The report of the mediator Edouard Couty, commissioned by the Minister of Health Agnès Buzin to make the transparency on working conditions at Grenoble university hospital, is overwhelming for the management style. A management that 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 CHU Grenoble management is pinned in a report of the Ministry of Health. Written by Edouard Couty, national mediator sent by the Minister of Solidarities and Health Agnès Buzin the day after the tragedy, to establish a "diagnosis on the situation of the establishment and the nature and difficulties encountered", the report was released.
At the end of three days of audition on the spot, Edouard Couty draws the vertiginous list of a series of failures, in particular in the management of the caregivers. "The style of management, which permanently maintains a certain pressure on the teams and prioritizes the result ... must bend", he writes, referring to "budget issues".
Conflict, pressure, abuse and burnout
According to our information, some specialties considered as "unprofitable" with regard to the compensation system in force in hospitals, T2A, are particularly under pressure. Thus, in Grenoble, pediatrics and diabetology would not be profitable enough for management.
A diabetologist tells, in a letter co-written with a fellow pediatrician who came to us, the reproaches that were made to him during the annual reviews: "Do you know how much your activity has caused the pole to lose money this year? "There is almost no hospitalization of your diabetics in emergencies and resuscitation ..." or "consultations of 45 minutes of diabetes, it is not profitable! It is necessary to consult faster or more often, or to bring patients to day hospital by adding complementary examinations ... ". Similarly, adjusting the treatment of his patients by mail was not "valorized" financially, and therefore not profitable for the caisses of the hospital.
"We have been alerting our management for years about the incessant increase in our workload.For years the answer is the same: no way is possible to finance additional time medical or paramedical health care", denounce the two doctors .
The situation is such that many staff have left or stopped. A complaint was filed against X by a surgeon at the facility this week for mobbing. After 17 years at the University Hospital of Grenoble, he recounts his setting up in the Dauphiné and that "the difficulties began in 2010", following "the restructuring of the hospitals of 2007". It evokes a "conflict between the old and the new generations and a climate of tension that has increased, with stormy meetings, even violent acts and suffering that 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 of the field", in a "very constrained" economic context. "There is a lack of attention to the difficulties and suffering of the staff," notes the mediator.
During a meeting at the Ministry of Health last week, the management of the University Hospital was signified the obligation to put a "plan of action" in place to find "calm and serenity". The management promised that it would put a new organization in place by "two to three months". But what will she be able to do if nothing is changed in terms of the hospital's business model. Almost all the French University Hospital Centers have seen their deficit worsen since the T2A (activity pricing) was put in place. It is the business model of hospital-business that does not work in the opinion of all experts.