Contenu du sommaire : Organiser les coordinations et coopérations en santé : impulsions, obstacles et réalisations.

This article presents the initial results of a national experiment aimed at introducing episode-based bundled payments in the French healthcare system. Launched in 2019, restricted for the moment to three pathologies (hip and knee replacement and colectomy for cancer) and to around 40 hospitals, this experiment is presented as a step to move away from a much criticized activity-based payment system and to promote value-based payment. Episodes of care's financing aims to pay healthcare organizations on the basis of a flat rate payment for a group of acts and services associated with a pathology upstream, during and downstream of in hospital surgery. Coupled with quality objectives, bundled payments are expected to support both quality and efficiency gains by incentivizing hospitals to optimize patients' pathways and care coordination between acute care hospitals and primary care providers. Based on a qualitative empirical study, this article analyzes the extent to which the incentives associated with the introduction of this payment method participate to transform care practices at the hospital level. Building on a multidisciplinary approach (health policy and management and health sociology) and reflecting on the literature on management tools, policy instruments and algorithmic regulation, we show that the financing framework used to calculate the reimbursement package does not yet produce the expected incentives in terms of care coordination.

The emergence of new actors dedicated to the patient care's coordination is one of the characteristic facts in contemporary health system's evolution. It covers multiple forms of professional practices and roles, that sometimes make this phenomenon difficult to assess. Our research aims to better understand the content and the way health's coordinators (working in organizations dedicated to coordination support or in health structures) carried out their activities, in order to characterize the dynamics of this professional field under construction. The analysis of these questions is based on a theorical framework at the crossroad of the literature on coordination in management sciences and a group of researches in health management, sociology and management sciences about jobs and professional dynamics inside or outside health's field. Our results, achieved by a qualitative research methodology, offer a comparative analysis of different coordination actors' profiles, which bases a typology of their professional identities.

This study proposes to analyse the influence of an inter-organisational governance model on the capacity of actors to decide and act. A case study was conducted within a non-hierarchical network, the MAIA. This research firstly enabled the governance model studied to be qualified. Secondly, the sources and power games between the two spheres of influence of the health and social sectors were identified. This analysis made it possible to evaluate their influence on the decision-making process of the actors and to identify blocking points. Levers for action were highlighted that could shed light on the implementation of new governance models for the new coordination support systems (DAC).

While many works advocate the use of collaborative governance to solve complex problems, few focus on the performance of these arrangements. We place this research in the tradition of Ansell and Gash's model (2008) by integrating the performance matrix proposed by Emerson and Nabatchi (2015). Based on a field study conducted over two years with a public inter-municipal cooperation establishment whose objective was to improve access to care, we show that : (1) the overall performance is rather weak, (2) the scarcity of resources (doctors) induces a strong competition between participating organisations which prefer to resort to internalisation strategies (acting on their own) or outsourcing (contracting with private partners). We discuss the interest of introducing into Ansell and Gash's model a strategic reading based on the nature and control of the resources at stake, as well as on the exploration/exploitation phase.

In this research we investigate, from a diagnostic perspective, the current organization of relations between actors in the health and socio-medical systems and the responses that these same actors have been able to make to the health crisis. Based on 59 interviews with various members of these systems, it highlights the disorganization of these systems at the time of the crisis and the emergence of new organizational or at least interrelational practices, federated around a common ethos. Since the use of literature on health networks seems insufficient to make sense of these emerging configurations, the formulation and outlines of an organizing bricolage animated within dialogical spaces are proposed.

The purpose of this article is to show that the managerial literature on value co-creation by professional entities can be used to analyze the evolution of practices in the health sector and to highlight cooperative forms of care in mental health. An exploratory case study on the evolution of care mechanisms for young adults with a dual diagnosis (addiction and psychiatry) shows that the concept of value co-creation helps consider and understand the various types of cooperation between practitioners, that are currently expanding. The main contribution of the article is to show that these types of cooperation can be identified using two typologies. One typology is based on the scale of the cooperation (micro, meso, macro and mega). The other typology is based on seven families of practices (creation of professional social capital, common languages, shared mental models, impact on the ecosystem, creation of new values, access to resources, experiential opportunities). Although not generalizable and highly contextualized, the results show a trend towards improved forms of cooperation among professionals, which could be strengthened by the continuation of such value-creating approaches in the mental health field.

To what extent do Multidisciplinary Group Practices (Maisons de santé pluriprofessionnelles, MSP) promote inter-individual and inter-organizational cooperation within their territory? As these structures have grown exponentially over the past ten years (from 174 in 2012 to more than 1,200 in 2019 according to the French Federation of Multidisciplinary Group Practices), they offer a relevant angle of attack to assess the effects of public policies dealing with the dynamics of cooperation between health professionals which have become central to the territorial organization of care over the past fifteen years. Using a multi-level structural analysis (Lazega, Jourda, Mounier and Stofer, 2007), we highlight the cooperation processes involving Multidisciplinary Group Practices in a French county, at the inter-individual level and at the inter-organizational level. We also put to the fore the interactions between these two levels. The cross-study of these two systems of interdependence (Lazega, 2015 ; Lazega and Snijders, 2016) allows us to appreciate the cooperation “in action” in the Multidisciplinary Group Practices. The statistical analysis of the networks shows that these structures seem to enhance multidisciplinary interaction and to play a structuring role in the sharing of patient files between organizations. However, the multi-level analysis does not show that health professionals interact preferentially with the professionals of the Multidisciplinary Group Practices : the individual characteristics (gender, age, place of practice) and the structural position of professionals prevail in the construction of professional interactions. The non-alignment of the links between organizations with the links between individuals thereby challenges the coherence of public policies enhancing group practices, which relate both to professionals as individual actors and to health organizations as a framework of action.

Most transnational corporations unilaterally commit to the 2011 UN Guiding Principles. In application of these principles and the interpretative guides that specify them, many human rights conflicts are managed by the company. With its resolution of 28 July 2022, the United Nations General Assembly considers the «right to a clean, healthy and sustainable environment» as a human right. In so doing, the United Nations (UN) is supporting a legal and managerial movement in which management becomes the means of resolving not only human rights conflicts - understood in a narrow sense - but also environmental conflicts. A conflict between indigenous communities and Glencore over the production of coal for Germany illustrates that this managerial handling of environmental grievances sometimes allows for a more operational definition of the right to the environment. These mechanisms also allow for better access to justice. However, both of these positive effects can only be realised if the controls and sanctions provided for by the public authorities are actually applied.