Philippe Colombat, Eric Galam and Matthieu Sibé *, experts from the National Observatory for the Quality of Life at Work of Health and Medico-Social Professionals (ONQVT), have resigned to denounce facts “in total contradiction” with speeches and renewed commitments during the “Ségur de la santé”. What is at stake, they emphasize, is the quality of life at work (QWL) of caregivers, yet part of a national strategy since 2016 and whose importance was confirmed by the “Ségur” in 2020. ” Quality is the fundamental element of the quality and safety of care, they point out. In its absence, it is indeed the health situation of today and tomorrow that is threatened. ” In this forum published by franceinfo, the signatories explain the objective of their approach: “To awaken and restart a real national QWL strategy so that the Observatory and the mission are not empty shells or simple alibis.”
In the era of burnout and Covid, applause now over, like government announcements, as solid as they are in their wording, is no longer enough. The urgency and the scale of the health crisis confirm, if it were necessary that the quality and the safety of the care be based on the presence, the availability and the serenity of the caregivers, conditions themselves guarantee of the attractiveness of health and social care establishments and professions. However, demotivations and professional exhaustion are increasing day by day while quite logically, medical deserts, hemorrhage of hospital caregivers, discouragement of ambulatory caregivers and distress of health students continue to progress.
This is the first time that the findings are so alarming: the public hospital is dying and the health map is desertifying! Absenteeism has never been so important, resignations are increasing. Many nurses, nursing assistants, doctors abandon the profession or move towards the private sector. The many vacancies require the closure of beds or the use of overpaid “mercenary doctors” in certain specialties on call. The situation is no better in medico-social establishments where the same ills generate the same difficulties in recruitment and retention. The salary increase, decided by the Health Segur, does not seem to do anything about it. The outpatient sector, too often the poor relation of the healthcare system, is not spared, also subject to specific organizational constraints which have a negative impact on the experience of liberal professionals. The medical deserts are there and will not be populated by young doctors who are forced and forced, regardless of aspirations to good care and the meaning they give to their profession. Likewise, the oldest will probably no longer remain in activity if they are not accompanied and recognized in their missions.
However, in December 2016 had been promulgated by the Ministry of Solidarity and Health, the national strategy for the quality of life at work (SNQVT) of health and medico-social professionals. A number of study and survey reports already warned of the deterioration in working conditions and the proven risks to the health of professionals and patients. This strategy was set in stone in “My Health 2022”, finally recognizing the quality of life at work (QWL) as a determinant of the quality of the health system. She gave herself as a cap of “take care of those who care for us”. The objectives displayed were threefold:
1. to give a national impetus, to bring a political priority.
2. improve the environment and working conditions of professionals on a daily basis.
3. support professionals in change and improve the detection of psychosocial risks.
It was resolutely long-term and in three directions: a mediation system for all staff in public hospitals, social and medico-social establishments, the establishment of a national QVT Observatory (ONQVT) for caregivers and a specific mission dedicated to the effective implementation of SNQVT measures.
However, the health crisis has confirmed the validity of the trust placed in medical and paramedical teams to create care based on needs in the field. The hope of launching the QVT dynamic was recently nurtured with the contribution of the RIST law of April 26, 2021, encouraging new governance, participatory management and compulsory management training for people appointed to positions of responsibility, necessities listed in the Public Health Code. In the same laudable momentum, several additional proposals promote QWL within the Claris circular (August 6, 2021) and the Action plan to develop the attractiveness of professions in the autonomy sector (August 30, 2021).
Since its creation in July 2018, the National QVT Observatory has activated multiple working groups, all made up of actors in the field. They formulated a battery of rigorously based recommendations concerning the preservation of work collectives, in particular through participatory approaches of institutional and local dialogue, taking into account the QWL of professionals during restructuring, anticipating the effects of new technologies. on QWL, the requirement to train all managers, in particular future doctors, in management, the systematic search for synergy between QWL, quality of care and support, the implementation of QWL in an outpatient setting exposed to the ‘isolated exercise, or even the constitution of a network of research teams on QWL and psycho-social risks so that QWL practices benefit from advances in knowledge. All of these proposals stress the need to create spaces for exchanges between caregivers (multi-professional staff, training, support), to animate work communities to improve real work, by restoring autonomy. to healthcare teams and professionals and by encouraging them to share experiences, vectors of recognition and involvement.
Unfortunately, the current facts appear in total contradiction, given these commitments, which resemble largely broken promises. As if those responsible for our health were oscillating between relevant declarations and timorous or simply cosmetic acts, making the SNQVT a mere rhetoric. To date, the positions mentioned in the Ségur de la Santé have not arrived, blocked in the regional health agencies (ARS). After the first Covid episode, managerial governance resumed its rights in the hospital: no longer a question of creating beds or positions, but rather blocking the workforce in the name of budget constraints. The many productions of the ONQVT did not give rise to any support or accompaniment to disseminate them, implement them and follow the dynamic of feedback driven by the Observatory. Moreover, since the beginning, a large part of the operation of this Observatory has rested on the voluntary commitment of the experts, signatories of this forum and now resigning. It should also be remembered that a few months after its start in 2016, the head of the QVT mission at the ministry fell ill and was never replaced. The National Support Center (CNA) created in July 2019 to offer solutions to the now blatant suffering of health students was abolished on September 16.
And at the same time, the cultural, societal, media, political and economic importance of health and of the market it represents, logically stirs up financial interests, leaving the field open to influence or image games, under an associative or compassionate mask, reducing QWL to the sole promotion of individual well-being in the workplace (massage, yoga, etc.). QWL is much more than that. It manifests the conditions for doing its job well. It is the main factor in the attractiveness of professions and establishments. Its determinants, in addition to a satisfactory work-life balance and the absence of interpersonal conflicts, are also linked to the content of the work and the meaning given to it by those involved. Two of its components appear essential in the course of scientific studies: workload and organizational and managerial factors, themselves closely linked. QWL is the fundamental element of the quality and safety of care. In its absence, it is the health situation of today and tomorrow that is threatened.
Faced with all of these findings, we have repeatedly alerted us to the urgency of granting SNQVT the necessary resources. It is also politics that we are talking about here. This is a human issue which requires a strong political response, voluntary and accompanied by the means adapted to a relevant and coordinated operation. Commitment, perseverance and vigilance remain essential. This is the meaning of our resignation process: to wake up and restart a real national QWL strategy so that the Observatory and the mission are not empty shells or simple alibis, so that QWL passes from speeches to acts.
Philippe Colombat, university professor in hematology, Tours University Hospital and Tours University
Eric Galam, university professor in general medicine at Paris-Diderot University
Matthieu Sibé, lecturer in management sciences at the Institute of Public Health, Epidemiology and Development of the University of Bordeaux