The report by mediator Edouard Couty, commissioned by Minister of Health Agnès Buzin to provide transparency on working conditions at Grenoble University Hospital, is damning for the management style. A management which is however strongly constrained by the financial conditions imposed by the Ministry.
After the suicide last November, in an operating theater, of a 36-year-old neurosurgeon, the dehumanized management of the management of the Grenoble University Hospital is pinned down in a report from the Ministry of Health. Written by Edouard Couty, national mediator appointed by the Minister of Solidarity and Health Agnès Buzin the day after the tragedy, to establish a “diagnosis on the situation of the establishment and on the nature and difficulties encountered”, the report has been made public.
After three days of hearing on site, Edouard Couty drew up a dizzying list of a series of failures, in particular in the management of nursing staff. “The management style, which permanently maintains a certain pressure on the teams and which prioritizes the result […] must bend, “he writes, referring to” budgetary issues “.
Conflicts, pressures, abuse and burnout
According to our information, certain specialties considered as “unprofitable” with regard to the remuneration system in force in hospitals, the T2A, are particularly under pressure. Thus, in Grenoble, pediatrics and diabetology would not be profitable enough for management.
A diabetologist recounts, in a letter co-written with a pediatrician colleague who has reached us, the criticisms made to him during the annual reviews: “do you know how much money your activity has caused the pole to lose this year? There has been hardly any hospitalization of your diabetics in the emergency room and intensive care unit … “or even,” 45-minute diabetology consultations, it is not profitable! Consultations must be done faster or more often , or bring patients to day hospitals by adding additional examinations … “. Likewise, adjusting the treatments of his patients by email was not financially “valued”, and therefore unprofitable for the CHU funds.
“We have been alerting our hierarchy for years to the incessant increase in our workload. For years the answer has been the same: no way is possible to finance additional time as a medical or paramedical caregiver,” denounce the two doctors. .
The situation is such that many personnel have left or have stopped. A complaint was filed against X by a surgeon at the establishment this week, for moral harassment. After 17 years at the Grenoble University Hospital, he tells about his closet in the Dauphiné and that “the difficulties started in 2010”, following “the restructuring of hospitals in 2007”. He evokes a “conflict between the old and the new generations and a climate of tension which has grown crescendo, with stormy meetings, even acts of violence and suffering which has been seen at all levels”.
Towards a new organization?
In his report, Edouard Couty denounces a “too important gap” between “the institutional discourse and the reality on the ground”, in a “very constrained” economic context. “It lacks special attention to the difficulties and suffering of staff,” notes the mediator.
During a meeting at the Ministry of Health last week, the management of the CHU saw the obligation to put an “action plan” in place to find “calm and serenity”. The management promised that they would put a new organization in place within “two to three months”. But what will she be able to do if nothing is changed in terms of the hospital’s economic model. Almost all French University Hospitals have seen their deficit worsen since T2A (activity-based pricing) was put in place. It is the business model of the hospital-business which, according to all experts, does not work.
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