Des indicateurs pour gouverner la qualité hospitalière. Sociogenèse d’une rationalisation en douceur

Abstract

Many reforms claiming to optimise hospital management have been introduced into the French healthcare system. In the shadow of highly visible and much criticised reforms, such as new health service pricing instruments inspired by New Public Management principles, another process is quietly taking place, through the implementation of various institutional devices to evaluate quality of care. These “quality indicators” are based on managerial as well as professional criteria. Constructed as a “soft” assessment mechanism, they nevertheless constitute a robust auditing technique, which has been carefully but widely disseminated to hospitals throughout the healthcare sector. This article retraces the sociogenesis of quality indicators over the last two decades. The idea of hospital accountability first emerged in the late 1990s, in a context characterised by nosocomial infections, patient activism and media-based hospital rankings. In the 2000s, experts and hospital regulators had to come up with an acceptable response to external pressure for accountability, which shaped the singular characteristics of these instruments. We argue that throughout this discreet process of sociogenesis, quality indicators allowed French regulatory institutions to take a softly-softly approach to the rationalisation of hospital activities, while buffering conflicts with health professionals.