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The implementation of certification procedures at the activity level in French hospitals

Abstract : Implementing quality measures is essential to improve the performance of healthcare organizations. The integration of these measures, particularly certification, into professionals’ practice is a pivotal issue for managers and the management of healthcare organizations. However, research on the implementation of these quality procedures into routine practices remains limited. In this thesis, we studied the implementation of certification procedures at the level of nurses’ activity following an abductive approach. First, we reviewed the literature on the implementation of evidence-based changes in the nursing practice. This review showed that despite the importance of previous research on implementation factors, the impact of local context on implementation processes was poorly understood. Therefore, we developed an integrative framework in two stages. The first was inductive and consisted of a qualitative case study conducted between April and December 2019. Here, we analyzed the implementation of certification procedures in a French teaching hospital. Data were collected using 16 semi-structured interviews with managers and nurses and 83 hours of observations. The second was deductive in which we analyzed the emerged themes using the Quality Implementation Tool (QIT) and Translational Mobilization Theory (TMT). The analyses were combined to construct the integrative framework for the implementation of change in nursing practice (IFINP). Then, to assess the generalizability of IFINP in multiple organizational settings, we conducted comparative case studies. Data were collected using 33 semi structured with relevant actors in the implementation of the certification procedures from three hospitals different in type and size and within three sectors. The framework was flexible to capture the different actions and elements that emerged during the implementation processes. These were helpful to characterize the leadership factors and managers’ role and showed a strong interference of the IFINP components. This thesis contributes to the development of knowledge relevant to the implementation of certification procedures at nurse’s level and offers a framework for managers with broader vision elements that influence the implementation processes at the organizational and professionals’ activity levels
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Submitted on : Tuesday, May 10, 2022 - 3:41:25 PM
Last modification on : Wednesday, May 25, 2022 - 6:17:15 PM


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  • HAL Id : tel-03663967, version 1


Israa Salma. The implementation of certification procedures at the activity level in French hospitals. Sociology. École des Hautes Études en Santé Publique [EHESP], 2022. English. ⟨NNT : 2022HESP0001⟩. ⟨tel-03663967⟩



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