CE26 - Innovation, travail

Work, Health, Social : public utilities professionnalism in health centers – TRASS

Submission summary

Even before the Covid-19 pandemic put the French health care system in an unprecedented state of tension, it had to face several challenges. In the perspective of a reorganization of primary care, the articulation between the hospital system and primary health care, the reduction of territorial and social inequalities and the aspirations of the new generations to work in teams are among the most salient. Faced with these challenges, several experiments in collective organizations claim to provide a response. As health care structures that practice third-party payment and where the health professionals are salaried, the health centers develop public health actions, using "new" professions, to counterbalance the proven inequitable effects of the dominant liberal model. Since health centers employ professionals under salaried status, these organizations constitute a rich field for analyzing the development of these professions, some of which have a strong historical background. In this project, we propose to study the rearrangements taking place within primary care teams and to identify, if necessary, the transformations in the relationships maintained with public policy actors.
The objective of the project is to understand the integration of coordination, social, sport and medical assistance professions in health centers and to outline the perspectives of deployment of these professionalities putting forward a rhetoric of general interest in a context of development of fixed remuneration. The aim is to analyze how the institutional and organizational framework influences work practices. This multiple entry point makes it possible to study, within the same structure, how the professionalities of medical assistance, nursing, coordination, social work and sport differ according to the status, practices or use of the premises. The empirical investigation is based on mixed methods: qualitative, quantitative and documentary. The qualitative survey using semi-structured interviews and observations in a sample of health centers of various statuses is complemented by a literature review and a documentary survey as well as by econometric work on the administrative data of the health centers. This research, conducted by sociologists, political scientists and economists, makes it possible to test two hypotheses. At the micro-sociological level, the central hypothesis questions the process that leads to the development of these professions within the health centers. Our hypothesis is that this process consists of the internalization of services that are usually outsourced (H1). We will use the instruments of the sociology of work and professions to analyze this process within the health centers and its repercussions on their environment. Because it shifts the focus from outside the structure to inside, this process transforms the place of the health centers in the health care system. This leads to the formulation of a second hypothesis, at the meso- and macro-sociological levels. It concerns the transformation of the governance of health centers from the point of view of territorial public policy. We hypothesize that the development of these new professions contributes to a territorialized, population-based public health policy (H2). Using a sociology of public action, it will allow us to question the territorial integration and cooperation resulting from these professionalities.

Project coordination

Nadège Vezinat (Centre de Recherches Sociologiques et Politiques de Paris - CRESPPA)

The author of this summary is the project coordinator, who is responsible for the content of this summary. The ANR declines any responsibility as for its contents.


CRESPPA Centre de Recherches Sociologiques et Politiques de Paris - CRESPPA

Help of the ANR 338,311 euros
Beginning and duration of the scientific project: December 2021 - 48 Months

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