Appropriating Control Rooms Towards Integrated Performance Management in Publicly-Funded Health Systems: The Case of Quebec
The general objective of the thesis was to understand the appropriation process of control rooms (integrated performance management tools) mandated in the context of the 2015 health system reform in Quebec, Canada. We present the development of a new qualitative methodological design - a multisite ethnographic case study – and its empirical application to reconstruct the story appropriating control rooms (2016-2019), both as an organizational process and as a form sociomaterial work. Appropriation as a process unfolds into three phases (implementation, test, adaptation) and follows three trajectories (cognitive, structural, technical). Appropriation as a sociomaterial work sequentially allows to reformulating performance management work, disrupting accountability work, and effecting value-based integrated performance management. A multi-level narrative process analysis of the data reveals how the appropriation of control rooms can strengthen the relationship between managerial and clinical relevance in the context of integrated performance management.