International Journal for Quality in Health Care 9:201-205 (1997)
© 1997 International Society for Quality in Health Care
research-article |
Management Tools and Organization as Key Factors Towards Quality Care: Reflections from Experience
Centre de Gestion Scientifique, Ecole des Mines de Paris Paris, France
Health care organization in French hospitals has become an increasingly important issue, as efforts to ensure better cost control have increased financial constraints, as patients have demanded ever better results and quality, and as nurses' expectations for better working conditions have grown. Organi-zing a health care unit requires an articulation between individual efforts — necessary both for gathering accurate information on each patient and for providing patients with personalized care — as well as an integrated system of various logistics, specialized services such as nursing care, custodial care, technical examinations, and administrative procedures. Coordination between these different components continues to be a significant challenge to hospitals, as each category has developed independently its own specialty and sense of autonomy, resulting in different professional rationalities, cultures, approaches, and sometimes conflicting behavious. Pointing out these difficulties is not sufficient to solve the problem, however, and since the management tools currently in use (activity measurements, procedures used to develop choices and judgements) are often kept in place for external reasons, they may actually perpetuate these behaviours.
This paper is a set of reflections derived from a long period of experience and research in the management of French hospitals and health management institutions. It reports that the financial reforms implemented in budgeting procedures for French hospitals, and the efforts to control costs better in the national health insurance system, have resulted in new types of behavious in physicians, nurses and health care managers, as well as the need for information that deals not only with health care activities but also with quality. © 1997 Elsevier Science Ltd.
Keywords: Quality, organization, management tools
Correspondence to. Dorminique Tonneau, Management Professor, Ecole des Mines de Paris, CGS, 60 Boulevard Saint-Michel, Tel.:(33)01-40-51-91-00; Fax: (33) 01-04-03-01; e-mail: tonneau@cgs.ensmp.fr.
Received for publication August 19, 1996. Accepted for publication January 6, 1997.