Abstract
Contrary to industrial organizations, where the projects contribute to satisfy performance criteria in order to ensure the timelessness, the health organizations develop projects in a mission obligation context. This obligation of result for some and obligation of operation for others constitutes a key difference associated with the fact of having a patient and his health, as support of the processes in a double hierarchy context. This communication intends to analyze specificities from one sector compared to the other on the leading level of the decisions, or not, within the emergence of projects. Opening with investigations undertaken with actors in the Health and industrial sectors, we will identify the key factors and their impacts on the decisions relating to the projects. These specificities and factors will be approached with the organization model and the traditional decision and its three strategic levels, tactical and operational that we will enrich by distinguishing the decisions of engineering and project piloting. We will introduce the competences concept which will clarify the bonds between the factors supporting the emergence of projects or the organization and competences of various actors throughout different trades.
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