What future does the French public hospital hold?

Résumé du document

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.

Extraits

[...] This statement is actually a tool dedicated to monitoring the implementation of credit authorizations allowed at the beginning of the year. In case of cost overrun, the structure is punished. To ensure a regular monitoring, the Establishment's Technical Committee (CTE in French) meets four times a year to check the gap between the Statement of Estimates of Revenue and Expenditure and the effective situation. In case of a significant gap, the National Health Agency of the region where the structure is located can ask for a recovery plan. [...]

[...] Companies need to make the financial commitment to lean operations and have to understand that initially there may be some losses in production before any gains are realized. Changes in management procedures and policies are fundamental, as well as all employees' commitment, to ensure the success of lean management principles. And most important, lean management has to be organized towards customers' expectations to be efficient, as highlighted by Simon Pollard, vice president of the industrial sector for Oracle: “Lean is often equated with the elimination of waste. [...]

[...] The cost of implementing quality management, conducting improvements and achieving specific goals must be carefully analyzed, so that the long-term effect of quality management processes on public hospitals consists in an additional added-value of produced services. Quality management techniques that will incur significant costs can be split into three categories: prevention costs, appraisal costs and failure costs. - Prevention costs consist in costs related to the design, the implementation and the maintenance of quality management. They are related to operations that are planned and incurred before any process to prevent failures and breakdowns. [...]

[...] If not detected, all those useless processes result in resources' waste and can decrease care quality because professionals spend more time tiring themselves out than focusing on their primary task consisting on spending time with patients and relieving them from pain. As previously discussed, the cost of non-compliance with quality standards is heavy and can endanger structures' sustainability. Workshops consequently have to analyze all processes in order to detect and cut out as much waste as possible, while retaining added-value steps that satisfy patients and enable to comply with national quality standards. [...]

[...] In France, people go to the hospital when it is necessary. Health Care is neither a luxury nor an insignificant service. Such an analysis of pubic hospitals' financing structure directly enables us to understand why so many organizations have difficulties to ensure a financial equilibrium. Unmanageable receipts doubled with structurally growing expenses, here is the formula to an unfathomed deficit. French Hospital Federation, which gathers and represents every public health care structures, assessed that public hospitals needed 1.5 billion Euros to balance their budget. [...]