The main mission of a public hospital is the care.
On the occasion of a disease newly identified (Covid-19), which is caused by a new coronavirus (Sars-CoV-2), the health professionals are qualified as " heroes ". Gold in reality, these professionals are merely exercising their respective specialties. This qualifier of "heroes" seems to us so incomprehensible. Moreover, this current spring viral has highlighted the inability of public hospital to manage this infection while maintaining its usual activity. The Covid-19 became the first emergency. Other pathologies, they have been relegated to a secondary position. The other deaths, even when they are avoidable, therefore, would be more acceptable than those related to the Covid-19.
taking Advantage of the emotion aroused by this context, to say the least, strange, and exceptional, in a population that is not familiar with the operation of the hospital, some voices are trying to blame this inability of the hospital to a lack of resources. The troupe puts pressure on the executive. Gold, again, and according to our experience in the field for more than twenty years, many evidence-based, verifiable, show that the inability of hospital French is not due solely to a lack of resources.
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examples Include the following : a position of" assistant specialist " is vacant within the pharmacy for internal use (PUI) of a public hospital. This position is funded. The candidates are not lacking : this type of position is sought after by the young pharmacists who complete their training in-house pharmacy. But the head of the service of this PUI refuses to fill this post. At the same time, the securing of the circuit of the drug is not implementation. And to justify this inertia (lack of security of this circuit), the argument of the lack of resources is supported. Recall that the circuit of the drug generates nearly 20 000 deaths per year, half of which is avoidable, due to malfunctions which have their source in particular in the non-compliance of the act.
A lack of means ? Really ?
let's Give another example : how to justify, therefore, the means used to organise the Party of the music in the walls of a hospital ? While reports of hospitalization, expected by general practitioners, are prepared with weeks of delay due to lack of time of medical secretary ?
The public hospital suffers, first of all, the disorder that reigns in his breast. He is a victim of the dispersion of its resources. The vested interests and personal are substituted in the general interest. The choice of practitioners, called to participate in the management of the hospital, according to their ability to bid ; and not according to the content of their curriculum vitae (CV). Skills matter : they are even afraid of it. The director dismisses all those who are able to bring him a contradiction useful.
The first circle of power looks like a conglomeration of clones. Commissions, committees, assemblies that proliferate. Elections to the medical committee of establishment (CME), when they are not rigged, are a function of cronyism : while the act requires a balanced composition of the CME, where all disciplines are represented, the CME is found with several anesthesiologists, many emergency physicians... while other disciplines are not given as no representative.
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The "friends" of the mayor, or other policies, have the benefit of a specific immunity. A hospital doctor can earn more responsibilities for decades, and until his retirement at the : head of division, head of department, a member of the CME, member of the management board, member of the supervisory board, etc., The lord, a local dimension, can even bequeath his "domain" to one of his vassals. The law is often violated. The organs of control, regulation and sanctions do not even respond to the alerts issued by hospital doctors. Worse yet, the authors of these alerts are placardisés, humiliated, or even " post-mentally ill ". Unions gangrene by the iron law oligarchic ; and that would have even managed to infiltrate some of the professional orders, etc
A turn-over in the endless hospital doctors and resignations that do not concern person
The conduct of the projects, however, validated by the institution itself, gives way in the face of the laziness and incompetence of some cowards. The latter are assured of the advancement of their careers, which is done according to the number of years worked, albeit at a well sleeping, and not according to an evaluation of the work carried out.
tiny hands, they are evaluated. This assessment determines the evolution of their career. The director, also, is being evaluated ; as well as assistant managers. But, not the lords. The rule is : the more a hospital practitioner wants to invest in the best interests of the institution and the patient, the more likely it will disturb the clan, the more he exposes himself to retaliation.
practice without interest override of the fundamental tasks. Within a hospital, an intranet site, designed for the coordination of vigilance sanitary, has been approved by the High Authority of health (HAS) during the visits of certification of this establishment. Now, this tool enjoyed by carers, has been diverted towards other purposes : to inform about the weather, give a quotation from one author to read (by day), the menu at the cafeteria, etc, It is a unilateral decision of a new framework making function of the director of communication. A decision just wipe out several years of work.
A communication to the outside world, which, often, is akin to propaganda. It seeks to beautify the image of the structure in defiance of the obvious. The "twiplomatie" hospital contributes to the misinformation and manipulation of public opinion.
The public hospital is in need of one and only true "head"
What was missing from the hospital, it is especially the effectiveness of the standard. And therefore, the sanction of individual behavior, deviant and recalcitrant, a minority that has appropriated the hospital Institution, while enslaving the majority of practitioners, as well as their professional independence.
The hiatus is housed in the power-holders on the medical-administrative local ; and in this struggle between the powers medical and administrative.
The public hospital is in need of one and only true "boss" is able to lead impartially and based on evidence. An arbitrator above the fray. Lead is not commanding. A management by the evidence, the image of a evidence-based medicine. This head cannot concentrate all powers : the refusal of the confusion of powers and tyranny.
today, the director of a hospital seems to be the " turkey of the farce ". It seems to be stuck between the power of the medical, the regional agency of health (ARS) and the mayor. Besides, the mayor should be the true representative of the users.
Currently, in the state of things, to give more autonomy to the public hospital would be tantamount to encouraging lawlessness, which has become so familiar. The public hospital was better at the time of the prefects. The chairman of the supervisory board should be entrusted to a magistrate of the regional chamber of accounts, for example.
The conflict, involving the public hospital, should be left to the common law ; and not this privilege of jurisdiction administrative, provider of the impunity of leaders.
A good management of public funds is not incompatible with quality of care. Good practices, devoid of any relationship or conflict of interest, generate substantial cost savings.
Our thinking leads us to say that the public hospital has rather need a shock to a structural and a new cultural approach. Therefore, on the occasion of the future " Segur of health ", we plan to submit to the president of the Republic a list of well-argued proposals, new and independent.
*Amine Umlil is hospital pharmacist, head of the territorial Center for independent information and advice drug, at the centre hospitalier de Cholet.
