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Adopting an intra-organizational viewpoint is essential to grasp legal intermediation. To deepen our understanding of such phenomena, this chapter proposes a qualitative and “multi-level” approach drawing on insights from the neo-institutional literature, policy ethnography analysis and the research on legal intermediaries. Such a perspective is particularly suited to capture the complexity and the depth of institutional change. Using the 12-hour work legal mechanism of derogation in the context of French public hospitals as an example, this chapter highlights how both macro-level actors (actors of a “reform network”), and micro-level ones (hospital directors) contribute to the shaping and framing of legality in French public hospitals. Results show that variation in how those actors use law depends on the local configuration. Second, results demonstrate that the legal games they play are not merely based on symbolic and superficial compliance with the law, but also on outright manipulations and conscious rule-breaking.

Purpose: This chapter describes the main features of the financing of health care expenditure in the French health care system.

Methodology/Approach: This chapter presents key reforms that have been implemented to make the health care system more sustainable in the main dimensions of care: ambulatory, hospital, pharmaceuticals and insurance coverage.

Findings: Overall, French public authorities have followed three paths to improve the sustainability of the health care system: reducing public expenses, generalising access to complementary health insurance and streamlining care toward the most disadvantaged individuals. Looking in the future, the sustainability of the French health care system will mainly rely on two areas of recommendations. The first area is to respect the national annual target for health insurance spending, with a focus on responsible prescriptions, optimised care pathways and increased use of primary and ambulatory care where possible. The second area is to increase efficiency on the short to medium terms. This includes an increased quality of the care toward patients with a disability or special needs, a clearer engagement of patients within their care pathways to increase treatment compliance, and more generally a search for coordinated care that is fair and appropriate.

We utilise the actor-network theory (ANT) – based especially on Latour (2005) – to examine how management accounting tools affect physicians’ representations and new managerial practices in French public hospitals currently undergoing reform.

We conducted a longitudinal case study – based on interviews and observations – in a large French public hospital in which dashboards are diffused to physicians and nurses dealing with both medical and managerial activities.

The case shows that head physicians and nurses are implicated in their new managerial tasks and spend time analysing dashboards. Management accounting tools thus play a role, as mediators, in organising new managerial practices, and dashboards are a means of materialising and giving structure to new managerial practices and enabling discussions and exchanges to take place between actors who were previously separated.

The case shows that management accounting tools are not necessarily useful because they help in decision-making or control – as in the dominant paradigm; rather, they are beneficial because they may help in changing representations and building a new collective organisation. Future research should therefore expand on the organisational and social roles of management accounting tools, especially in the healthcare field.

Most ANT-inspired studies in management accounting focus on explaining changes in accounting practices, which are perceived as a consequence of an ANT process. This chapter, however, analyses the practices by which management accounting tools act as a vehicle to organisational change.

Purpose: As specific emotional arenas, hospitals are characterized by the interweaving of various emotional requirements, arising from different sources of norms, rules, or guidelines. This study aims to highlight an often-overlooked dimension of emotional labor in healthcare by describing the coexistence of emotional rules (i.e. feeling and/or display rules) through a multilevel perspective (institutional level, cluster/department level, service level, ward level, professional level). Study Design/Methodology/Approach: These emotional requirements for nurses and nursing assistants are investigated through three sets of data (observation, interviews, and internal documents) in a French public hospital, focusing on two hospital services: three long-term care units (primary field of investigation), and five adult medical emergency wards (secondary field of investigation). Findings: The results of the analysis show the pervasive nature of emotional requirements which are intertwined and more or less implicit/explicit according to the level analyzed. In addition to organizational rules, professional and social emotional rules contribute to shaping emotional requirements, particularly through rules of “empathetic expression” and those of retenue bienveillante. Research Limitations/Implications: This research has contributed to showing the dynamic nature of emotional requirements and their appropriation and modulation by healthcare professionals. The qualitative methodology used allows for unique insights but limits the generalization of results. Originality/Value: This research has addressed various gaps in the existing literature by describing emotional requirements through a multilevel analysis, by outlining a set of rules that had not been previously described (retenue bienveillante) and by including the population of nursing assistants as well as nurses in a study on hospital emotional labor. Future research could envisage spatial analysis of emotional labor to help better understand emotional requirements' variability according to emotionalized zones.

While the main emotional labor strategies are well-documented, the manner in which professionals navigate emotional rules within the workplace and effectively perform emotional labor is less understood. With this contribution, I aim to unveil “the good, the bad and the ugly” of emotional labor as a dynamic theatrical performance.

Focusing on three geriatric long-term care units within a French public hospital, this qualitative study relies on two sets of data (observation and interviews). Deeply rooted within the field of study, the chosen methodological approach substantializes the subtle hues of the emotional experience at work and targets resonance rather than generalization.

Using the theatrical metaphor, this research underlines the role of space in the practice of emotional labor in a unique way. It identifies the main emotionalized zones or emotional regions (front, back, transitional, mixed) and details their characteristics, before unearthing the nonlinearity and polyphonic quality of emotional labor performance and the versatility needed to that effect. Indeed, this research shows how health-care professionals juggle with the specificities of each region, as well as how space generates both constraints and resources. By combining static and dynamic prisms, diverse instantiations of hybridity and spatial in-betweens, anchored in liminality and trajectories, are revealed.

This research adds to the current body of literature on the concept of emotional labor by shedding light on its highly dynamic and interactional nature, revealing different levels of porosity between emotional regions and how the characteristics of each type of area can taint others and increase/decrease the occupational health costs of emotional labor. The study also raises questions about the interplay of emotional labor performance with the level of humanization/dehumanization of elderly people. Given the global demographics about an aging population, this gives food for thought at a social level.

Since the 1990s, the French government has offered tax exemptions for people who buy property and rent it out for at least nine years. This legal framework, centered on incentives, can be considered a new kind of (de)regulation of housing policy, triggering a multiplication of private intermediaries devoted to finding clients for tax exemptions. Based on interviews with 28 investors who feel they have been abused (many of them have started legal proceedings against professionals from whom they bought a property), this study provides a new entry for analyzing legal intermediation, showing that it does not affect all laypeople in the same way, especially when looking at the latter’s social and economic resources. We analyze how and with what devices professionals, whose commercial practices are not fully regulated by law, rely on the law for the success of their transactions, especially with taxpayers who have money to become investors but who are not rich enough to pay for the services of a tax professional. We argue that the ability to resist the appeal of putting money into investments that turned out risky depends on investors’ social and economic resources. Finally, we analyze how the process of legal intermediation described in this chapter impacts investors’ legal consciousness and creates distrust toward the law.

Legal intermediation is an emerging theoretical concept developed to grasp the importance of the process and actors who contribute to legal endogenization, in particular in the field of economic activities and work governed by various public regulations. This chapter proposes to extend the analytical category of legal intermediary to all actors who, even if they are not legal professionals, deal on a daily basis with legal categories and provisions. In order to deepen our understanding of these actors and their contribution to how organizations frame legality, this chapter investigates four examples of legal intermediaries who are not legal professionals. Based on field surveys conducted over the past 15 years in France on employment policy, industrial relations, occupational health and safety regulation, and forensic economics, I make three contributions. First, the cases show the diversity of legal intermediaries and their growing and increasingly reflexive roles in our complex economies. Second, while they are not legal professionals per se, to different degrees, these legal intermediaries assume roles similar to those of legal professionals such as legislators, judges, lawyers, inspectors, cops, and even clerks. Finally, depending on their level of legitimacy and power, I show how legal intermediaries take part in the process of legal endogenization and how they more broadly frame ordinary legality.

We present a description and analysis of the current reforms in the French system of “assurance maladie”, or its health insurance system, particularly as they bear on quality at the hospital level. The measurement and management of quality play a significant role in the reform, thus providing a particularly timely example for health care policy makers, researchers, and managers. We discovered several lessons from the French experience. First, the issue of workload influenced thinking about how best to build a given indicator, and led to careful evaluation of the added value of additional data collection. In some cases the indicators are actually more of a screen or filter than an actual assessment of quality, with particularly high or low values signaling the need for further investigation rather than serving as assessments per se. Second, the development and implementation of quality indicators (QIs) demand the involvement of professionals in the process. Third, process indicators seemed to be more useful than outcome indicators. Fourth, expectations for quality management should be aligned with feasibility and with the reality of measurement system. For example, the workload is closely tied to the state of the hospital data collection systems (indicators selection). Lastly, the twin objectives of quality improvement and accountability do not necessarily mesh easily or well.

Whereas many researchers have examined the way in which health institutions have been transformed through funding modalities, and particularly through prospective payment systems (PPS), few have investigated the architecture of these systems, that is, costs and cost variance. Focusing on the study of costs and on the production of hospital rates, this chapter shows that the French PPS, called “rate per activity” made possible what we call a policy of variance. For health policymakers, the aim was to make the different accounting figures between hospitals, and between ways of practising healthcare, visible, in order to reduce these variances. This policy was attended by uncertainty in the processes of quantification, which led to metrological controversies. As a consequence of the issues around the way of calculating costs, some accounts and calculations were redone. In this chapter, we consider the case of metrological controversy over the remuneration of costs for cystic fibrosis patients’ hospital stays, and over the action of a patient organization that criticized the costs calculated officially. It leads to the analysis of the way calculative infrastructures, as cost accounting and rates, are challenged, and how some actors try to stabilize them.