Pilotage de la performance du circuit du médicament hospitalier au travers du management des risques iatrogènes

摘要

The activity of health establishments is complex because of the numerous care services, the multiplicity of speakers and trades, competences and care procedures which accompany each pathology. Constraints are coming stricter and stricter, of a medical nature, human, ethical or social nature but also of a financial, regulatory or even political nature. New situations, sometimes unknown or even unexpected, can lead to appearance of risks and damages at the same time to patients (iatrogenic events) and to services concerned, impacting the performance. To face these situations, the establishments try to set up an organization which corresponds more and more to industrial systems organization, placing customer in the center of the concerns. However, the parallel and the total transposition of industrial tools prove to be difficult. Our doctorate work will concern an inevitable process in a care establishment : the medication use system. Through management of the iatrogenic risks, the evaluation and the improvement of its performance will be searched, first in the form of a model (plan) and then through a concrete application in a hospital and university complex (CHU Nice).