Structure du temps de travail des infirmières de santé publique: effets de l'âge des patients, de la nature des prestations fournies et du lieu du contact. [Structure of work times of public health nurses: effect of the age of patients, nature of care given and location of contact].

In the framework of health services research sponsored by the Swiss National Science Foundation, a research was undertaken of the activity of the large majority of the public health nurses working in the Swiss cantons of Vaud and Fribourg (total population 700,000). During one week, 130 nurses gathered, with a specially devised instrument, data on 4165 patient visits. Studying the duration of the contacts, one has distinguished contact duration per se (DC), duration of the travel time preceding the contact (DD), and total duration in relation with the contact (DTC-addition of the first two). It was noted that the three durations increased significantly with patient age (as regard travel time, this is explained by the higher proportion of home visits in higher age groups, as compared with visits at a health center). Examined according to location of the visit, contact duration per se (without travel) is higher for visits at home and in nursing homes than for those taking place at a health center. Looked at in respect to the care given (technical care, or basic nursing care, or both simultaneously), our data show that the provision of basic nursing care (alone or with technical care) doubles contact duration (from 20 to 42-45'). The analyses according to patient age shows that, at an advanced age (beyond 80 years particularly), there is an important increase of the visits where both types of care are given. However, contact duration per se shows a significant raise with age only for the group "technical care only"; it can be demonstrated that this is due to the fact that older patients require more complex technical acts (e.g., bladder care, as compared with simpler acts such as injection). A model of the relationships between patient age and contact duration is proposed: it is because of the increase in the proportions of home visits, of visits including basic nursing care, and of more complex technical acts that older persons require more of the working time of public health nurses.

"Public on the outside, private on the inside": the organizational hybridization, sense of belonging and identity strategies of the employees of a public unemployment insurance fund in Switzerland

A number of studies show that New Public Management reforms have altered the current identity benchmarks of public officials, particularly by hybridizing values or management practices. However, existing studies have largely glossed over the sense of belonging of officials when their organization straddles the concerns of public service and private enterprise, so that the boundary between public and private sector is blurred. The purpose of this article is precisely to explore this sense of belonging in the context of organizational hybridization. It does so by drawing on the results of research conducted among the employees of a public unemployment insurance fund in Switzerland. On the one hand, the analysis shows how much their markers of belonging are hybrid, multiple and constructed in negative terms (with regard to the State), while indicating that the working practices of the employees point to an identity that is nevertheless closely bound with the public sector. On the other hand, the analysis shows that the organization plays strategically with its State status, by exploiting either its private or public identity in line with the needs related to its external image. The article concludes with a discussion of the results highlighting the strategic functionality of the hybrid identity of the actors.

Paper 2: EUROCAT public health indicators for congenital anomalies in Europe.

OBJECTIVE: The purpose of this article is to present the specific public health indicators recently developed by EUROCAT that aim to summarize important aspects of the public health impact of congenital anomalies in a few quantitative measures. METHODS: The six indicators are: (1) congenital anomaly perinatal mortality, (2) congenital anomaly prenatal diagnosis prevalence, (3) congenital anomaly termination of pregnancy, (4) Down syndrome livebirth prevalence, (5) congenital anomaly pediatric surgery, and (6) neural tube defects (NTD) total prevalence. Data presented for this report pertained to all cases (livebirths, fetal deaths, or stillbirths after 20 weeks of gestation and terminations of pregnancy for fetal anomaly [TOPFA]) of congenital anomaly from 27 full member registries of EUROCAT that could provide data for at least 3 years during the period 2004 to 2008. Prevalence of anomalies, prenatal diagnosis, TOPFA, pediatric surgery, and perinatal mortality were calculated per 1000 births. RESULTS: The overall perinatal mortality was approximately 1.0 per 1000 births for EUROCAT registries with almost half due to fetal and the other half due to first week deaths. There were wide variations in perinatal mortality across the registries with the highest rates observed in Dublin and Malta, registries in countries where TOPFA are illegal, and in Ukraine. The overall perinatal mortality across EUROCAT registries slightly decreased between 2004 and 2008 due to a decrease in first week deaths. The prevalence of TOPFA was fairly stable at about 4 per 1000 births. There were variations in livebirth prevalence of cases typically requiring surgery across the registries; however, for most registries this prevalence was between 3 and 5 per 1000 births. Prevalence of NTD decreased by about 10% from 1.05 in 2004 to 0.94 per 1000 in 2008. CONCLUSION: It is hoped that by publishing the data on EUROCAT indicators, the public health importance of congenital anomalies can be clearly summarized to policy makers, the need for accurate data from registries emphasized, the need for primary prevention and treatment services highlighted, and the impact of current services measured.

Peut-on faire confiance à l'administration ? Une analyse du concept de confiance, appliqué au secteur public

D'une manière générale, la confiance est un « lubrifiant » (Arrow, 1974) facilitant les relations sociales (eg Luhmann, 1968, Giddens, 1984, Zucker, 1986). D'un point de vue économique, un environnement institutionnel bénéficiant d'une confiance élevée serait corrélé avec la performance de l'économie nationale (eg Dyer and Chu, 2003). La confiance, en tant que capital social, permettrait et engendrerait des comportements altruistes et coopératifs impactant et soutenant la prospérité économique d'une communauté (Fukuyama, 1995). Dans un cadre organisationnel, la confiance engendre une communication plus ouverte et facilite l'échange d'information (eg Smith and Barclay, 1997, Currall and Judge, 1995), facilite la gestion des conflits (eg Blomqvist, 2002), l'apprentissage commun (eg Bijlsma-Frankema, 2004) ou diminue les coûts d'intégration (eg Bidault and Jarillo, 1995), par exemple.

Les difficultés de gestion des partenariats public-privé en Europe. Pour une lecture "institutionnelle"

Les partenariats public-privé se développent dans la quasi-totalité des pays de l'OCDE. De nombreux acteurs, publics ou privés, y voient un moyen pour développer de nouvelles infrastructures et prestations publiques à moindre coût et de manière sensiblement plus rapide et plus efficace. Considérés sous l'angle de leur gestion, les PPP s'avèrent finalement bien plus complexes qu'ils ne paraissent d'un premier abord. Basé sur une revue de la littérature européenne portant sur les expériences en cours sur le Continent, l'article vise à faire état de la nature des débats gestionnaires entourant cette nouvelle forme de coordination des activités étatiques en relevant plus spécifiquement les difficultés auxquelles la plupart des PPP sont confrontés, sur la base d'une lecture institutionnelle.

Data Envelopment Analysis (DEA) : A pedagogical guide for decision makers in the public sector

This guide introduces Data Envelopment Analysis (DEA), a performance measurement technique, in such a way as to be appropriate to decision makers with little or no background in economics and operational research. The use of mathematics is kept to a minimum. This guide therefore adopts a strong practical approach in order to allow decision makers to conduct their own efficiency analysis and to easily interpret results. DEA helps decision makers for the following reasons: - By calculating an efficiency score, it indicates if a firm is efficient or has capacity for improvement. - By setting target values for input and output, it calculates how much input must be decreased or output increased in order to become efficient. - By identifying the nature of returns to scale, it indicates if a firm has to decrease or increase its scale (or size) in order to minimize the average cost. - By identifying a set of benchmarks, it specifies which other firms' processes need to be analysed in order to improve its own practices.