. This analysis shows that, universally, the variety of functions of the personnel department can not be explained by a unvocal determinist relationship between the contingent factors studied and the functions of the department. For the latter, it would seem more appropriate to contemplate a positively contingent approach favouring the strategy of the actors in the organisations
Galhuid, Frédéric. "Le régime fiscal des délégations de services publics locaux". Aix-Marseille 3, 1999. http://www.theses.fr/1999AIX32034.
Texto completo da fonteMalléa, Patrick. "Performance durable en santé et territoire : méthode d'anticipation et d'évaluation des vulnérabilités pour les agences régionales de santé (MAEVA)". Paris, ENMP, 2010. http://pastel.archives-ouvertes.fr/pastel-00566253.
Texto completo da fonteCan we, today, address the citizens' healthcare without talking about his territory ? This seems unbelievable, and the French government has already understood this and to answer to this question has designed and launched the "ARS", which stand for "Healthcare Regional Agency", in order to define and manage healthcare strategy at its own territory level (region). But, before arriving to this conclusion, the healthcare system had to reform itself along four centuries moving from healthcare concept to healthcare system concept. This has been conducted through several reforms from decision makers that had to use quantifiable elements to perform so. Therefore, some specific indicators, called "health deterministic indicators", have been put in place. Then, the sum of all these along the years bring the French government to launch the ARS which are defined within the law called "HPST" standing for Hospital Patient Healthcare and Territory). Now, if we are looking closer to the ARS mission, it clearly appears that they are closely linked to the notion of "sustainable performance" for which it is important to define underneath concepts as "Performance", "sustainable performance" and of course "healthcare sustainable performance". Then, to applied those healthcare sustainable performance principles, the ARS would have to learn how this performance could be increased or decreased based on some specific mechanisms. Therefore, the notions of "risk" and "vulnerability" became key components of such an approach. However, looking forward it appears that the vulnerability has a close link to risk and that the risk is essentially linked to a mismatch between the "offering" and the "demand" or the "needs" of the citizens. Then, by integrating all those aspects, the ARS would became a healthcare sustainable performance for a territory vector, thanks to new governances, a better risk management politic and the usage of performance measures as healthcare expenses for a territory, regulation tool. Based on this it is easy to understand that the ARS will be at the heart of the reform and will have to drive the regional health system. But, and it is true for all sectors (private and public), the management of such a system cannot be done without an accurate information system. Then, the next question is "what is an information system for a health system?" but also, "how to feed this information system in order to let it provide relevant information?" Therefore, to understand this, it is necessary to understand the definition of all existing information system types and their role in the healthcare environment and how the citizen and the patient will take benefits of that. Based on this theory, it is now interesting to better understand the status of the current health information system and why he has failed in his pupil service missions, and that in order to better understand how, through a new ARS governance, it will be possible to have health information system able to reach the sustainable performance goals. The failure notification and the willingness to get the French healthcare system out of this trap is real. However, it is important to notice that to succeed in the mission regarding the information system, it will be necessary to adopt an accurate methodology. But, it is also important to understand that after investigation, no such methodology has been found and it appears necessary to build one in order to satisfy the needs of health professionals, citizens, patients. The final goal being to allows the French health system to reach the health sustainable performance goals by the understanding and the resolution of business pains coming from the citizen requests known and understood at the right time and the right location. It is easy to understand that cannot be done without a better understanding of the human, geographical, politic, social and health environment that could be better handled through new technologies. Therefore, it will be possible to put in place certain of these technologies that will enable this approach by allowing a global access to data or simplifying application integration into complex business processes or providing analysis and permanent traceability tools allowing to take "preventive" decisions (real time) or "corrective" decisions (after past facts analysis). Everything, of course, being at maximum secured and with maximum integrity guarantee. This thought has bring to the definition of MAEVA methodology which seat in the middle of a particular context composed by actors (health professionals, citizens, politicians, patients, etc. ), stimulus (known or unknown meaning handled or not), the health system itself (on which the methodology is applied) and results (benefits for the health system increasing the sustainable performance of the health system). To do so, I has been necessary to build the method in two "layers". The first layer is made of components called "fundamentals" which permit to define the project foundations that has to be implemented by following MAEVA rules. These fundamentals, counted as four (plus one) allow the definition of a global consensus for the project and for the associated community of practice in order to successfully deliver the related project. The "fifth" fundamental allows the rationale to pursue on a new version or to stop the project in its current stage if the necessary condition to continue it are not met. Once these basis have been setup, the method offer the capability to define five actions which will allow to manage the project from the beginning until the final delivery. These actions are: "Integration", allowing the integration of the data sources needed to the project implementation; "Detection", allowing the definition of "actuators" components bringing to a risky situation ; "Anticipation", allowing the definition of self defense mechanisms against the previously mentioned "actuators"; "Action", allowing the realization of the project mission; and at the end, "Evaluation", offering factual elements to analyze project outcomes and provide therefore facts to the fundamental "Decide". All these components are linked within the methodology through two "tools": Iteration, allowing to complete a phases with results coming from an upfront phase; and the Active Memory Zone (ZAM) which is used to be the project memory in order to store traceability data, but also "keep in mind" all taken decisions. This methodology, as defined, hasn't been designed theoretically in few months, but has been the result of real life projects analyze done during the past five years in the area of health system performance. It is also good to know that the MAEVA approach based on consensus will be a great help for the ARS, as they will have, since the beginning, work with people, processes and information coming from diverse horizons that were, until now, more in competition rather than in collaboration mood. But all of this is just about the first version of the methodology and already, due to read publications, it appears that some research works, like "Design Thinking" should be integrated partially or totally in a future "release" of MAEVA
Arekian, Valérie. "Recherches sur la notion de régulation en droit public français : le cas des services publics de réseaux". Lille 2, 2003. http://www.theses.fr/2003LIL20032.
Texto completo da fonteGinglinger, Édith. "Finance et entreprises règlementées : application à la gestion déléguée des services publics locaux en France". Paris 9, 1988. https://portail.bu.dauphine.fr/fileviewer/index.php?doc=1988PA090024.
Texto completo da fonteGinglinger, Édith. "Finance et entreprises règlementées application à la gestion déléguée des services publics locaux en France /". Grenoble 2 : ANRT, 1988. http://catalogue.bnf.fr/ark:/12148/cb37613926g.
Texto completo da fonteHemedzo, Komi Lolonyo. "Etude comparée du fonctionnement du service social des pays du sud (Afrique) et du nord (France) : structures, formes et manifestations de l'esprit de solidarité au Togo et en France". Besançon, 2010. http://www.theses.fr/2010BESA1028.
Texto completo da fonteSocial security protection requests more work since one never finished resolving social problems. The increase in healthcare expenditures does not rhyme necessarily with the quality of social security systems in OECD countries. However it is important to say that developed countries showed good results and made good progress compared to developing countries in regard social construction. The African system remains centered more on retirement than on other aspects of social security. Thus the passage from an exclusive system to a generalized system is a necessity. There is a link between a high level of social security protection and solidarity. The improvement of social security systems constitutes one of the major objectives of the battle against the merchandization of the social security in developed as well as in developing countries. In any case, it is necessary to recognize that if Europe (in this case France) is at this level, this is due to the fights of left forces and the unions. By lack of that, the African model will remain at the phase of what Tönnies calls the gemeinschaft. The gemeinschaft rhymes with the mechanical community solidarity. African systems have the imperious necessity to go from gemeinschaft to geselschaft. In other words, arrived to the organic solidarity of Tönnies, theses systems can adopt the contractualization of Rousseau. Togo for instance must not follow exactly the French process in all the details but its projections in this perspective can be done with the view in the rear mirror concerning traditional or historic solidarity. One wonders why the momentum of community solidarity is not so far contractualized
Mbouna, Murielle-Natacha. "Analyser la participation des usagers à la gouvernance du système de santé : une perspective de la théorie des parties prenantes". Lyon 3, 2010. https://scd-resnum.univ-lyon3.fr/out/theses/2010_out_mbouna_m.pdf.
Texto completo da fonteSince 1996, consumers are entitled to sit in the Boards of directors of French public hospitals. The law of March 04th, 2002 dealing with patients' rights dedicates them as actors of the health care system governance. This phenomenon, which is called sanitary democracy, organizes consumers' involvment within health policies decision processes. By questionning consumers power in decision-making, the sanitary democracy remains problematic. Are consumers salient stakeholders or not in the French health care system governance? My theoretical Framework mainly deals with the Stakeholder Theory. The salience of stakeholders is thus, determined by three factors : the attributes of legitimacy, urgency and power (Mitchell et al. , 1997). In short, salience in an organization depends on the identification of stakeholders' attributes. The concept of power (Dhal, 1957; Etzoni, 1998) is aslo mobilized to explain the relationship between thoses attributes on the one hand and consumers' contribution as stakeholders on the other hand. Secondary analysis of primary data is undertaken with the method of the Data quality review (DQR). Our primary data stems from four research studies (DGS 05-06; Cruq 07; Cissra 07 and Cissra 08) which are used to improve the empowerment of consumers in the French health system governance. In conclusion, three types of consumers (conceived as stakeholders) are highlightened by Mitchell et al. : non stakeholder, dependent stakeholder and definitive stakeholder. Futhermore, three perceptions of managers' minds are pointed out Etzoni' s notion of utilitarian power : non salient, poorly salient and highly salient. Thus, various types of power blur the reality of consumers' power in the French health system governance
Quantin, Catherine. "Contribution à l'évaluation de l'activité hospitalière : une modélisation par sous-groupes homogènes pour une gestion médicalisée à l'hôpital". Dijon, 1997. http://www.theses.fr/1997DIJOE016.
Texto completo da fonteSince the early 1980s healthcare systems in the industrialized nations have been undergoing radical reform aimed at curbing overspending of hospital expenditure. After a discussion of the limits of a prospective payment due to heterogeneity of costs within DRGS, we demonstrate the ability of a novel statistical model to identify high cost patients. We derive from this statistical model an economic heuristic in order to account for high cost patients in budget allocation and a structural and contingent method is proposed as a budgeting tool. Economic analysis based on this modelling of DRG heterogeneity further reveals the potential for improving the equity and the efficiency of the prospective payment system by restricting its perverse effects. This model may also be used as a strategic management tool for hospitals or as a means for regulators to evaluate treatment and admission practices so as to improve health care provision. This statistical analysis was designed on the basis of a mixture of weibull distribution, in which proportion of high-cost patients was expressed according to the multinomial logistic regression, allowing the determination of high-cost factors. An application of the statistical model to 124 DRGS on a French reference database stresses the problem of heterogeneity of costs and length of stays within most of DRGS. An example of identification of explanatory variables of high costs is carried out on several DRGS. The economic application of the statistical model is discussed pointing out the implications, in terms of efficiency, of improving hospital management. The other advantage of this statistical model is to allow the assessment of a revision of the DRG classification from both statistical and economic point of views
Le, Ny David. "Management du processus de négociation collective : "le cas des établissements EDF GDF Services"". Paris 2, 2007. http://www.theses.fr/2007PA020021.
Texto completo da fonteMbibi, Sidi Mahmoud Aidara. "L'interopérabilité au sein de l'architecture d'entreprise : étude d'un cas pour la gestion de la santé". Thesis, Université Laval, 2013. http://www.theses.ulaval.ca/2013/28999/28999.pdf.
Texto completo da fonteAit, Ouchannik Sadia. "Les mutations contemporaines de l'organisation des soins en santé mentale : répercussions sur les pratiques de soins psychiques et sur la subjectivité". Electronic Thesis or Diss., Amiens, 2019. http://www.theses.fr/2019AMIE0007.
Texto completo da fonteMultiple reforms aiming at modernizing the public utilities and controling in a better way their spending have gradually transformed the running and organization of public health institutions in our country. A complete overhaul according to the terms of the new hospital governance accompanied with the introduction of management tools stemmed from New Public Management has been carried out. This work is about the transformations of care organization in health care facilities. The study of the proceduralization of care practices allowed to bring to the fore the role of Evidence-Based Medicine in the enterprise of standardization in care systems. Effects of these management logics on the different registers of the intersubjective bond have been grasped, bringing out the forms they spread in group dynamics and teams instituted, with in the background the transformations of sociocultural meta-framework. A particular care has been attached to health managers'view considering the specificity of their task which set them at the crossroads of clinical, managerial and administrative dimensions. The analysis of clinical situations allowed to bring out the sight of the medicalization of psychological suffering and the extension of the concept of "psychic handicap". Transformations in the notion of psychic care have been confronted with mental health paradigm ; Michel Foucault's work has enable to show that mental health policy system are part of a mode of neoliberal governmental rationality framework
Le, Breton-Lerouvillois Gwénaëlle. "L'offre de soins en Basse-Normandie : approche de la proximité et de l’accessibilité : essai de géographie sociale de la santé". Caen, 2006. http://www.theses.fr/2006CAEN1459.
Texto completo da fonteRaboisson, Didier. "Approche institutionnelle de la santé animale : place des compétences, des territoires et des collectifs dans la gestion de la santé des bovins laitiers en France". Thesis, Toulouse, INPT, 2011. http://www.theses.fr/2011INPT0046/document.
Texto completo da fonteThis research analyzes cattle health through individual and collective competencies, based on Commons institutionalism. The first part defines a new institutional conceptual framework, alternative to the neoclassic microeconomic models, to study animal health. Health management is analyzed at farm level in terms of farmers' competencies and capabilities considering the relationship between individuals and unorganized going concern. It integrates thereafter organized going concerns and defines production focused organizations and health focused organizations. The competencies and capabilities have both territorial components. The model is validated empirically in the second part, using the national cattle identification database and the milk control program database, for 2005 and 2006. Dairy cattle mortality and milk bacteriological quality (somatic counts) are explained with linear models and static and dynamic panel models, respectively. A global effect of farmer's health competencies on the overall health issues of the farm is shown, but competencies must be translated into capabilities (actions) before impacting on health. The spatialization of the models reveals some territorial correlations that clearly show the effect of institutions on animal health. The institutional analysis shows that an important part of the herd health rests on the farmer's individual competencies, as well as on some collective competencies. These competencies can be strengthened and revealed into capabilities with more accurate and regular preventive interventions in farms and with more farmers' education
Tsanga, Tabi Marie. "Théorie et réalité du service public local : le cas de la distribution d'eau potable". Paris 10, 2003. http://www.theses.fr/2003PA100045.
Texto completo da fonteThis work is an analysis of the theoretical, institutional and socio-technical background of water public services and a monographic study of the managerial practice of this service. From this, we develop a model that explains the contemporary public action of organisations whose mission is to provide essential and collective public services. Thus, in a sector where selling and territorial rationale, and a purely material concept of the service due to the "technical system" at work, are prevalent, we demonstrate that the challenge of water public services in our era, consists also in problem resolution more complex than simply bringing in expert knowledge solutions. Furthermore, this thesis is a new approach to interpreting the action of public services, more focused on the problems of society in which these services are integrated
Chaty, Lionel. "La responsabilité en valeur : projets de service et centres de responsabilité dans l'administration française". Paris 1, 1995. http://www.theses.fr/1995PA010304.
Texto completo da fonteThe process of an administrative reform is discussed in this dissertation. The reform was initiated in 1989 under the aegis of the then prime minister, michel rocard, with a view to enhaucing individual accountability in the civil service, through greater budgetary flexibility and effective use of skills. It relies on a body of beliefs gradually constituted since the end of the forties around the entrepreneurial world, through business management institutions and scientific validation mechanisms. Inspired by conclusions presented by a senior official's association ("service publics"), reformers around michel rocard defined the main lines of the reform. Its materialization opposed the pro-reform ministry of civil service and the budget ministry, guardian of traditional budgetary rules. Within the reformed administrative services, different degrees of involvement were seen in three different staff categories : the managers, in favor of budgetary flexibility and a symbolic dimension;innovative personnel, often at line management level, seizing reform-related opportunities; and the subdued rank and file who gradually lost interest. The discussion si geared to the notion of change as a result of representations and beliefs, the mobilization of innovative personnel, existing political opportunities and the actual definition of the reform by implementing agents
Pariente, Pierre. "Le contrôle de gestion dans les collectivités locales : application au cas des communes". Paris, Institut d'études politiques, 1996. http://www.theses.fr/1996IEPP0024.
Texto completo da fonteThe strengthening of the management tools in local communities has become a necessity in the current social and economic environnement, as they ar required to intervene much more often. Amongst those, management control is the instrument. We focus on the hypothesis of a proximity of content and of an heterogeneity among causes and objectives of the fonction between management control in private firms and in local communities. Firstly we set the problem and the context focusing on the specificites of state organizations. Secondly we make an analysis of a certain number of experiments of management control development in some particularty advanced councils and we confirm the hypothesis of a proximity of the content of the fonction between management control in private firms and in local communities. Thirdly we focus on the theorical and practical consequences of this research. Through a synthetic and typological study, we answer to the hypothesis of heterogeneity of causes and objectives of the fonction between management control in private firms and in local communities. Then we focus on theorical aspects of management control. Finally we focus on the main tendancies of management control in local commiunities and the reasons of its difficulties. We conclude that there is a wrong appreciation of the importance of conducting change