Approche territoriale d'une gestion dynamique et multidimensionnelle des accompagnements au sein d'un réseau de structures médico-sociales
The medico-social sector in France is a sector that help and support people in vulnerable situation. This sector concerns in particular people with disabilities (PWD). Depending on the disability, PWH may require adapted medico-social support that helps them living almost like any other person. Different social and medico-social institutions (SMSI) provide these supports. If the person wishes to access this support, it must address a request to the Departmental House of Disabled People (DHDP). A multidisciplinary team (MT) analyses the request and proposes to the person a list of SMSI considered appropriate to the person's situation. This process is called the orientation process for PWD and presents several problems that this thesis seeks to solve. The current process is often too long and sometimes does not always formulate applicable solutions. Some people may stay without support for several years. The main objective of this thesis is to improve the orientation process based on a change in the orientation policy. Instead of proposing a list of institutions from which the person has to choose one (disability-institution policy), we propose a list of services from different SMSI capable of meeting the identified needs (needs-services policy). The list of services can be provided by one or several MSI. In order to shift towards a needs-services policy, we propose a method for modelling complex processes involving autonomous actors. This method was used to model the orientation process to analyse problems, causes and find improvement opportunities. We then proposed a service characterization approach (qualitative and quantitative aspects) in order to identify the dimensions that defines a service. This approach was used in the characterization of medico-social services for the needs-service policy. Finally, we propose an assignment model using a sliding horizon mixed-integer linear formulation. This model proposes an orientation according to the needs-services policy. This model has been tested with representative data of different SMSI that help us to identify and propose better organizational practices for the orientation process.
KEYWORDS : Industrial engineering, medico-social sector, Handicap, people with disabilities, Pwd, orientation management, process modeling, service, assignment model, linear programming.