Usages des indicateurs de qualité en établissement de santé

The French Health Ministry is testing a set of quality measures in a group of hospitals, in order to expand it to the whole system. These measures are supposed to produce different effects according to the stakeholder's interest. On one hand, for hospital managers, quality indicators are supposed to assist the decision making process. On the other hand, for health authorities, quality indicators are supposed to produce a global view of the entire system. This framework raises the question of how top hospital managers are using quality measures. We explore the uses of quality measures in two large French hospitals. Based on our observations and on twenty interviews, our results suggest, firstly, that there are two main uses of quality measures, which we characterize as bureaucratic and managerial. Secondly, the bureaucratic and managerial uses coexist in each organization. However, the attitude of top managers towards quality measures does not influence its use in hospitals.