Decoupling of HRM as health sector regulation[Le découplage de la GRH comme regulation du secteur sanitaire]

This systematic review of the academic literature since early 1990s on the application of some HRM practices in health care sheds light on the persistence decoupling between institutional norms and standards related to human resource management (HRM) procedures and the actual practices in organizations. Contrary to the affirmation of NIT, translation processes do not put an end to decoupling. The isomorphisms identified by the neo institutionalists relate to leadership decisions, not practices. The application of HRM practice bundles is opposed by health care professionals. This analysis of the «critical» approach is apparently contradicted by that which we describe as «optimistic» because even if virtues are found in the application of these standards, these authors complain of the still too small number of hospitals who comply. Thus, the power of leaders seems limited like that of caregivers, who try to impose the regulation in accordance with their institutional medical logic. Neither the control regulations nor the autonomous regulations manage to impose themselves, remaining durably disconnected, so much so that the institutional logics oppose each other, fuelled by divergent evaluations of the working conditions. Finally, our theoretical contribution is to consider decoupling as a disconnected form of regulation that is put in tension by managers in their project of optimization of resources. In the end, our results question the validity of the managerialism of the New Public Management in a context of shortage of caregivers.