Sandra Bertezene tells you why the CNAM supports the Au cœur de l'hôpital initiative

Written by Perrine Croatto, on 09 April 2018

Sandra Bertezene, Director of the Healthcare Services Management Chair at CNAM, explains why she supports the "Au cœur de l'hôpital" initiative and shares her idea for improving working conditions in hospitals.

What motivated you to support this initiative?

I wanted to participate in this initiative because it reflects the changes taking place in the healthcare sector. The research and teaching activities that I develop within the framework of my Healthcare Services Management Chair at the Conservatoire National des Arts et Métiers (CNAM) contribute to this movement, and it is within this framework that I collaborate with ANEO. Furthermore, this initiative is original; it unfolds in several stages: first, a call for contributions to collect experiences of best practices in improving working conditions in hospitals; then, an event on May 17th to discuss these initiatives; and finally, the formalization of a synthesis document reporting on these innovative initiatives in order to share them with as many people as possible. These three stages make this event a unique experience that can be useful to healthcare professionals in training at CNAM.

Share with us an idea to improve working conditions in hospitals?

With overcrowded emergency rooms, exhausted staff, and expensive nursing homes, among other issues experienced by healthcare services, it is legitimate to wonder if the terms "humanism" and "management" are truly compatible within organizations that aspire to be humanistic. To answer this question, it is first interesting to highlight one of the major reasons that can explain these difficulties: the lack of individual responsibility (as subsidiarity is not institutionalized) and the compartmentalization of activities (admission office, radiology, etc.) hinder the agility needed to cope with a changing and uncertain environment. This results in dysfunctions and waste even as the lack of resources is continually denounced.

To counteract these adverse effects inherited from the classical organizational model, transdisciplinary thinking promotes understanding what a professional or a patient is. Reducing a patient to their pathology would deprive them of the possibility of being considered other than as an object of care, which goes against the principles of benevolence and empowerment (actions that promote individuals' ability to make choices and turn them into actions that impact health). Similarly, being a healthcare assistant is not just about a series of regulated tasks but rather an intertwined set of skills, qualities, talents, values, etc. We cannot reduce a professional to a set of norms for fear of promoting a reductive professional responsibility that allows responding to any dysfunction by saying, "it wasn't in the job description" or "the procedure didn't foresee it."

Humanism invites us to give a preponderant place to humans and to consider that their humanity (i.e., behavior that creates connections between people) is acquired through culture, knowledge, and understanding. Within organizations, numerous research studies have indeed highlighted the link between knowledge management, productivity, quality, and performance. This type of management relies on establishing an environment conducive to the creation, sharing, and use of knowledge. It also relies on tangible and intangible resources such as trust to promote the deployment of a continuous process of knowledge transformation by the staff themselves. This system promotes individual responsibility through the development of autonomy and the importance placed on the voice and person of the resident or patient.

This model, experimented with by various organizations, offers promising prospects for our healthcare services. However, the success of knowledge management depends at least on the ability to build a shared vision of the values that will guide the strategy, to perceive the constructivist and systemic nature of the environment to understand phenomena in all their complexity, and thus to have the means to anticipate dysfunctions and reduce resource wastage that result from them in order to better cope with an uncertain environment.