Régulation et gestion de la qualité des soins dans les établissements de santé. Une comparaison avec le secteur nucléaire

Abstract

In France, the incentives to improve the quality of care in health organizations are mainly based on deviations from expected processes, despite numerous criticisms. The instrumental management model used may indeed be too far removed from the concrete practices of the careunits. An alternative model, placing more emphasis on the informal and relational dimensions, has developed in particular from research on HROs (High Reliability Organizations) and is now strongly promoted by many managers in the health system, but remains little applied in practice. A comparison with the nuclear sector shows that it is the same in the latter, which may seem paradoxical, since nuclear installations are considered HROs. In fact, in either case the validity and use of the cultural model is problematic. The article argues for the establishment of more modest and more realistic learning systems on local management of the quality of care.