Des pôles d'activités hospitaliers entre gestion de la crise et mise en œuvre d'une politique de santé publique

Abstract

The implementation of the recent act to amend the law on hospitals, patient health and territories (HPST Law) completes the reform of the organization and governance of health facilities, which was announced in 2002 by the "Hospital 2007" plan. What kind of assessments and perspectives can be considered and envisaged for these Hospital Activity Poles? We compared our experience with a review of the professional and scientific literature in order to stimulate answers to these questions for advocacy purposes prior to the Act's implementation. The hospital's cluster of activities should reinforce--not call into question the core activities and the financial stability of the facility, while respecting the contract on agreed objectives and the necessary means and resources to meet the health needs of the catchment population as well as national priorities. Although significant, but limited, successes exist, five obstacles to hospital reorganization can be identified. These include, for example: lack of delegation of management and centralization of decisions, the heterogeneity of numerous Hospital Activity Poles or problems related to timing. These obstacles may cause strain, or put the Hospital Activity Poles and the health facilities in a difficult situation with respect to their dynamics. This may show that the State and social health insurance should steer and direct public health policy and that the delegation of management roles and responsibilities to the Hospital Activity Poles should be addressed.

Strategies to improve the quality of reference networks for rare diseases

“…[3,31,32] (Continued) Poles of care: Grouping some specific medical departments within the spatial architecture of the medical facility in order to improve the management of some specific diseases/groups of diseases that require these specific services. [32,33] Financing of healthcare coordinators Healthcare coordinator: person who ensures patients' follow-up between different medical departments of the hospital or between the hospital and the general practitioner/external hospitals.…”

“…Technical poles: Grouping some departments with specific technical equipment in order to improve medical procedures and/or reduce technical costs. [32,33] Financing of communication coordinators Communication coordinator: person who ensures exchanges of information and the partnership between the hospital and patients' organizations.…”

Marketisation and regional planning in neoliberal public services: Evidence from French hospitals

“…Hospitals have also been required to form pôles de santé , regrouping various services into connected faculties overseen by a chef de pôle who acts as line manager. These actors are in turn ‘contractualised’, following CPOM objectives (Bréchat et al 2010):So you have a pyramidal system where the government names the director of the ARS . .…”

Mandatory internal mobility in French hospitals: the results of imposed management practices

“…This pooling of resources was aimed at improving patient care through better organisation at the operational level, but also as a way to reducing management costs (Bréchat et al . ). The cluster system resulted in significant modifications to the work environment and contributed to increase the mobility of staff by organising teams according to activity.…”