Transformation numérique d’un hôpital public en réseau intelligent de soins, France

Thesis Abstract

The rapid digitization of public hospital services in France presents both opportunities for integrated care and challenges related to interoperability, data governance, and clinical workflow disruption, necessitating an in-depth examination of how a public hospital can evolve into an intelligent care network. This study investigates the determinants, processes, and impacts of transforming a tertiary public hospital into an interconnected ecosystem that leverages digital platforms, decision-support tools, and interoperable health information exchanges to enhance patient outcomes, efficiency, and equity of access. The primary aim is to elucidate how digital transformation strategies can be operationalized to create a cohesive networked care model within the French public health system, while ensuring patient safety, data security, and professional acceptance. Specific objectives are (1) to map the architectural layers of an intelligent care network, including patient-centered data repositories, interoperability standards (HL7 FHIR, DICOM), and clinical decision support systems (CDSS); (2) to identify organizational, technical, and regulatory barriers to digitization and their differential impact on clinical workflows across departments; (3) to evaluate the relationship between digital maturity and clinical integration outcomes, such as care coordination, wait times, and readmission rates; (4) to assess patient and provider perceptions of data governance, privacy, and trust in an interconnected system; (5) to develop a framework of best practices for governance, investment prioritization, and change management relevant to French public hospitals undergoing networked care transformations. Methodologically, the study adopts a mixed-methods design anchored in a realist evaluative approach. The population comprises administrative staff, clinicians (physicians, nurses, allied health professionals), IT personnel, and patients within a flagship public hospital in the Île-de-France region that is piloting a networked care platform. A purposive sample of 60 clinicians and 200 patients will be drawn to capture diverse experiences, complemented by 20 interviews with senior managers and IT leaders. Data collection instruments include structured surveys measuring digital maturity (using the DMM—Digital Maturity Model adapted for French healthcare), semi-structured interviews guided by the Technology-Organization-Environment (TOE) framework, and focus groups with frontline staff to explore workflow integration. Administrative data will be extracted from the hospital’s information system to examine metrics such as length of stay, 30-day readmission, referral turnaround times, and instance-level data on care transitions. For data analysis, quantitative data will be analyzed using multivariate regression to test hypotheses on digital maturity and operational outcomes, and structural equation modeling (SEM) to assess relationships among governance, interoperability, and care integration. Qualitative data will be analyzed through thematic analysis guided by grounded theory principles, with coding conducted in NVivo to derive themes related to acceptance, perceived usefulness, and adaptation. A conceptual model drawing on the Technology Acceptance Model (TAM) and the Consolidated Framework for Implementation Research (CFIR) will be tested against empirical findings to explain the diffusion of an intelligent care network within a public hospital setting. Expected findings include (a) a positive association between higher digital maturity and improved coordination metrics (reduced referral delays, lower 30-day readmissions) when data standards enable seamless information sharing; (b) evidence that governance structures and data governance maturity mediate the relationship between technology deployment and clinical acceptance; (c) nuanced differences in adoption patterns across departments, with high-engagement specialties showing faster workflow alignment but requiring intensified change management support in radiology and emergency departments; (d) valid concerns among patients and clinicians regarding privacy and trust that influence ongoing participation in networked care. The study contributes to knowledge by integrating frameworks from health informatics, organizational theory, and implementation science to produce a context-specific model of networked care transformation in a French public hospital, offering transferable insights for policy-makers and hospital leadership. Recommendations emphasize modular platform architecture with standards-based interoperability, robust data governance, targeted change management programs, and a staged investment plan aligned with clinical impact milestones. The conclusion underscores that sustainable transformation hinges on aligning technology with clinical workflows, governance, and culture, and that the proposed framework can guide scalable replication within the public hospital sector in France.