Comment améliorer l’usage du Dossier Patient Informatisé dans un hôpital ? : vers une formalisation habilitante du travail intégrant l’usage du système d’information dans une bureaucratie professionnelle

Abstract : The main focus of this thesis is the Electronic Patient Record (EPR) in hospitals, and more particularly the difficulties of use after the implementation phase. Our approach aimed to design, with the academic knowledge of Information Systems, a method allowing field actors to act on this specific issue. In concrete terms, we were looking for ways to improve "misfit" situations, i.e. situations in which health professionals consider the use of EPR to be unsuitable for their profession. To do this, we sought to understand the mixed record of EPR use reported in the professional literature, by using the dual nature (enabling or coercive) of technology-induced work formalization (Adler & Borys, 1996). Enabling technology allows a user to be positioned as a source of solutions, while coercive technology tends to consider them as a source of problems. In the first manuscript on the autonomy of health professionals in relation to the hospital information system, we concluded that an enabling formalization is needed to improve the use of EPR. In the second manuscript, we showed that in the examples of negative experiences of the EPR reported in the literature, it was possible to highlight the different aspects of coercive formalization. To argue on the dual nature of the formalization of work induced by EPR, we have reported in the third manuscript an illustrative empirical study. Our data show that for the same EPR, in the same hospital, there may be islets of enabling formalization.Moving beyond the health field of application alone, we have further developed Strong & Volkoff's 2010 conceptualization of the misfit between business process and Enterprise System (ES), using the concepts of affordance and affordance-actualization used by the same authors in 2013 and 2014.The fourth manuscript therefore presents an original model for analyzing the use of information technology for a given business process in the form of a combination of actualizations, non-actualizations or partial actualizations of multiple affordances of the enterprise system by multiple actors. From a critical realistic perspective, misfit is then the perception by an individual or group of individuals that this combination does not satisfactorily meet all or some of the objectives of the process.We then report on how we used this model to improve the use of EPR in post-implementation in an action research project. The analysis of a misfit situation according to our method allows a recombination, by seeking a coherent sequence of technical and organizational adjustments acceptable to all stakeholders and whose arrangement allows the disappearance of the initial misfit, but also of all the misfits revealed during the analysis. This recombination then leads to a formalization of the work that has all the characteristics of an enabling formalization.The discussion of the thesis addresses the conditions for the success of the method, the choice of situations on which to apply it and the resulting research perspectives.
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David Morquin. Comment améliorer l’usage du Dossier Patient Informatisé dans un hôpital ? : vers une formalisation habilitante du travail intégrant l’usage du système d’information dans une bureaucratie professionnelle. Gestion et management. Université Montpellier, 2019. Français. ⟨NNT : 2019MONTD005⟩. ⟨tel-02305513⟩

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