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When Innovation Takes Place in a Rural Territory: Thinking of the Care Pathway as a Dispositive

Author

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  • Cassandra Delorme

    (CleRMa - Clermont Recherche Management - ESC Clermont-Ferrand - École Supérieure de Commerce (ESC) - Clermont-Ferrand - UCA - Université Clermont Auvergne, IAE - UCA - Institut d'Administration des Entreprises - Clermont-Auvergne - UCA - Université Clermont Auvergne, S&T - chaire Santé et Territoires)

Abstract

Faced with a shortage of resources that undermines access to healthcare in rural areas, this research examines how the concept of a dispositive can be used to analyze the structure of a regional healthcare pathway. Although central to public policy, the notion of pathways remains fragmented between political-strategic, organizational, and experiential perspectives. To overcome this fragmentation, we draw on the theoretical framework of dispositive developed by Gilbert and Raulet-Croset (Lire le management autrement: Le jeu des dispositifs. Editions EMS, 2021), which combines ideology, management discourse, instrumentation, and spatial anchoring. Our ethnographic methodology combines observations, interviews, and documentary analysis of a pathway deployed between 2021 and 2025 in a rural French region. The process analysis reveals four sequences of evolution marked by tensions between governance ambitions and operational imperatives. The results show that the pathway is a dynamic arrangement structured around the ICOPE ideology, adapted assessment tools, and innovative hospital anchoring. This research enriches our understanding of pathways by reconciling their multiple facets and highlights the structuring role of actors as an intrinsic component of the system.

Suggested Citation

  • Cassandra Delorme, 2026. "When Innovation Takes Place in a Rural Territory: Thinking of the Care Pathway as a Dispositive," Post-Print hal-05746620, HAL.
    • Handle: RePEc:hal:journl:hal-05746620
    DOI: 10.1007/978-3-032-26184-7_17
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