Projets de changement organisationnel et pratique de la pharmacie hospitalière au Québec: des espaces techniques à l’espace stratégique
Bibliographic record
Abstract
Dans les systèmes de santé contemporains, le changement organisationnel repose surtout sur des modèles de gestion à la mode ciblant la performance, mais méconnaissant les pratiques qui ont cours dans les organisations qu’ils visent. Ainsi, si le travail des médecins et personnels infirmiers est par exemple relativement connu, ce n’est pas le cas de celui de la pharmacie d’établissement qui connaît pourtant d’importants changements. Parce qu’elle permet de mettre en évidence la relation réciproque entre action et structures organisationnelles et institutionnelles, nous avons choisi d’explorer cette pratique de la pharmacie hospitalière à partir de la théorie de la structuration. Le matériel empirique a été recueilli par observations et entrevues au sein d’un département de pharmacie d’un hôpital québécois. L’analyse des interactions entre ses agents met en évidence deux espaces de structuration des pratiques : technique et stratégique. Après les avoirs définis et illustrés par des exemples, nous relevons les implications managériales de ce résultat. Change management in contemporary healthcare systems usually relies on trendy tools aimed at increasing performance without consideration for the practices actually going on within healthcare organisations. Some of these practices are well documented, like those pertaining to the medical profession or to nursing, but others are mostly ignored. This is particularly the case of hospital pharmacy practice, which is undergoing major changes mostly unnoticed to healthcare organisations researchers. In order to address this issue we used a structuration theory framework to better understand how actual practices and change projects are affecting each other. Qualitative data collected through observations and interviews in a regional hospital from Quebec show how pharmacy hospital practice is structured through two complementary spaces: the technical space and the strategic space. We discuss how our findings might challenge the way change projects are managed within the context of hospital pharmacy practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.005 | 0.008 |
| Scholarly communication | 0.011 | 0.005 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".