Within ten years, the French public hospital system's organization experienced several structural reforms. New managerial concepts coming from the industrial for-profit field spread into the public hospital sector, and outcome-oriented rationales replaced the unconditional answer to the population's health needs. Three main reforms have been implemented to take measures dedicated at improving public hospitals' performance regarding their financing, management and quality policies.
Those measures have had dramatic repercussions on hospital culture: organizing medical services to generate the highest profits often hardly matches professionals' devotion to their duty to patients. As a consequence, public hospitals often fail to federate different professional bodies under a common philosophy and to spread shared values that will give a meaning to structures' mission and corresponding organization. Seeking performance is not about following a unique, standardized model. Each business field has its own specificities, and performance-seeking processes have to be adapted to suit those specificities and optimize each organizational model to get the best out of structures' processes.
[...] But a new issue then arose: what is a profitable activity? A new definition was commonly adopted: a profitable activity generates substantial resources while mobilizing few means and resources. Globally speaking, we can summarize five major reasons why activity-based payment model generates pernicious effects: - It was implemented in a hurry, generating around 592 million Euros of deficit in 2008 because structures did not have time to adapt their management processes to balance the decrease in allocated resources. - The model encompasses more than 2,300 Diagnosis-Related Groups in which managers are supposed to classify medical activities to make them corresponding with a specific tariff: it is very complex and time consuming to gather different activities in so many groups. [...]
[...] There are different types of expenses in a public hospital, the most significant being the labor force. Expenses are classified into four categories: -Staff (medical, paramedical, technical and administrative professionals) -Medical expenses (drugs, surgical equipment…) -Expenses related to premises, linen, catering -Amortization, financial and exceptional provisions As we can see, many expenses are hardly manageable by hospitals themselves. For instance, national authorities set drug prices and hospitals have no choice but buying drugs at their market price. Hospitals' expenses consequently escape any king of control. [...]
[...] Any other management style would face the same issues: replacing people is not, contrary to what sociological reflexes dictate, a way to compensate for organizational flaws. Facing the same structural specificities, people react approximately the same way. This is the reason why measures to reform the French health care system, and more particularly the public hospital system, should focus on solving structural and organizational issues (such as the way resources are implemented) instead on trying to enhance bad management practices. What future for the French public hospital? This question is pretty complex. [...]
[...] What future does the French public hospital hold? “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, and political belief, economic or social condition. Governments have a responsibility for the health of their people, which can be fulfilled only by the provision of adequate health and social measures.” Constitution of the World Health Organization, 1946 Contents Executive Summary 9 Introduction 10 1. [...]
[...] Workplaces are often ill-adapted to the nature of the task to be accomplished. Results of the PRESST-NEXT study previously quoted in the second part of this study shows that less than 35% of nurses within the Public Assistance Hospitals of Paris find their work area adapted to their work. Moreover, the time hospital professionals spend walking is incredible: according to the same study, 60% of nurses and 80% of auxiliary nurses spend more than six hours a day standing. As Marie, nurse at William Morey hospital in Burgundy, says, “all rooms have stairs while we have to pull carts all day long. [...]
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