Philippe Mossé

When flexibility diversity becomes socially acceptable: The case of the French hospital industry

The aim of this article, which is mostly based on case studies of public and private French hospitals, is to analyse the employment of nurse assistants (NA) and unqualified health care workers (agent des services hospitaliers or ASH), focusing particularly on questions of flexibility. First, the article shows that in French hospitals, the cleaning and basic health care tasks are performed by a relatively stable core group of employees and by a more flexible workforce. From the hospital perspective, the need for flexibility is related to the growing trend towards rationalization. But employees see the demands for flexibility from a different angle, depending on their professional histories. The article also shows that the nurse assistants and unqualified health care workers who work under these unstable conditions may see this situation as a transition period and as a gateway to permanent jobs. Consequently, and despite the difficult working conditions, the job opportunities offered by hospitals may be attractive to women with few or no qualifications.

Hospital investment policy in France : Pathways to efficiency and the efficiency of the pathways

OBJECTIVES This article examines the ambivalent notion of New Public Management as applied to health policy in France, by investigating the implementation of the efficiency-driven hospital investment plan, Hôpital 2012, conceived at national level, but implemented through regional hospital authorities (ARHs), with formal responsibility for selecting successful funding applications. METHODS The methodology combines qualitative and quantitative analysis, in order to highlight and explain discrepancies between goals and results. RESULTS Despite formal adherence to objective efficiency indicators, certain decisions were based on incomplete information and others on considerations out with initially established criteria. Competition from the private sector was perceived as a threat to public hospitals and the public sector emerged as a major beneficiary of the investment plan. Central ministerial intervention emphasising financial and quantitative considerations led the ARHs to focus more on individual hospital performance than on wider healthcare needs. CONCLUSIONS Data-production became almost an end in itself, threatening to undermine the objectives it sought to pursue. Nonetheless, extended deadlines entailed by ministerial intervention were appropriated as a resource by local actors, leading to ARH decisions which deviated from the official efficiency model, but resulted in increased effectiveness, taking fuller account of local conditions.

Les infirmières travaillant au domicile des patients : maîtriser l’espace et le temps d’un exercice professionnel (une enquête franco-japonaise dans quatre régions : Picardie, Paca, Nagano et Fukushima)

INTRODUCTION this article presents the main results of a survey comparing works and opinions of nurses working at their patients homes in France and in Japan. CONTEXT previous studies on hospital nurses had shown some differences mainly linked to the way the tensionbetween cure and care is managed in the two countries. OBJECTIVE the hypothesis is made according to which this tension involves nurses beyond their professional practices. At stake, are the characteristics of the two professional spaces and the mobility they made possible. METHOD an original questionnaire has been conducted gathering 200 nurses working at patients home. Four Regions have been chosen (two in France, two in Japan) in order to take into account environmental differences. RESULTS it appears that representations as well as the relations to the labor itself are heavily shaped by each nurse passed experience, the hospital setting being the main reference. However, the way this experience is included in the professional trajectory is mainly built by private choices. DISCUSSION grounded on a qualitative study, these results have to be confirmed using a larger survey.