Angajament şi distanţare faţă de muncă şi faţă de pacienţi în spitalele franceze
Involvement and detachment concerning the work and the patients in the French hospitals

Summary/Abstract: In recent years, the changes in healthcare policies in France (implemented under the constraint of economic rationalization) have led to profound internal and external reorganizationsof hospitals, as well as to an increased level of their productivity. The system of “activity‑basedpricing” (T2A) came to be articulated, together with many other reforms of the hospital, inconnection with the „New Public Management” project and aimed at de‑bureaucratizing the public sector. These developments had a significant impact on the specific dynamics of the medical andnursing professions and led to transformations in their approach to work and patients in the hospital.The codification of actions and, more generally, the professionalization of the care occupations havechanged the relationships between professionals in the context of the new division of tasks or thenew way in which the work groups operate.We study the organizational innovations and working conditions in the hospitals, based on data fromthe 2013 French National Survey „Working Conditions”, as well as on the interviews carried out as part of a post‑survey project. For this purpose we use a sociological and statistical approach. Wetry to identify firstly the main organizational evolutions of the institutions and secondly the perceptionthe caregivers have regarding work conditions, in terms of commitment and sense of duty, but alsoin terms of evolution of their relationship with the beneficiaries of their care, the patients.Commitment and detachment, two key concepts in Norbert Elias’ sociology, allow us to analyze here the often contradictory nature of these relations, which are often subject to tensions between the affirmation of professional vocations, attachment to values and institutions pertaining to the world of healthcare, on one hand, and taking distance in a crisis situation, with the development of new strategies towards the profession and the institution, on the other hand. The denunciationof the working conditions and the demonstrations of professional disengagement (expressions ofdivided habitus), reveal the „circular connection between a weak control of the events and a weakcontrol of oneself” of which Elias spoke.

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