Changes that require new modes of management

Twelve births in five hours. In twenty years of career motherhood of Lagny located in marne-la - Vallée, Caroline had never known the rush of the early February. "S Nou have that five delivery rooms, some women have given birth in rooms or rooms for admission." "A three midwives, he took to fend for themselves, call doctors, to ensure that they deliver not at the same time", she recalls. Three midwives of day, two night. This workforce has not moved for several years while the number of births rose by 100 per year on average. The premises are planned for 2,200 deliveries per year. Has there 2.720 last year. End of nerves, 30 midwives of Lagny seek additional posts. In vain.

While the Minister of health, Roselyne Bachelot, has come full circle, last Wednesday, the first part of the hospital 2012 plan, with the award of an envelope of 883 million euros to modernize certain institutions, number of public hospitals, whose accounts are in red, started large manoeuvres for savings. In 2008, the deficit was always the tune of EUR 575 million for public hospitals (against 760 estimated in 2007). And in September, a report of the Court of Auditors pinned their management, pointing to differences in costs "surprising" between institutions. "Balance system, it is save him!" insists on the Ministry.

Public-private partnerships

Everywhere, clusters of hospitals, the pooling of services or public-private partnerships are being considered. Everywhere, managers think about out patients on weekends or in the evening to close services and savings of staff while increasing the rate of occupancy of beds.

Thus, hospital of Provins, the 50-bed surgery service, once split into 25 orthopaedic beds and 25 beds of visceral surgery, is was reorganized: half of the beds are now devoted to hospitalizations in the week, the other to support short (emergency), which allows close beds in off-peak hours. Result: 104 days of hospitalization and less and five deleted posts. But it's not all: a strategy brings a machine of Radiology and medical imaging team at the local level. The health personnel of the hospital, he will share his time between the public hospital and private clinic nearby Saint-Brice. A building of the clinic will on its site and the renovated operating will be common. To cross employees of private and public servants.

Because, at the time of budget restrictions, the savings are also downsizing, which weigh up to 70 of the budget of a hospital. A constraint with which it must now be juggling. Head of establishments of Saint Omer and Calais, Philippe Blua undertook to open new services in constant numbers: "we strengthen the number of posts in the new specialities: Urology, Neurology and ophthalmology at Saint Omer", tells it, also President of the national Union of hospital managers. And to maintain the quality of care: "Must strengthen the mobility of officials, for example, between two or three services medical." Call internal teams as reinforcements. Orient staff to the services at the peak of activity. With the staff, sometimes it takes a little bit.

Changes that require new modes of management. "A nurse can be moved to the foot in another service, which is very destabilizing and may put patients at risk, admits Patrick Lorson, the Director of the centre hospitalier de Dreux, just to balance its budget in 2009. If it does not address this reform with a different personnel management it will happen pas. Hence his willingness to associate with arranging a medical corps, which escapes most QELROs. "The law HPST us grows to make decisions with them requires them to hear, to give their opinion, but also to get involved", continues Patrick Lorson.

Irreconcilable priorities

However, the dialogue is sometimes difficult between two worlds which priorities appear to compete. "He must increase revenues by increasing the number of stays, control spending by reducing their duration." "I was asked 100 coefficient of occupancy of beds, I wasn't enough turnover," says Jean-Louis Lejonc, former head of a medical centre, including Geriatrics, the Henri Mondor hospital group - Albert Chenevier de Créteil. Lasse war, this doctor gave up driving the pole, in November, ordering "s on inability to organize internal redeployment of non-medical staff in the pole to keep open all beds. In an Office without a soul, Jean-Louis Lejonc is bitter: "It is true that it has much squandered in hospitals and the need to do something." But the activity had made great progress in geriatrics year last with 32 of stays on only short breaks. It should be 28 nurses for 69 open beds. We have more than 18. I had to close beds, this has been strongly alleged.

Blame also at Lagny, where, to increase efficiency, Thomas Leludec, pilot institutions of Lagny, Meaux and Coulommiers, not a homework: transfer of the Interventional Cardiology of Meaux and Coulommiers on Lagny, sterilization services moved to Meaux to avoid building a (saved EUR 1.5 million), repatriation of the laundries in Meaux... But nothing to relieve the maternity or emergencies. "The support of the patients is deteriorating, emergencies become a service in hospital with patients who roam on beds or place, rebelled Serge Cottin, Secretary of the section South of Lagny.". Why increase the capacity of the hospital if it cannot implement face staff

On the ground, the tension mounts. The equation is not simple. "The most difficult to manage, it is the contradiction between demand for improving the quality and safety and the decline means." "A force, it runs to square the circle", considers Danièle Lacroix, Director of the Hospital of Meulan, who said "in the absolute need to downsize because the establishment is very deficit." 40 jobs were deleted on 900.

Lifting of the AP - HP shields

But the lifting of shields is particularly bright assistance publique-Hôpitaux in Paris, dedicated to see its 37 institutions grouped into 12 hospital groups, to create "a Public Assistance modernized to allow patients to access both to care and advanced care", in the words of the Director General of the AP - HP, Benoît Leclercq. Some 3,000 to 4,000 posts will be deleted, including 1,000 from 2010. The goal: a savings of over 300 million by 2012. What generate the excitement in this structure, which has 1.121.775 employees... an emergency 29 seconds for 4.686.000 annual consultations and 22.474 beds.

The sling is organized. A Armand-Trousseau, University centre of the renowned but considered obsolete, child teams rail against transfer programmed heavy Pediatrics to Robert-Debré and Necker hospitals. Led by its President, Christmas Garabédian, the Medical Advisory Committee was counterattacking, armed with its own plan of reorganization. The last House in the same building coherent activities such as sur-spécialités, emergency medicine and research, and in another, to build, surgery and intensive care. A reorganization that would remove a bed on two. But would result in major economies, all jobs be preserved The doctor remains of marble: "our goal is to reduce the suffering of the sick: we refuse to give on the workforce."