Mesure de la performance dans les organisations de réadaptation en déficience physique

This thesis aims to assess the degree of implementation and use of performance measurement systems (PMS) by decision makers in rehabilitation organizations and to understand the contextual factors that influenced their implementation. A multiple case study was conducted using two data sources: individual interviews with senior executives in rehabilitation organizations from the province of Quebec and organizational documents. The Consolidated Framework for Implementation Research was used to guide the collection and analysis of data. Intra-case analysis and a cross case analysis were conducted.  Our results show that organisational readiness for PMS implementation was high and that the PMS was successfully implemented and used in several ways, based on organizational needs. Organizations used them passively (as an information tool), purposefully (to act on underperforming areas) and politically (for negotiating with government authorities).  This diverse use of PMS is the result of complex interactions between factors from the internal context of each organization, PMS characteristics, the implementation process and the external environment in which these organizations operate.  Within the internal context, the continued commitment and leadership of senior management were decisive in implementing the PMS through their influence on the identification of the need for a PMS, users’ engagement, organizational priority given to the PMS, resources allocation to its implementation, quality of communications and organizational learning climate. However, even if factors such as resources allocated to the implementation, organizational priority of the PMS and the learning climate were found to be barriers to its implementation, ultimately, these barriers were not important enough to hinder PMS use.  This study also confirmed the importance of PMS characteristics, particularly the perception of quality and usefulness of the information. However, by themselves, these characteristics are insufficient to ensure implementation success.  This implementation analysis also revealed that although the implementation process did not follow formal stages, a PMS development plan, participation and commitment of decision makers and the appointment of a project leader all facilitated implementation of the PMS. However, the lack of evaluation and collective reflection on the implementation process limited the potential for organizational learning, a prerequisite for performance improvement.  As for the external context, the support of an external organization proved to be an essential enabler for PMS implementation by rehabilitation organizations despite the absence of governmental policies and incentives to do so.  This study contributes to increasing knowledge about the contextual factors and their interactions in the implementation of innovations such as PMS and confirms the importance of addressing implementation analysis with a systemic perspective.

Keyphrases: Performance, Étude qualitative, Performance, Performance measurement system, Rehabilitation, Qualitative study, Implementation, Healthcare decision makers