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All the professional studies on this page were carried out by trainees within the frame of the EUROPHAMILI training module.
In a European dimension, health networking is guided through a trend of high decentralization and empowerment of local initiatives. The current trend is towards new innovator approaches and new organizations to improve continuity of care and coordination of care in a multidisciplinary context. In UK, the primary care trusts model is supported by a coherent health policy; the networking has more informal characters in other countries (Spain) or is limited to local initiatives in some cities (Italy); in East-European countries (inclusive Romania) the level of local initiative is very low but there are real premises to shift from informal to formal local health networks.
The French model of health networks emerged from the spontaneous aggregation of patient and health professional around specific public health issues (AIDS).
The year 2006 seemed to mark a further step in the end of the health networks first cycle: in particular in experimentations and maybe 2007 could be a new period toward regulations that miss to healthcare system. The experimentation level is continuing in both term of financing and evaluation process. Nevertheless there is a political pressure to introduce an external evaluation approach for French health networks governed by principles such as institutionalisation, refinancing, rationalisation.
In this context the present study’s purpose is to provide evidences on the French health networks evaluation system in a perspective regarding the introducing external evaluation and to identify the position of the external evaluation in the life’s cycle of health network.
The methodology is to analyse the current evaluation system combining both theoretical and practical approaches; it focuses on collecting and analysing the experts’ opinions about legal frameworks, obstacles, added values in order to understand what would be its roles and the perspectives induced in the life’s cycle of health network.
By comparing both approaches (theoretical and practical) external evaluation seems to lead to new perspectives in consolidating self evaluations, providing professional tools and methodologies, therefore ensuring helpful support for promoters thanks to high level of expertises and neutrality. Their specialisations will strengthen the experiences shared and therefore the learning process. To guarantee a successful implementation every actor have to keep in mind the fact that evaluation is more a support than a sanction to overpass this common confusion’s feeling regarding this topic in France. The methodology has to be simple, coherent and adaptive regarding these complex and dynamics organisations such as health networks.
External evaluation and more widely evaluation shall not be considered as a tool but a way to shift health networks from experimental step to a regulation function.
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A European perspective of services organisation for dependent elderly people care (2007)
A European perspective of services organisation for dependent elderly people care (2007)
This study was developed during three months of internship at Direction Régionale du Service Médical,” Rennes, which is a partner institution of ENSP- Europhamili; having as a subject of research the provision of care for dependent elderly people. Population ageing affects individuals and nations everywhere. The dependence problem has been build as a social and communitarian problem in the different European countries.
The main goal of our study is to present and analyse the different policies and strategies implemented for dependent elderly people in a European perspective and focusing in a comparison between France, Romania and Spain.
Through literature review, interviews and analysis of data, we established the background of our study; we analyse how is reacting European society to the ageing problem; what policies are developed; the services which are offered; the coordination between the health and social sector and the trends in the elderly care.
This study revealed the fact that it is necessary to have a good coordination of the social and medical services offered to the elderly, both from the public and private sector, realized from a single entity and there must be an adequate way to inform the populations of these services.
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In French maternities, as in many European countries, there is a special attention for the improving maternity care, in order to assure a good health status for both the mother and her child. In the same time, there is tendency to propose an early discharge, if both the mother and child‘s status and the environment allow it, in order to decrease the length of hospital stay.
In this context our study analyzes in a European perspective, the personalized early discharge project implemented at the Sagesse clinic from Rennes – France.
The objectives of this study were to see how is organized this kind of early discharge, to identify negative and positive points in its functioning and to analyze the satisfaction of the patients and the professionals involved.
To reach our aim we used as methodology interviews with key persons involved in the project and also literature review.
As results obtained we found that the monitoring scheme in this personalized discharge is easy and flexible, clearly based on free choice of women; the patient’s and professional’s satisfaction is high, whilst the economic benefits obtained are not important.
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Influences of colorectal screening programme implementation on the quality of health care (2007)
Influences of colorectal screening programme implementation on the quality of health care (2007)
Colorectal cancer is currently the second most common form of cancer in Europe and also the second most common cause of death. Reducing mortality from colorectal cancer can be achieved by the introduction of population-based screening programmes. The main objective of our qualitative study done in Britanny (France) was to find out whether the implementation of mass screening influences the quality of other aspects of health care provided by different actors of the health care system. We performed 15 face-to-face, semi-structured interviews with health professionals in the period from 11 April until 18 May. Most of the interviewees after taking part in the screening programs became more prevention orientated and implementation of screening programmes have a positive influence on them and on the quality of their services. They became closer to their patients, spending more time speaking with them and more confident relationship was created. Thus screening can significantly improve health outcomes and quality of practice of health care system but only with implementation of organized screening approach.
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Fable of the Bees, Tragedy of the Commons (2005)
Fable of the Bees, Tragedy of the Commons (2005)
Early discharge program applied in the maternity hospitals in order to reduce the number of days after the delivery. It has become accepted practice among the world. France comes to that idea with reluctance.
La Sagesse has created the Flexible Discharge Program based on voluntary adhesion and principle of “flexibility”: the possibility to stay as long as women want; possibility to leave the program at every moment.
We try to initiate some recommendations to increase the number of women who participate in that scheme. Hypothesis were confronting to the opinion of 47 women in questionnaires and interview.
We found that improvement of information and the coordination between professionals is important which only leaves cultural aspects a limitation.
We suggest that it is possible to ensure patients’ choice and to increase alternative choice to hospitalisation, by making women conscious of impact of their choices on the care proposed to the community.
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Organization of Palliative Care in Brittany : Lessons learned for Armenia and Republic of Moldova (2005)
Organization of Palliative Care in Brittany : Lessons learned for Armenia and Republic of Moldova (2005)
Palliative care is a complex, active and intensive type of care, promoting the quality of life of the terminally ill patients and their families. The development of palliative care services in France has been slower than in other European countries. Palliative care is provided in France by variety of types and models of care in hospital and at home: palliative care units, mobile teams, identified beds and palliative care team home services. The beneficiaries of palliative care services are patients with advanced progressive chronic diseases and limited life expectancy, with uncontrolled symptoms and psycho-social needs. The institutional line restricts the palliative care for last three months of life. The lack of identification of the terminal phase is an obstacle to transfer patients to more appropriate care in health facility or at home. The palliative care service has a transversal cooperation without vertical hierarchy. Furthermore palliative care as a new domain is not yet far and widely recognized. Thus the creation of networks with coordination and collaboration between care delivering units and professionals working outside of care services, and the medico-social service in each sanitary sector is considered as a priority. Low motivation of GPs due to insufficient financial remuneration is another limitation to develop palliative care at home. The SROS III covers many aspects of palliative care organization in the region, it doesn’t provide any recommendations concerning the organization of the activity of networks, mobile teams and HAH structures. The message of palliative care is that whatever the disease, however advanced it is, whatever treatments have already been given, there is always something which can be done to improve the quality of life remaining to the patient. Recommendations given to develop palliative care in Armenia and Republic of Moldova are drawn based on assumption to avoid obstacles and problems faced in France.
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Health providers: views of at-home chemiotherapy in Rennes: a qualitative approach (2005)
Health providers: views of at-home chemiotherapy in Rennes: a qualitative approach (2005)
In the last decades, socio-demographic, technological and consumer trends have promoted the development of Hospital at Home (HAH) as an adequate complement to conventional hospital care in France, particularly for palliative patients. More recently, national authorities have removed some of the regulatory and budgetary barriers that were hampering the growth of HAH services to other profiles of patients. However, clinical concerns, normative barriers, and hospital specialists’ prevailing attitudes towards home care, seem to limit the further development of at-home chemotherapy in France.
Departing from this general context, this study explores the particular situation evolving in Hospital at Home Pays de Rennes, a non-profit organization created in January 2004 in Ille et Vilaine. After one year of activity, when a majority of interventions have been focused on palliative care, the organization is planning the expansion of services towards chemotherapy patients. Based on the interviews conducted with local hospital and home care providers, this study explores current opportunities, as well as the main threats and obstacles for advancing towards this goal.
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Key success factors in implementing electronic medical records in University Hospital of Rennes (2005)
Key success factors in implementing electronic medical records in University Hospital of Rennes (2005)
An electronic Medical Record (EMR) is not just the future of Health care; it is the solution for high efficiency Health care today. Evidence suggests that implementation and adoption of EMR in the health care organizations are considered prerequisites for the efficient delivery of high quality health care in hospitals, and a positive return on investment for the practice. Study Objectives: To describe the existent situation and experiences on EMRs in the world and in CHU Rennes; To identify the key success factors for the implementation of EMR in CHU Rennes; To make recommendations for a successful EMR implementation. Purpose of the study: To describe the existent situation regarding the initial steps for implementation of a common Electronic Patient Information System in University Hospital of Rennes, to identify the main challenges, and to recommend activities to be developed during the process of implementation of the project. Design and method: This professional study has employed a qualitative approach. It is based on collection of available data concerning implementation of EMR and critical analysis of semi-structured interviews with different health professionals. The method we used is a descriptive analysis of published literature and reports, and critical analysis of interviews. Conclusions: The benefits of implementation of an EMR system in CHU Rennes are obvious both for patients and health professionals. Access to the information, increased safety and quality of care are the main positive aspects of EMR from the prospective of patient health. With the implementation of an EMR the health professionals from CHU Rennes will gain from the possibility to share health information regarding the patient among departments and sites. Elimination of order duplication and implementation of electronic remainders will make health care provided more efficient and cost effective. Availability of data will help clinical researchers, quality assurance and clinic managers, as well as financial managers, in their activities, making their work more efficient and resources allocation more consistent with clinical decision.
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Stress among farmers in Brittany (France): myth or reality ? An exploratory study (2005)
Stress among farmers in Brittany (France): myth or reality ? An exploratory study (2005)
Multiple studies worldwide have recognized farming as one of the most stressful occupations. This qualitative study done in Brittany (France) have had the aim to find out are local farmers experiencing socio-emotional stress, and if yes, what factors are perceived by local professionals and farmers as main stressors. During May-June, 2005 six face-to-face interviews with key members of the Regional Chamber of Agriculture of Brittany as well as six phone interviews with the farmers practicing conventional farming in the region were conducted. The findings indicated that farming in Brittany is perceived by local professionals and farmers as a stressful occupation. The main changes happened during last 15 years in terms of new legislations and regulations, global changes in the market led to financial constrains were among the most severe stressors added pressure to life of local farmers. The need to find out new mechanisms to support farmers in Brittany to cope with existing difficulties was recognized.
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Crisis management in Lödz : a new department in the Centre for Health Promotion (2004)
Crisis management in Lödz : a new department in the Centre for Health Promotion (2004)
The study takes place in the frame of Europhamili session in the “Centre for Health Improvement”, situated in the centre of Lödz, Poland. It is divided in two parts, tobacco addiction and crisis intervention – this second part having started its activity on 2004 April 1st .
The main goal of our study is to analyze the management of health promotion and intervention in individual crisis in the community ( Lödz area).
Through meetings, interviews and analysis of datas, we established the background of health promotion and crisis intervention related to real situations in Poland and Lödz. We used case studies of psychological intervention in crisis situation according to the reasons.
Our study of management of the Centre for Health Improvement is focused on three different levels : professional, institutional and community. The results allow us to compare the experience between a different organisation (the crisis intervention centre in Krakow) and the way it is realized in both Moldova and France.
From an external point of view, we analyze the managerial organisation and the quality of psychological services provided in the centre and make some suggestions for the future.
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Poland as many other European countries experienced the action of reforming health care system. In 1999 the Semashko model was replaced with a compulsory health insurance system. There were many reforms after 1999 whose goal was to improve the functioning of health care system. Between 1999 and the 1st of April 2003, the health care system was decentralised. The financing and administration tasks were transferred from the Ministry of Health to the sixteenth Regional Offices, which negotiated and purchased health services on behalf of the insured. The lack of central control over the national health policy and exaggerated independence of the Regional Offices led to putting into force of a new legislation after the 1st of April 2003, on whose basis was implemented re–centralisation of the whole system. But financial constraints constituted an important factor of the failure of the new health care reform. The organisation of the health care in Poland since 2003 has experienced some difficulties. The health services were provided to the insured according to the financial resources commanded by the Regional Offices of the NHF. The main problem faced by all regional offices was the scarcity of resources, which were not enough to satisfy the unlimited health demands of population. One of the biggest needs of population in Poland and particularly in Lodz is represented by services for prevention and treatment of cardiovascular diseases. Between the years 2000 and 2002 the Lodz Regional Sickness Fund realised the cardiological preventive programme recognising the need connected with the risk of circulatory system diseases. In 2003 the programme for prevention of cardiovascular diseases was not initiated in Lodz. Because the cardiovascular diseases are the main cause of premature deaths (most of them being preventable) in the whole Poland means that the National Health Fund has to make a decision regarding the financing of preventive services for heart diseases in order to lower the expenditure in the health care system. More preventive services mean more money saved for curative services, which would be necessary to be offered.
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Economic evaluation of preventive programme (2004)
Economic evaluation of preventive programme (2004)
The aim of the study is the estimation of the role of economic appraisals in decision making within health sector and assessment of “worthwhileness” of preventive programs. Health Economics can greatly contribute to the decision making by using related economic evaluation methods, which has expended markedly in the past few years. This involves the appraisals of health care alternatives through the calculation of the amount by which the benefits generated exceed the costs incurred. An understanding of cost-benefit analysis can also ensure that appropriate costs are identified and valued.
Material and Methods:
From the economic and medical literature we have gotten familiar with health economics, as the important bases for any decision making process on disease prevention or patient treatment programs within health systems. We studied smoking and related burden in many countries and societies, as an example for possible intervention. Based on the available information on the topic from Internet, medical libraries, National and local Institutions and from the field practices, we calculated possible benefits of perspective smoking cessation program. The programme is supposed to last for two years in Lodz, Poland and middle age population with smoking habits in considered as a target group. For the analysis, we estimated separately the expected costs to be spent for the smoking cessation program and benefits form it in monetary terms, taking into account its diminishing values in time. To simplify the calculation we decided to deal with lung cancer as the most frequent, but not the only, disease cased by smoking. Prevention of the development of such disease would save the recourses usually needed for cancer treatment, it’s pre- and post-operation diagnosis and follow ups
Results:
The results of our calculation showed that benefits from the cessation programme were much higher compared to the costs spent for it even though, they would be seen in the future. Sensitivity analysis proved the proposed programme to be robust and marginal analysis provided information on ineffectiveness of prolongation the programme up to thee years, as well as shortening to one year, due to high rate probability of relapses in the latter.
Conclusion:
Cost-benefit analysis can substantially contribute to the medical appraisals. The model was concerned with smoking related issues in Poland, as one of the important public health problems, but the techniques tend to have universal applicability to other countries and to any other topics within health systems.
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Patients: satisfaction with the health care services provided by Ambulatory Care Units (2004)
Patients: satisfaction with the health care services provided by Ambulatory Care Units (2004)
Primary Care Trusts health improvement through provision of care, commissioning of services and partnership engagement. How does a Strategic Health Authority know if public health skills have been used to underpin these responsibilities?
The aim of the survey is to assess the impact of public health skills on the key responsibilities of PCTs.
A questionnaire for Assessment of Organisational Effectiveness was adapted from Quinn and sent to five PCTs, Trent SHA and Finance Directors of NHS Trusts. Due to insufficient responses only Erewash PCT and Nottingham City PCT were included in the assessment. Received data was computed and pointed out on radar graphs.
The profiles of the graphs for front line staff were held up against the national health improvement indicators. The results did not show up a link between the cultural graphs for front-line staff and the health improvement indicators. The framework was not able to show a connection between organizational culture and health improvement indicators. However,
- The number of questionnaires sent out and returned have been low.
- The selection of respondents biased.
- The number of indicators comparable low.
- The number of years comparable few and the differences between the 2002 and 2003 indicators for Erwash PCT and Nottingham PCT to weak.
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An overview of QMC's Coronary Care Unit approach to assessing patients with myocardial infarction (2003)
An overview of QMC's Coronary Care Unit approach to assessing patients with myocardial infarction (2003)
In the perspective of the EUROPHAMILI project, the portrayal of the National Health Service (NHS) and a brief characterisation of Queen’s Medical Centre (QMC) and coronary care unit (CCU) premises are prepared. The assessment and initial delivery of hospital care among patients with myocardial infarction is presented in European, international, national and local guidelines.
The implementation of a new framework like the National Service Framework carries a number of innovative features that have to be implemented and may cause reluctance. Thus, in this scope, the internal organisation of the CCU is presented in four different dimensions: tasks and individuals; formal organisational arrangements and informal culture; shared vision and leadership.
In final considerations, the authors perceived QMC as a NHS hospital which follows world-wide accepted standards. The implementation of standards brought up changes in working practices and in some professional roles. The perceptions towards these changes vary among the different professional classes.
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The TRAC programme: promoting access and making choice a reality for patients (2003)
The TRAC programme: promoting access and making choice a reality for patients (2003)
The British National Health Service Plan aims to achieve a major reduction in the time patients wait before gaining access to care in the secondary sector, and to establish systems that give patients greater influence over their own care.
This report describes a pilot project for cataract surgery referral management in ophthalmology. It was part of the Trent Access and Choice scheme (TRAC), a fast-track regional project initiated in the East Midlands in October 2002.
TRAC intends to improve access and offer choice to patients at the point of referral from the primary care sector. The traditional system of referral management is described, and a new pathway via a call centre proposed. The public policy, clinical and management perspectives of key stakeholders in patient referral management are reviewed, and issues relating to access and choice as factors of patient empowerment highlighted.
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Increasing duration rates for breastfeeding - A case study in Gedling (2003)
Increasing duration rates for breastfeeding - A case study in Gedling (2003)
The present case study has been carried out by a Danish EUROPHAMILI trainee, doing a 3-month stay in Nottingham, United Kingdom. It describes and analyses the promotion of breastfeeding support in a local Primary Care Trust (PCT) called Gedling. The National Health Service (NHS) has set a target for the next 3 years to increase the initiation of breastfeeding by an annual 2 per cent for disadvantaged groups. How to influence the duration of breastfeeding positively - particularly for the disadvantaged groups in Gedling area - constitutes the main issue of the present report.
The case study explores the breastfeeding support made on 3 different levels:
- The European level
- The United Kingdom level
- The Gedling PCT level
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A comparative study between England, France and Poland
The study took place during the second pilot EUROPHAMILI training session in Nottingham, England. It was carried out while staying at Rushcliffe Primary Care Trust, the basic body of new English health care system. The data was obtained from Rushcliffe PCT documents, different meetings and interviews we had with various professionals, internet sources and wide range of lectures and professional documents concerning the subject.
On the one hand, the primary care sector (and general practice in particular) is considered as a key sector for the quality of the HCS as a whole. On the other hand, most of the European countries have to face both an increase of the health care expenditures related to this sector and concerns about the quality of the coordination of care.
The aim of the study is to present an overview of these issues at a European level by comparing the organisation of general practice in health care system of France, Poland, and the UK. Taking into consideration especially the ways of funding and tools that are used to monitor GP performance, we intended to find out similarities and differences between the countries in those aspects so as to draw some guidelines adapted to local circumstances.
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Stanislaw Radominski, a student from Poland, carried out this qualitative study using interviews and document analysis. The study took place during the first EUROPHAMILI training session in Rennes, France. The object of this document is to describe and analyse the workings of the contracting system in the region, after 5 years on from the HCS reform. It was carried out while staying at ARH-Bretagne with a help of different professionals from the field and ENSP. This is an attempt to summarize the current situation, especially in the public sector and present the opinions of different partners taking part in the local health care system. A number of conclusions and recommendations are made.
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The object of this work was to study an innovative project which was set up in Laval's hospital (70km far from Rennes). This project aims to develop an ambulatory dialysis centre with tow units : one managed by a private non for profit association while the second unit is run by a public hospital. The framework of management plans to have common strategies but also plans to have a number of shared resources such as ; the medical team, the biomedical team, the production of filtered water and services like cooking and laundry.
This project is the result of a long and sinuous history. On one hand since the 70s the prevalence of renal incapacity has been growing faster and faster. In France the very
powerful regulation system in terms of medical equipment did not succeed in coping with this stream at the national level as well as the local level of Laval. On the other hand, the choice for such a model of organisation –co-operation between a private and a public institutions- is the result of long and numerous discussions and negotiations between the partners.
The development of the project and its implementation will push the partners in a process of organisational and cultural change at the managerial level as well as at the professional
level. The more or less strong professional identity built by the actors will be then confronted with other identities, and we can wonder about the results of this confrontation.
The general objective of this report is to present elements of analysis of this project in the perspective of this confrontation of culture and identity. It aims to give evidences to the project managers to conduct the project as much as possible respecting the social reality.
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The study theme was purposed by Médipsy and Europhamili for the 2002 session.
Background
Previous studies pointed to the need of conceptual frameworks to guide mental health services reforms. The aim of this study was to draw up a comparative inventory of the ways psychiatric patients are managed in terms of therapy and care and how this provision is organised and funded in Italy, Portugal and Spain.
Methods
The matrix model was used for describing and interpreting complex mental health data.
Results
Information for different sources was used to describe and compare the changes in the process of mental health care at micro, intermediate and macro level in these countries. Criteria of transferability of development models in mental health care were under discussion. The case of Médipsy was a reference considering its development.
Conclusion
Specific dimensions of national contexts in mental health care reforms could be identified, but the common dimensions pointed to a common trend, and similar development strategies.
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The Assessment of Rennes Cancer Institute (2002)
The Assessment of Rennes Cancer Institute (2002)
In the wake of the 1991 hospitalisation law and 1996 hospitalisation and health expenditure legislation, Cancer Centre Eugène Marquis, like any other hospital, has been pushed on co-operation on grounds of both rationalisation and quality improvement. In July 2000, in the frame of its “projet d’établissement”, it embarked on a new form of partnership “communauté d’établissements” with the teaching hospital (CHU) and a non profit-making hospital, “Clinique de la Sagesse” in order to be recognised as a reference centre in cancer care for the whole region.
The main operational objectives of this joint enterprise notably included the promotion of multidisciplinary teamwork and medical complementarity, the creation of a common medical file in cancerology and of a regional network.< br>
Beyond its first concrete achievements, the Rennes Cancer Institute seems to have eased relations between stakeholders, more inclined to develop patient-centred projects -by sharing resources- than to compete with one another.
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Internal contracting at CHU Rennes : Obstacles Overcome And Future Challenges (2002)
Internal contracting at CHU Rennes : Obstacles Overcome And Future Challenges (2002)
Objectives:
To analyse the impact of internal contracting at Rennes University Hospital during the last 5 years. Contracting is complex. We have focused on: economic impact of internal contracting, changes required in the way information is presented and the impact of internal contracting on job content and co-operation.
Material and Methods:
Qualitative study consisting of deductive and inductive analysis of interviews with Managers, Head-doctors and Matrons; supplemented with a document analysis.
Results:
Greater awareness of costs. Expenditure on staff and pharmaceuticals is still high. Information system is improved - giving decision-makers better quality of management tools. Job enrichment and improved co-operation among managers and departments.
Discussion:
Difficulties in budget balance, but improvement in efficiency. Improvement of quality and quantity of information. Internal contracting enable the Hospital to be better prepared for new changes. European context taken into consideration.
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The hospital of Avranches-Granville is a community-based hospital in the process of implementing Electronic Patient Recording within its institution. There are controversies among physicians with regard to the recording procedure of medical data and to the level of sharing information among health care providers. The issues are related to the confidentiality and security of medical data and to providing the best patient care. The author, a Europhamili trainee, is a physician member of the institution. With the knowledge acquired through the teaching units, the author attempts to apply the management principles on the physicians organizational form in order to reach a consensus on EPR in the hospital. He tries to deal with the motives that drive individuals and define group dynamics interaction with leadership. This is an essay to tie knots between the practice of medicine and the exercise of management.
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Health policy in Europe becomes increasingly concerned with the problem of growing costs of care. A growing perception is that there are more cost-effective methods of hospital care and hospital management than currently provided. During three months, from April to June 2002, we studied the activity and co-operation of Private Associated Clinics (CPA) in Rennes and in the Brittany Region, France. The study was a part of the EUROPHAMILI training programme for health care professionals. We intended to know the organisation of the French hospital care system, the functional organisation of private clinics and to understand the reasons for co-operation between private hospitals. The objective of our study was to make the reference of French experiences to our home countries and to the European Union. The research was based on interviews, bibliographic studies and observations on the field. The co-operation revealed to be related to new medical, economic, marketing, legislative, demographic, strategic and patients’ exigencies. The co-operation between private clinics and the phenomenon of grouping together seems to be a general tendency in all European countries. We discuss the role and the place of private initiatives for public services in the last part of our report.