Communication et processus organisants : le cas du traitement des évènements de sécurité dans le domaine du contrôle aérien

Notre objet d'étude se situe dans le domaine du contrôle aérien, et concerne plus spécifiquement ce qui est identifié comme le " système de traitement des événements sécurité " dans le cadre plus large du " système de gestion de la sécurité ". La sécurité de l'aviation se doit d'être maîtrisée et sans cesse retravaillée en lien avec l'augmentation du trafic aérien. Aux évolutions règlementaires et techniques sont associés de nouveaux enjeux liés aux démarches qualité-sécurité. Ces démarches s'appuient sur un principe d'amélioration continue mis en place à travers de ce qui est désigné en termes de " notification et traitement des événements relevant de la sécurité ", ainsi que de " retour d'expérience ". Or les normes ne sont jamais simplement appliquées, elles sont mises à l'épreuve des situations concrètes, négociées et interprétées. Dans cette recherche, nous interrogeons les formes de textualisation (Taylor, 1993) des organisations à travers les normes inscrites dans des textes prescriptifs, ainsi que d'autres " écrits professionnels " omniprésents dans les organisations (Delcambre, 1990 ; 1993). Nous interrogeons les processus organisants du point de vue de la manière dont ils se constituent, se négocient et se recomposent entre différentes formes scripturales. Ce faisant, nous proposons de contribuer à une approche communicationnelle des organisations renouvelée, mobilisant et retravaillant certaines contributions de deux approches très contemporaines : des approches de la communication constitutive des organisations (CCO) caractéristiques de tout un courant de recherches nord-américaines, et des approches communicationnelles des organisations (ACO), telles que travaillées par des chercheurs français et plus largement européens.Our object of study is situated in the field of air traffic control, and more specifically concerns what is identified as " security events processing system " in the wider context of " system security management ". The aviation security must be controlled and constantly rework due to the increase of the air traffic. The regulatory and technical evolutions are associated with new stakes related to quality and safety approaches. These approaches are based on a principle of continuous enhancement implemented through what is called in terms of " security events notification and processing " as well as " experience feedback ". However, the norms are never simply applied, they are tested in concrete situations, negotiated and interpreted. In this research, we question textualization forms (Taylor, 1993) of organizations through the norms inscribe in prescriptive texts and other " professional writings " omnipresent in organizations (Delcambre, 1990, 1993). We question organizing processes from the point of view of the way in which they constitute, negotiate and recompose between different scriptural forms. We propose to contribute to a renewed communicative approach of organizations, mobilizing and reworking some of the contributions of two very contemporary approaches: the approaches of communication as constitutive of organization (CCO) characteristics of all current North American researches and the communicative approaches of organizations (ACO), as worked by French researchers and more broadly European

Co-construction des discours organisationnels entre les « méta-textes » et les textes locaux

Dans cet article, nous proposons d’étudier l’imbrication des textes au sens de James Taylor (1993) afin de saisir les discours organisationnels. Pour ce faire, nous distinguons les textes émergeant des situations locales d’interactions des textes plus globaux qui cherchent à préconfigurer les processus organisants. Il s’agit d’analyser le processus d’articulation entre ces deux dimensions organisationnelles en prenant en compte les normes et les formes organisationnelles dans l’analyse des discours

Architexture organisationnelle

In this article, we explore the notion of architexts by examining how an organizational architexture is woven together through a string of architexts produced in response to the requirements listed in normative documents. We will look specifically at the mechanics of the process for deconstructing what is written in paper format and how it is transcribed to digital format. We will adopt a pragmatic interdisciplinary perspective and draw on the constitutive communication of organizations to take a closer look at organizing processes

Usages et usagers de l'information à l'ère numérique

Tout au long de ces dernières décennies, de nombreux auteurs ont critiqué le déterminisme technique (voir notamment Ellul, 2004 ; Miège et Vinck, 2012). Cette remise en cause a concerné en particulier la notion de « société de l’information ». Gaëtan Tremblay souligne à son propos : « Le déterminisme technologique sous-jacent au modèle de la société de l’information, dans lequel l’évolution des technologies de l’information et de la communication est présentée comme le facteur déterminant du changement, en fait nécessairement une explication réductrice incapable de prendre en considération les stratégies d’acteurs et les conflits qui en résultent » (Tremblay, 2007, 119). Depuis les annonces faites autour des autoroutes de l’information dans les années 1990, du programme e-Europe des années 2000, ou plus récemment du Digital Agenda de l’Union Européenne, le mythe d’une société dorénavant qualifiée de « numérique » est plus fort que jamais.… [En savoir +

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline