Entre sécurité des soins et injonctions à la performance économique au bloc opératoire : faut-il choisir ?

In a context where health care facilities are encouraged to control their costs, while responding to safety stakes, the article questions how these two types of performance can complement one another. The article proposes to revisit the work on "high reliability organizations" (HRO), adopting a managerial approach through the study of organizational arrangements, rarely addressed in its current form in these research stream [Lorino, 2005; Brabet, 2005]. The empirical study of two operating rooms examine the principles highlighted by HRO's authors, in the context of economic rationalization. It reveals that the organizational arrangements developed in order to improve economic performance can also play an important role in patient safety. However, the complementarity between efficiency and safety is based on the collective work of caregivers who adapt tools or devices when they deal with unexpected events. The occurrence of unexpected events requires managing these performance as closely as possible to the activity. This result calls for directions to open the "black box" and not only focusing on the structuring work done upstream part of action, but also considering and facilitating the organizational work actually performed by caregivers.