Governance Tensions in the Healthcare Sector: A Contrasting Case Study in France

Abstract

Background: Political and managerial reforms affect the health sector by translating into governance tensions. As identified in the public management literature, they come from the diffusion of management principles and practices from the business world. They manifest at four levels: institutional, organisational, managerial and instrumental. The objective of this research is to understand how these tensions express healthcare institutions with different status. Methods: We conduct a contrasting case study exploring the cases of two French healthcare institutions, one private for-profit (clinic) and one public not-for-profit (cancer treatment centre). Our analyses are mainly based on the content analysis of 32 semi-structured interviews conducted with staff (nurses, doctors, management and administrative staff) of these two institutions.Results: Our results show that these tensions can be distinguished into three categories (tensions on professional values, standards and practices) which are expressed differently depending on the type of healthcare institution and its main management characteristics.Conclusions: Unexpectedly, in the for-profit institution, the most intense tensions concern professional standards, whereas they concern professional practices in the not-for-profit institution. These analyses can help guide policy makers and health care managers to better integrate these tensions into their political and managerial decisions.