Évaluation de la pertinence d'un projet de réseau de santé prenant en charge les urgences neurotraumatiques graves

Abstract

The aim of the study was to realise a strategic analysis of the feasibility of implementing a health care network for the management of severely head-injured patients in the Alpine region. We conducted face-to-face semi-structured interviews. Manual and computerized analysis of interviews was realized. Textual analysis was performed using the ALCESTE software package. A strategic analysis according to Crozier and Friedberg was performed. Eighteen interviews were realised: 13 physicians, 3 hospital directors and 2 head nurses. We identified 5 types of problems in the management of severely head-injured patients: the lack of human and material resources (33.1% of the variance), problems of communication (12.2%) and surgical competence (24.00), trajectory of care influenced by the concurrence between hospitals (18.0%) and relationship between professionals (12.6%). The stabilisation of process of cooperation was expected by all the professionals and a health care network seemed to be adapted as a coordination tool. Its implementation needed to take into account 3 individual representations: the will for collaboration--cooperation (23.3%), the negotiation (48.4%) and the contracts of the cooperation (28.3%). This study confirms that actors noted the need for improving the management of severely head-injured patients in the Alpine region. However, negotiation to express and solve controversies appears being a precondition to prevent from the blocking of the network by resistances to change.