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Doctors/Dr. EL HÉDI GUELMAMI Mohamed


Thesis topic:

Management of a private clinic in Tunisia: Translating and aligning for a better management


The private hospital sector is an integral player in the global health care field (Decosta, 2007). Its organizational specificities depend on a complex architecture, which has evolved over several decades, as well as on a main actor: the physician (Michel, 1999).

Private practice has gone from being an individual practice, with a specialist practicing in smaller clinics, to a collective endeavor where several physicians work together within a multidisciplinary clinic, leading to the emergence of the private clinic (Claveranne and Piovesan, 2003).

Research in management sciences (Contandriopoulous, 2008) has paid little attention to the private hospital sector, and research in the sociology and economics of the health care sector has focused primarily on the public sector.

The organizational architecture of the private clinic is dynamic, ever changing, and contains a variety of actors whose actions are sporadic and asynchronous. The regulation of this organization is orchestrated by the manager of the clinic, who is in charge of harmonizing the voices of all the actors.

The manager must understand what the different actors want, why they act the way they do, how they associate with each other, and must know how to translate these needs and interests into a language that is understood by all. The manager must understand the negotiations, alliances, conflicts of interest, and underlying tensions for him/her to successfully perform this translation.

Through this process of translation, the network is constituted in a pro-active approach that brings all the stakeholders together for the purpose of alignment.

Callon defines the techno-economic network as the coordinated set of heterogeneous actors involved in the elaboration and diffusion of innovation and organizing the relations between scientific-technical research and the market, through numerous interactions (Callon and Bell, 1994).

We see the network of a private health care structure as consisting of a group of heterogeneous actors coordinated by a manager, involved in the elaboration and dissemination of medical innovation, and orchestrating the relationships between caregiver, patient, and institution, through the alignment of many interactions.

The notion of poles and intermediaries, proposed by Callon in 1991, explains the mechanisms coordinating these heterogeneous sets of actors. By analogy, we consider that our network consists of three poles: the “Institutional” cluster representing the clinic, the “Healthcare” cluster representing the physicians, and the “Patient” cluster representing the patients. These three poles link different actors belonging to the same world.

The research approach adopted will be based on the methodological positioning inspired by the theory of translation in a relativistic view. It consists in allowing knowledge dealing with the problematic of our work to emerge from the field, through an exploratory context based on an inductive approach.