“In the hospital, the services are doing better when the managers trust their teams to build the care”

A pioneer, the doctor Philippe Colombat established in 1992 a participatory organization and management in his medical oncology department at the CHRU of Tours. A response to the dehumanization of care and the exhaustion of caregivers. Since then, he has been promoting the participatory approach and studying it in the QualiPsy psychology research team (University of Tours). Today, the former head of the oncology-urology pole chairs the National Observatory for the quality of life at work of health and medico-social professionals. A strong stake in these times of pandemic.

The crisis gave the desire to change profession to 40% of nurses, according to a survey, carried out in May, of their national order. After a year and a half of the pandemic, how are caregivers doing?

Wrong. They are exhausted. They have to manage a heavy workload, the uncertainties in the face of this new virus, the fear of catching it and infecting their loved ones… All this without the means to recharge their batteries. The desire to change jobs expressed by these nurses results from professional exhaustion (burn-out), with three components: emotional exhaustion, the dehumanization of the relationship with others and the loss of meaning and sense of purpose. self-fulfillment at work. Its frequency was already high before the crisis, especially in the hospital public service. But the Covid-19 pandemic has exacerbated the difficulties.

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What lessons do you draw from the health crisis?

According to our feedback from the field, in the departments that are doing the best, managers trust their teams to build care. This confirms one thing: we must have confidence in collective intelligence. The post-crisis period should be an opportunity to change the system. From the latest reports, I have the feeling that the stars are aligned in this direction. The action plan for professions of old age and autonomy, from the El Khomri report [2019], wants to reduce claims in nursing homes and improve the quality of life at work [QVT]. The Rist law of April, which incorporates recommendations from the Claris report on hospital governance [2020], repositioning the service as a reference level and promoting participatory management. Recently, the governance and participatory management project for establishments has even been included in the Public Health Code. Today, everyone talks about the quality of life at work – i.e. a person’s perception of the match between their expectations and their physical, psychological and social experience at work -, participatory management and their links with attractiveness of professions, staff loyalty, quality and safety of care.

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