Operating Room Organization and Methodology of Surgical Activity Regulation.

This article discusses the implementation of surgical activity regulation methodology in the operating room to reduce organizational dysfunction, improve quality of work life of the surgical staff, and decrease staff overtime.

The Patient as an Actor in His Care Pathway: Insights From the French Case.

In France, patients' right to take part in decisions regarding their health has been recognized by law since 2002. This legal recognition was the outcome of a long-standing call to allow all individuals to be "actors in their own health" and to co-develop their care pathway with the professionals involved. In practice, care pathways simultaneously intertwine both standardization and personalization dynamics, which involve different forms of professional-patient interaction. This article analyses the links between the organizational variables of care pathways, and the ways in which patients are involved in the management of their own pathway. To date, these links have received little attention in the management science and health literatures. We draw on material from a case study carried out in 2 French territories, combining the analysis of patient pathways with interviews conducted with professionals and carers. Building on this analysis, we propose a typology of patient profiles which distinguishes between their different forms of involvement in the development of their care pathway, based on its organizational characteristics.

[The French health care funding system for research and innovation in oncology]. / Place des missions d'intérêt général (MIG) relatives à la recherche et à l'innovation dans le financement des établissements de santé en cancérologie.

INTRODUCTION: This article provides an overview of the French health system with respect to allocation of public resources to hospitals, to encourage research and innovation, particularly in the field of oncology. It is explained in a historical, economic and scientific perspective. RESULTS: Important structural and conceptual reforms (T2A, HPST law, etc.) have been carried out. These have significantly impacted the way public funding is allocated. Funding of innovation and research has been modified into a more incentive logic, aimed at strengthening competitiveness between all health care actors. The funding allocation system has evolved towards a more ubiquitous redistribution, including non-academic and private institutions. The baseline endowment includes indicators relating to scientific publications (60% of the endowment), teaching (25%) and clinical trials (15%). Research funding is then redistributed by regional health agencies, and used in health care institutions at the discretion of the directorates. Other funding sources such as calls for grants, funding for mobile research centers and teams, tumor banks and temporary user licenses are also part of the funding by the French Ministry of health. CONCLUSION: Changes in the health research funding system have an incentive purpose. They have significantly modified the global healthcare landscape. Feedback on these changes will be necessary to assess the success of the reinforcement of the dynamics of research and innovation.

When the management of nurse absenteeism becomes a cause of absenteeism: a study based on a comparison of two health care facilities.

AIM: The study aims to explore perceptions of the causes of nurse absenteeism. BACKGROUND: Nurse absenteeism is rising in many countries. However, there is little evidence as to how strategies adopted in order to cushion the effects of absenteeism on workload influence absenteeism itself. METHOD: The study used a 'qualitative' method based on cognitive mapping techniques in order to represent perceptions about absenteeism graphically. The study was conducted in two health-care facilities with a sample of 55 interviewees. RESULTS: Absenteeism is due in part to strategies adopted in order to cushion the effects of absenteeism on organisations. Furthermore, the strategies are self-legitimising. The more they are used, the more they are regarded as normal and useful. CONCLUSIONS: A plan to reduce absenteeism among nurses must explicitly take into account the strategies used to cushion its impact. IMPLICATIONS FOR NURSING MANAGEMENT: To cushion the effects of absenteeism among caregivers, managers must make trade-offs that take into account, for example, the workload or disruption linked to the substitution of personnel.

[Analysis of hospital outpatient care of a rare disease: cystic fibrosis]. / Analyse de la prise en charge hospitalière ambulatoire de la mucoviscidose.

INTRODUCTION: Following the generalization of neonatal screening, the French CF Care Network has become structured around 45 qualified centres, the French CF Society, 2 national expertise centres, the Patient Registry and the National Protocol of CF Care in collaboration with the Vaincre Ia Mucoviscidose patient association. This organization and progress in treatment have resulted in the outpatient follow-up of a growing number of patients. Since 2010, the CF Network representatives have been conducting an assessment of outpatient follow-up to identify difficulties in complying with national and international clinical practice guidelines. METHODS: Two complementary quantitative and qualitative approaches were used to characterize and quantify the activities carried out by professionals in 8 centres both for outpatient visits and patient care coordination. RESULTS: Two thirds of the 1,4 75 patients followed in the centres were managed over the period, less than half (40%) of them attended outpatient visits, but all of them were concerned by care coordination activities, whether or not they were related to the visit. The core team (doctor, nurse, physio-therapist) is not mobilized at each scheduled outpatient visit as recommended. Professionals devote 40% less time for follow-up in adult centres than in paediatric centres, all activities included. The multidisciplinary outpatient visit process is complicated by the lack of available resources and the unsuitability of certain premises. DISCUSSION: With a constantly growing number of patients, CF centres are struggling to comply with good clinical practice and meet the specific needs of adult patients and transplant recipients. An upgrade of professional resources and an update of the National Protocol appear to be necessary.