[Recommendations for the implementation of multi-professional staffs (MPS) in care services]. / Recommandations pour la mise en place de staffs pluriprofessionnels (SPP) dans les services de soins.

The context and constraints of modern medicine (hospital beds and caregivers' reductions, ambulatory shift, new therapeutic approaches, integration of supportive care…) combined with new societal and Health system changes (ageing population, chronic diseases, new requirements of the patients…) redefine the orientations of care and question professional practices. The participative approach (PA) as a model of team organization proposes solutions involving the skills of the various interacting caregivers and experimental knowledge and consideration of patient needs. The multi-professional staff (MPS) is a collaborative tool of this participative approach that federates a team around a health or care project personalized from the crosschecked eyes of care professionals and from a shared decision-making process. Its objective is to combine the improvement of quality of care with quality of life at work. It requires a transversal mindset of teams, intrinsic values and specific characteristics. Its organization is simple but requires some rules and we will develop the main steps to success. This article, which is the result of a joint reflection and experience of health professionals, shows the principles and wants to demonstrate the weakness of MPS. The interest of the French National Cancer Institute for this collaborative tool is an asset for further work in the perspective of generalization of MPS for all patients with chronic disease and not only for patients at palliative phase.

[A better management for a better care]. / Mieux manager pour mieux soigner.

The frequency of personal exhaustion is particularly high in oncology. In most cases its causes are related to an association of personal and professional problems. Factors connected to the work can be separated in five categories: type of work, work overload, interpersonal conflicts, organizational and managerial factors. The quality of work life is a more recent concept and joins in the field of the positive psychology. The participative approach is an organizational model which rested initially on 4 components: internal formation, team support meetings, pluriprofessionnal staffs and project approach. More recently we added a fifth component because we noticed that the model could work only if there were meetings between the doctors and the head nurses of the services. This model is a priority criterion of HAS accreditation of establishments since 2010 for the management of patients in palliative care in all services. In the last part of this article, we shall see the impact of the managerial and organizational factors but also of the organizational model of the participative approach on the quality of work life of caregivers but also on the quality of care offered to the patients and to their close friends.