Improving medically assisted procreation process: which contribution of high-reliability organizations theory?[Améliorer l’efficacité du processus de procréation médicalement assistée : quels apports de la théorie des organisations à haute fiabilité ?]

The main concern of the Medically Assisted Procreation (MAP) units of public hospital is to improve their success in terms of proven pregnancy rates following embryo transfer. The success of this sector of this relatively new specific care depends mainly on the practices of caregivers, but also on involvement of patients' couple, assuming part of the protocol independently. This article examines whether the analysis grid of High Reliability Organization (HRO), could be applied to these units and if it could help to suggest ways to improve the reliability of these activities. We chose qualitative exploratory case studies in order to test the relevance of the characteristics of the HROs and to identify the specificity of MAP's services. We made ethnographic observations in 2 units of MAP of French public university hospitals, and interviews with at least one representative of each category of personnel in these units. The results show MAP activities correspond well to the eight characteristics of HROs proposed by Roberts and Rousseau [5]. Here, activities are complex, require a strong coupling between gynaecology and reproductive biology and they are subject to uncertainties and strong temporal pressures. To ensure their reliability, services have developed working practices conform to those described in HROs by Weick and Roberts [15]. These include actions aimed at strengthening collective intelligence, resilience and vigilance. We conclude HRO theorisation can be applied to scheduled care services (like MAP) and we propose a series of managerial practices aimed at enhancing the reliability of MAP.