Karemere Hermès, Ribesse Nathalie, Marchal Bruno, Macq Jean
Université Catholique de Bukavu, Sud-Kivu, RD Congo.
Université Catholique de Louvain, IRSS, Bruxelles, Belgique.
Confl Health. 2015 Jun 8;9:17. doi: 10.1186/s13031-015-0046-5. eCollection 2015.
This study deals with the adaptation of Katana referral hospital in Eastern Democratic Republic of Congo in a changing environment that is affected for more than a decade by intermittent armed conflicts. His objective is to generate theoretical proposals for addressing differently the analysis of hospitals governance in the aims to assess their performance and how to improve that performance. The methodology applied approach uses a case study using mixed methods ( qualitative and quantitative) for data collection. It uses (1) hospital data to measure the output of hospitals, (2) literature review to identify among others, events and interventions recorded in the history of hospital during the study period and (3) information from individual interviews to validate the interpretation of the results of the previous two sources of data and understand the responsiveness of management team referral hospital during times of change. The study brings four theoretical propositions: (1) Interaction between key agents is a positive force driving adaptation if the actors share a same vision, (2) The strength of the interaction between agents is largely based on the nature of institutional arrangements, which in turn are shaped by the actors themselves, (3) The owner and the management team play a decisive role in the implementation of effective institutional arrangements and establishment of positive interactions between agents, (4) The analysis of recipient population's perception of health services provided allow to better tailor and adapt the health services offer to the population's needs and expectations. Research shows that it isn't enough just to provide support (financial and technical), to manage a hospital for operate and adapt to a changing environment but must still animate, considering that it is a complex adaptive system and that this animation is nothing other than the induction of a positive interaction between agents.
本研究探讨了刚果民主共和国东部卡塔纳转诊医院在一个变化的环境中的适应情况，该环境受到长达十多年的间歇性武装冲突的影响。其目的是提出理论建议，以不同方式处理医院治理分析，旨在评估其绩效以及如何改善该绩效。所应用的方法采用了案例研究，使用混合方法（定性和定量）进行数据收集。它使用（1）医院数据来衡量医院的产出，（2）文献综述以识别研究期间医院历史中记录的事件和干预措施等，以及（3）来自个人访谈的信息，以验证对前两个数据来源结果的解释，并了解转诊医院管理团队在变革时期的响应能力。该研究提出了四个理论命题：（1）如果参与者有共同愿景，关键主体之间的互动是推动适应的积极力量；（2）主体之间互动的强度很大程度上基于制度安排的性质，而制度安排又由参与者自身塑造；（3）所有者和管理团队在实施有效的制度安排以及在主体之间建立积极互动方面发挥决定性作用；（4）分析接受者群体对所提供医疗服务的看法有助于更好地调整和使医疗服务提供适应人群的需求和期望。研究表明，仅仅提供支持（财政和技术）来管理医院以运营并适应变化的环境是不够的，还必须加以推动，因为这是一个复杂的适应性系统，而这种推动无非是在主体之间诱导积极的互动。
