IntRodUcIng opeRAtIng IncoMe StAteMentS At the level of depARtMentS In A pUblIc hoSpItAl: pRopoSItIonS And AnAlYSeS bASed on A cASe StUdY

Abstract

Our paper is based on a longitudinal case-study conducted in a French public teaching hospital at the time of the generalized implementation in France of a DRG-based payment system, the creation of new organizational entities (departments), and the production of new performance metrics-the departments’ operating income. Our case study combines interviews, participant and non-participant observations. Our analysis indicates that representations, behaviors and practices regarding the economic and medical performance management of the hospital have evolved in various ways. While ideas and practices relating to the management of this performance have actually been diffusing, actors’discourses and representations exhibited several misunderstandings, contradictions and inaccuracies about the new performance management and measurement system. We have also noted that, over the course of our field-work, medical practitioners’representations have evolved as they became more defiant towards ongoing changes. We develop several interpretations of this evolution-notably, the new system inability to provide practitioners with the autonomy which, in their understandings, they could be expecting, or its inability to provide them with operating rational tools and frameworks for the management of their activities. Based on our case-study analysis, we reflect on this experience of the introduction of economic and medical management performance systems and metrics in the context of a public hospital and we derive several propositions regarding the implementation of new performance management systems.