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Hospital restructuring today is the object of a debate which goes beyond the hospital sector alone to concern all public action. Constituting at one and the same time a dynamic, a policy and a dimension for rationalisation which has gripped the hospitals, it is based on a plurality of logics. Conversations with actors in such restructurings aimed to highlight the “referentials” for their actions. Globally, two main referentials have appeared. The first puts the emphasis on the decisions, the results sought, the incentives, the criteria for activity and resources; the second privileges the procedures and the quality of any negotiations. An analysis of usage of the “PMSI” and of accreditation, shows that the remarkable track followed by the French hospital System is largely arrived at via compromises made between these two referentials.