Analyse des nouvelles formes organisationnelles hospitalières en émergence au Mali

Au Mali, une loi hospitalière a été adoptée en 2002 pour définir le cadre institutionnel d’une réforme majeure. Cette loi a décrété des transformations substantielles de la structure interne, tant administrative que clinique des établissements publics hospitaliers notamment l’implication des populations locales dans la prise de décision de l’établissement, l’autonomie administrative et financière à travers la délégation budgétaire et l’implication des professionnels de santé à la gestion, l’intégration des services de spécialité et la participation du secteur privé au service public hospitalier. Cependant, la capacité des hôpitaux à réussir les transformations prévues a été remise en question par la majorité des acteurs internes et externes. L’objectif de cette thèse a été d’étudier de quelle manière l’hôpital malien se transforme sous la pression de la décentralisation des pouvoirs de l’État et d’étudier comment les groupes d’acteurs réagissent face à ces changements à partir de deux cadres d’analyse. Le premier cadre intègre les caractéristiques essentielles des transformations hospitalières en termes de différents types de décentralisation et le second cadre inspiré des travaux de Crozier et coll. (1977) analyse les jeux de pouvoir entre les groupes d’acteurs hospitaliers selon deux niveaux à savoir un niveau stratégique et systémique. Pour cela, nous avons conduit une étude multiple de deux cas et utilisé trois modes de collecte des données à savoir les entrevues semi-structurées auprès des informateurs clés, l’analyse documentaire, et l’observation lors de réunions. Dans un premier temps, les analyses ont révélé pour les changements intervenus dans la structure, selon l’importance des responsabilités attribuées à l’hôpital public, (1) plusieurs variantes de la décentralisation. Globalement, l’intention politique était focalisée sur une délégation puis une déconcentration et une dévolution; les mécanismes mis en place ont penché plus vers une déconcentration puis une délégation et une dévolution tandis que les transformations réellement effectuées dans les établissements publics hospitaliers ont plutôt confirmé une déconcentration en plus d’une délégation particulièrement dans le cas de l’implication des populations locales dans la gestion hospitalière. Tandis que l’hôpital public pouvait faire des recettes à partir du recouvrement partiel des coûts des soins auprès des usagers, l’État gardait une main forte sur la gestion financière et la gestion du personnel, et définissait les directives et les objectifs à poursuivre. (2) Les analyses apportent une compréhension des liens existant entre les différents éléments du processus de réforme, le type de mécanisme mis en place dans le cadre de la réforme semble déterminer le type de transformation effectué selon les fonctions que peut assurer l’hôpital public. La logique traduit le passage de la délégation vers une déconcentration qui est jugée comme étant la forme la moins poussée d’une décentralisation. Dans un deuxième temps, les résultats confirment la présence de conflit entre les normes professionnelles établies et reconnues par les professionnels de santé et les normes organisationnelles et institutionnelles mises en avant par la réforme. Elles sont défendues par la majorité des gestionnaires qui sont imputables face aux autorités alors que les normes professionnelles dominent dans les services cliniques. Les deux cas ont mis en évidence le soutien de leur direction générale, il existait une tension dans les réactions des médecins, qui a été variable selon le type de changement structurel visé, tandis que les infirmiers se sont montrés plutôt accessibles face aux nouvelles mesures introduites par la réforme. L’une des originalités de cette thèse tient au fait que très peu de travaux sur les pays en développement ont tenté d’opérationnaliser de façon multidimensionnelle les concepts de décentralisation avant d’analyser les variantes susceptibles d’exister entre eux et les stratégies développées par les groupes d’acteurs de l’hôpital. En outre, alors que la pertinence de la prise en compte des caractéristiques du contexte organisationnel dans la mise en place des réformes des systèmes de soins est au cœur des préoccupations, ce travail est l’un des premiers à analyser l’influence de l’interaction entre le processus de réforme hospitalière et les prises de position des acteurs. Les résultats de cette thèse fournissent des recommandations aux décideurs politiques et aux gestionnaires quant aux modes de changement structurel à privilégier ou en éviter dans la planification, l’exécution et la mise en œuvre du processus de réforme hospitalière en fonction des caractéristiques du contexte organisationnel sanitaire. La planification de la réforme est essentielle : Élaborer un projet d’établissement discuté et validé par l’ensemble des acteurs de l’hôpital. Ce projet doit être compatible avec les objectifs du schéma d’organisation sanitaire nationale et déterminer les moyens en personnel et en équipements, dont l’hôpital doit disposer pour réaliser ses objectifs. Concevoir un cadre budgétaire et financier hospitalier flexible (qui va alléger la chaine de prise de décision), sur lequel reposera le nouveau système de gestion des hôpitaux. La capacité de mobilisation et d’exécution des ressources hospitalières devrait renforcer l’autonomie de gestion. Enfin, promouvoir une culture de l’évaluation et faciliter les évaluations périodiques de la mise en œuvre de la réforme hospitalière par des organismes d’évaluation externes et indépendants.

Key roles in intranet implementation : the conquest and the aftermath

Intranet technology has been rapidly adopted by many organizations. From being a largely unknown technology prior to the mid-1990s, numerous organizations today have implemented or are currently implementing intranets. The intranet implementation processes of three large organizations in two countries were studied over a period of 5 years. In particular, the paper investigates the role players who spearheaded the intranet implementations in these organizations. Five interrelated roles during the intranet implementation process are identified: the technology champion, organizational sponsor, intranet coordinator, intranet developer and content provider. In the light of the nature of intranet technology, each respective role is analysed in terms of its significance, key challenges and interrelationships during the implementation process. The paper further examines the dynamics of these roles in the aftermath of implementation as the technology becomes embedded in routine organizational activity.

Corporate intranet implementation : managing emergent technologies and organizational practices

This paper examines the adoption and development of intranets in large business organizations. The authors demonstrate that intranet technology introduces a host of new managerial and technical challenges and requires new approaches to IS development. Evidence from two European corporations indicates that the traditional division of labor and definition of work roles in IS development breaks down. The distinction between developers and users becomes increasingly blurred and new organizational roles and structures associated with intranets are emerging. However, ready-made organizational models for implementing and managing intranets do not exist and the two organizations in this study have followed two different approaches. One organization favors a “planned change” approach, emphasizing management control and careful planning. The other organization prefers an “improvisational” approach, emphasizing experimentation, innovation and local initiative.

Diferenças principais entre líderes e gerentes e seus respectivos papéis na organização

Liderança e Gerenciamento não são a mesma coisa. Ambos são importantes, porém têm propósitos muito diferentes. Neste contexto, esta dissertação considera a idéia de que se, até no campo das ciências exatas existe alguma confusão com relação ao uso indistinto de determinados termos, no campo das ciências humanas o uso inadequado das palavras aumenta, na prática, a possibilidade dessa imprecisão, podendo levar a conclusões duvidosas. No momento em que a velocidade das mudanças no meio organizacional se faz sentir num ritmo cada vez mais rápido, o desenvolvimento das competências dos recursos humanos assume uma posição crucial. Torna-se essencial a busca por algo ou alguém que possa arregimentar esforços na procura de um caminho especial a ser seguido, frente aos desafios impostos pelo ambiente. Desta forma, a partir do objetivo geral de identificar e caracterizar as diferenças principais entre Líderes e Gerentes e seus respectivos papéis nas organizações, é apresentada uma análise comparativa entre as diversas correntes teóricas que abordam o tema, ressaltando-se a importância de se diferenciar esses dois tipos de comportamentos, igualmente imprescindíveis às organizações atuais.

Análise organizacional de acidentes de trabalho no setor de distribuição de energia elétrica

Pós-graduação em Saúde Coletiva - FMB

Análise organizacional de acidentes de trabalho no setor de distribuição de energia elétrica

Pós-graduação em Saúde Coletiva - FMB

Determinants of cerebral extracellular potassium after severe human head injury

The key role players of brain swelling seen after severe human head injury have only been partly determined. We used our human head injury data base to determine relationships between potassium, glutamate, lactate and cerebral blood flow (CBF). A total of 70 severely head injured patients (GCS < or = 8) were studied using intracerebral microdialysis to measure extracellular glutamate, potassium and lactate. Xenon CT was used to determine regional cerebral blood flow (rCBF). The mean +/- SEM of the r value of all patients, between potassium and glutamate, and potassium and lactate was 0.25 +/- 0.04 (p < 0.0001) and 0.17 +/- 0.06 (p = 0.006), respectively, demonstrating in both cases a positive relationship. rCBF was negatively correlated with potassium with marginal significance (r = -0.35, p = 0.08). When separated into two groups, patients with contusion had higher potassium levels than patients without contusion (1.55 +/- 0.03 mmol/l versus 1.26 +/- 0.02 mmol/l, respectively). These results in severely head injured patients confirm previous in vitro and animal studies in which relationships between potassium, glutamate, lactate and CBF were found. Potassium efflux is a major determinant of cell swelling leading to clinically significant cytotoxic edema due to increased glutamate release during reduced cerebral blood flow.

International student recruitment to universities in England: discourse, rationales and globalisation

2E4 (dounclaintieo)n The recruitment of international students to universities in England has become a central issue in an era of globalisation for university administrators, senior managers, international offices and heads of schools and faculties. We examine the policy rationales for the recruitment of international students to England. Through the use of in-depth interviews with key role players at four English universities, we compare the rhetoric, rationales and reasons for the recruitment of international students. A range of discourses can be identified in the recruitment of international students and an economic competition rationale is dominant. This is expressed within the discourse of globalisation.

Expertise Development in Volleyball: the Role of Early Sport Activities and Players’ Age and Height

The purpose of this study was to analyse the developmental pathway of skilled and less skilled volleyball players by focusing on the quantity and type of sporting activities, as well as their age and height in comparison to peers in those experiences. Retrospective interviews were conducted to provide a longitudinal and detailed account of sport involvement of 30 skilled and 30 less skilled volleyball players (15 male and 15 female players per group) throughout different developmental stages (stage 1: 8-12 years; stage 2: 13-16 years; stage 3: 17-20 years). Results indicated that the developmental pathway of these volleyball players (i.e. skilled and less skilled) was characterized by an early diversified sport involvement with a greater participation in sport activities during stages 1 and 2. However, skilled players specialized later in volleyball (between age 14 and 15) and performed more hours of volleyball at stage 3 (from 17 years of age onwards). Also, skilled players (male and female) were younger in both the diversified sport activities and volleyball at the later stages of development (i.e. stages 2 and 3), and skilled female players were taller than peers in those activities in the early stages of development (i.e. stages 1 and 2). The present findings suggest early diversification as a feasible pathway to reach expertise in volleyball and highlight the importance of practicing with older peers once specialization in the main sport has occurred. The findings highlight the need for coaches and sport programs to consider different stimuli existing within the training environment (i.e. characteristics of athletes, such as age and height) that influence the quality of practice and contribute to players’ expertise development.

Expertise Development in Volleyball: the Role of Early Sport Activities and Players’ Age and Height

The purpose of this study was to analyse the developmental pathway of skilled and less skilled volleyball players by focusing on the quantity and type of sporting activities, as well as their age and height in comparison to peers in those experiences. Retrospective interviews were conducted to provide a longitudinal and detailed account of sport involvement of 30 skilled and 30 less skilled volleyball players (15 male and 15 female players per group) throughout different developmental stages (stage 1: 8-12 years; stage 2: 13-16 years; stage 3: 17-20 years). Results indicated that the developmental pathway of these volleyball players (i.e. skilled and less skilled) was characterized by an early diversified sport involvement with a greater participation in sport activities during stages 1 and 2. However, skilled players specialized later in volleyball (between age 14 and 15) and performed more hours of volleyball at stage 3 (from 17 years of age onwards). Also, skilled players (male and female) were younger in both the diversified sport activities and volleyball at the later stages of development (i.e. stages 2 and 3), and skilled female players were taller than peers in those activities in the early stages of development (i.e. stages 1 and 2). The present findings suggest early diversification as a feasible pathway to reach expertise in volleyball and highlight the importance of practicing with older peers once specialization in the main sport has occurred. The findings highlight the need for coaches and sport programs to consider different stimuli existing within the training environment (i.e. characteristics of athletes, such as age and height) that influence the quality of practice and contribute to players’ expertise development.

Vertical jumping tests versus wingate anaerobic test in female volleyball players: The role of age

Single and continuous vertical jumping tests, as well as the Wingate anaerobic test (WAnT), are commonly used to assess the short-term muscle power of female volleyball players; however, the relationship among these tests has not been studied adequately. Thus, the aim of the present study was to examine the relationship of single and continuous vertical jumps with the WAnT in female volleyball players. Seventy adolescent (age 16.0 ˘ 1.0 years, body mass 62.5 ˘ 7.1 kg, height 170.4 ˘ 6.1 cm, body fat 24.2% ˘ 4.3%) and 108 adult female volleyball players (age 24.8 ˘ 5.2 years, body mass 66.5 ˘ 8.7 kg, height 173.2 ˘ 7.4 cm, body fat 22.0% ˘ 5.1%) performed the squat jump (SJ), countermovement jump (CMJ), Abalakov jump (AJ), 30 s Bosco test and WAnT (peak power, Ppeak; mean power, Pmean). Mean power in the Bosco test was correlated (low to large magnitude) with Pmean of the WAnT (r = 0.27, p = 0.030 in adolescents versus r = 0.56, p < 0.001 in adults). SJ, CMJ and AJ also correlated with Ppeak (0.28 ď r ď 0.46 in adolescents versus 0.58 ď r ď 0.61 in adults) and with Pmean (0.43 ď r ď 0.51 versus 0.67 ď r ď 0.71, respectively) of the WAnT (p < 0.05). In summary, the impact of the Bosco test and WAnT on muscle power varied, especially in the younger age group. Single jumping tests had larger correlations with WAnT in adults than in adolescent volleyball players. These findings should be taken into account by volleyball coaches and fitness trainers during the assessment of short-term muscle power of their athletes.

Achieving supply chain sustainability : the role of relationship management, culture and procurement form

In this research we examined, by means of case studies, the mechanisms by which relationships can be managed and by which communication and cooperation can be enhanced in developing sustainable supply chains. The research was predicated on the contention that the development of a sustainable supply chain depends, in part, on the transfer of knowledge and capabilities from the larger players in the supply chain. A sustainable supply chain requires proactive relationship management and the development of an appropriate organisational culture, and trust. By legitimising individuals’ expectations of the type of culture which is appropriate to their company and empowering employees to address mismatches that may occur, a situation can be created whereby the collaborating organisations develop their competences symbiotically and so facilitate a sustainable supply chain. Effective supply chain management enhances organisation performance and competitiveness through the management of operations across organisational boundaries. Relational contracting approaches facilitate the exchange of information and knowledge and build capacity in the supply chain, thus enhancing its sustainability. Relationship management also provides the conditions necessary for the development of collaborative and cooperative relationships However, often subcontractors and suppliers are not empowered to attend project meetings or to have direct communication with project based staff. With this being a common phenomenon in the construction industry, one might ask: what are the barriers to implementation of relationship management through the supply chain? In other words, the problem addressed in this research is the engagement of the supply chain through relationship management.