5th Annual European Public Health Conference EHESP Malte - Wednesday 7th novembre 2012 Hospital staffing in France : Medico-economic decision-making and quality impact Roselyne Vasseur Nurse Executive 1
I- Situation Overview Nurses represent the most important professionnal health category in the world with about 13 millions people, and about half a million in France, which is twice more than the number of doctors. The questions raised by nurse staffing in public hospitals are rarely adressed in France unlike various countries in north and south America, Europe or Asia. In France, only a few medical specialties such as pediatrics, neonatalogy and intensive care have a predetermined rate of nurses per patients. Eventhough a lot of statistical studies are regulary conducted by competent authorities, it remains quite difficult to compare the situation from one hospital to another. In France, the evaluation of the human ressources investment in health care is far from being systematic. 2
I- Situation Overview Decision makers still consider nurse staffing as a cost rather than as an investment. We rarely take into consideration the benefit of those investments : avoiding additional costs such as the lengthening of hospitalisation as well as the increasing number of investigations and treatments preventing complications by health education and prevention. For historical reasons - political, corporatism and lobbying - medical and nurse staffing have been managed and handled separately in french public hospitals, though they have to work in close collaboration for patients well-being. Medical and nursing staffs rates are not determined jointly which makes it difficult to persue efficiency and quality. It disturbs working conditions of both doctors and nurses, complicates patient s care and deteriorates economic efficiency. 3
II- General Context The ageing of population along with the development of chronical pathologies stand for an increasing amount of the budget s nation. The economic crisis that France and Europe are going through makes the evaluation and the control of our expenses in caring and curing more necessary than ever. Human ressources represent the major cost in our hospitals, but we don t assess the real impact of their activity. This situation is not sustainable as the link between working conditions and quality of both care and cure, has been recently highlighted in several international studies. 4
II- General Context As an example, the link between nurses shortage and the increase of nosocomial infections has also been clearly demonstrated. In march 2012, a large study has been conducted by the french nursing association «l ordre infirmier». Half of the 21000 nurses who responded to that study, described a flaw in nursing quality and security, resulting from hard working conditions. They described a work overload illustrated by a lack of nurses for too many patients. The limit of this interesting study was its declarative type. 5
III- Medical and Nursing evolutions In search of efficiency in public hospitals, the level of nursing staff tends to be decreased, while the number of doctors often remains untouched. Instead we should now aim at handling nursing and medical staff together. The shortage of doctors in various specialities such as anesthesia, pediatrics, ophtalmology, radiology, should lead us to expand the number of nurses as well as the scope of their activity. This has already been done in several countries such as England or Canada This would require to evaluate nursing impact on curing and caring in terms of quality including from an economic point of view. We have to conduct studies in this area in order to assess the real costs and benefits of the investment in nursing. 6
IV- Conclusion It is politics and hospitals managers responsibility to guarantee the appropriate level of medical and nursing staffing, taking into account the quantitative and qualitative parameters of their activity. In that perspective, studies need to be conducted in France in order to determine the required quantity and nature of the medical and nursing staff according to patients needs and expectations. Nurses should get involved and even take the leadership in those studies. 7
IV- Conclusion The way we take care of patients -through conventionnal, ambulatory or home treatments- should also be taken into consideration. In those time of budget restriction, this new way of making decision could ensure that we reach the appropriate national level of medical and nursing staff, regardless of the political background. The major goal everybody pursues, is to match the right level of human ressources with high quality of cure and care, according to international standards «evidence based medicine and nursing» to achieve the status of «magnet hospital». 8