Contenu du sommaire : La régulation de la qualité dans le secteur de la santé

?In a context of growing concern for patient safety and service quality, this article aims at identifying the key factors for indicators implementation in the French healthcare system. It is based on an historical approach of the case of quality regulation in hospitals. This study underlines the necessary steps of implementation car­ried by different institutional actors (politics, academ­ics, professional). It focuses on the conditions for the emergence of this new kind of regulation.?

The experiment IFAQ (Incitation Financière à la Qualité) aims at anticipating the future effects of a financial incentive for quality improvement in the French hospitals. The article discusses this innovation according to three aspects : the collaborative nature of the design of the payment system ; the complexity of the model so obtained and the reasons of such a result ; the consistency of a national tool developed from stan­dardized process measures and a local management of the quality in health care teams.?

For a long time, the nature of medical knowledge and the organization of the medical profession have allowed physicians to avoid any form of external control. Yet over the past two decades, the gradual institutionalization of care quality evaluation has come to question the medical autonomy. In the early 2000s, many industrialized countries have taken a new step in this direction by introducing indicators to assess the quality of medical practices in hospitals. Based on a qualitative study, this article aims at comparing the forms of this evolution in two different institutional contexts (Germany and France). By doing so, this article attempts to describe the emergence of these evaluation devices, and to analyse their effects on the professional autonomy of physicians.?

The objective of this study consist in displaying sociotechnical implementations which strongly intricate mucoviscidosis, a rare disease, within the medical field. Following the traces of cystic fibrosis, we are showing the central character of the accomplished standardizations by the social-technological network which surrounds it, in order to ensure its integration within the field of medicine. The major changes are concern­ing the medical perception, due to knowledge consortium, common medical practices and professional network. The clinical approach is still founded on medical practices, especially regarding chronical diseases. And, thus, Socio-technical network changes the pathological entity of Cystic fibrosis into a matter on which physicians can apply a clinical professional ap­proach. Four major steps need to be enlightened. The first stage deals with the constitution of the cystic fibrosis as a distinct clinical entity defined and shared on an international level. The second stage involves the centralization of these new patients within a small area where a detailed col­lection and assembly of information begins. By the third stage, cystic fibrosis is no longer seen as an incurable disease as medical discoveries increase and medical assistance is based more and more on local protocols. The Cystic fibrosis resource and competence centres make up the final stage, creating a technical structure and autonomous organization, bringing together the practical inventories and solving conflict between actors. These four stages make up a standardiza­tion process of cystic fibrosis within the world of medicine. In this study, the standardization around cystic fibrosis looks to link a rare dis­ease with the clinical reasoning which guides the standardization of care, of their organization and their quality. Once accomplished, it favors the institutionalization of the disease within the medical world. ?

This paper aims to analyze if social media help uni­versities to develop their brand value. To do this, we conducted a literature review on the role of social media in the construction of brand value, and a quan­titative analysis on the Facebook profile of the hundred best universities in the world using ten indicators. The conclusion of this paper is that Facebook helps univer­sities to develop their brand value through its ability to achieve a collective construction of brand value between the institution and its stakeholders.?