The patient–stakeholders place in performance management[La place du patient dans la hiérarchisation des parties prenantes en établissement de soin : un indicateur du souci éthique du management]

The health field is increasingly marked by performance measurement, where the keywords are "profitability", "efficiency" and "result". However, the right of Health is not a concept with which financial performance issues can be correlated. Indeed, the legislator has defined flagship laws protecting the patient, and this in an increasingly meticulous manner, in particular through the certification grids focused on "ethics" of the High Authority for Health. At the same time, agencies are created to support health structures in the search for performance, which defines the methods of financing these structures. Without forgetting all the stakeholders of these entities, in particular the shareholders and the limited partners, who all have primary interests respectively. The management of an SSR establishment requires rigorous performance management to guarantee a certain stability and regularity in the rotation of beds, while preserving the integrity of the patients and appropriate support towards discharge. To what extent could the management of a private follow-up and rehabilitation clinic (SSR) take into account all these injunctions? In this context, ethical management by stakeholders seems to be a form of action that can lead to a concrete response. Thus, this article aims to study how the place given to the patient by management by stakeholders can be characteristic of ethic research, and to what extent it can participate in the development of performance. To do this, we will take stock of the data in the literature dealing with performance in healthcare establishments, ethical and thoughtful management to better specify our mobilization of stakeholder theory (1). We will confront these theoretical elements with the analyzes of actors in the field (3) after clarifying our methodology (2). Through the analysis of the management implemented, we highlight the possibility of managing differently, leaving the door open to flexibility and adaptability for the well-being of the structure and the patients (4).