The economic upturn is highlighting tensions over recruitment and employee retention. In the healthcare sector, which has been hard hit by the health crisis and is under increasing pressure due to the growing needs of the population, departures and recruitment needs were all the more exacerbated.
2 years after the Ségur healthcare agreements, how can we meet these attractiveness challenges in concrete terms? Discover the essential levers for building and deploying a strategic approach to healthcare recruitment.
THE HEALTH CRISIS: A CATALYST FOR STRUCTURAL DIFFICULTIES
Structural difficulties exacerbated by the health crisis
In March 2019, a strike movement by paramedical professionals, initially contained to emergency services, spread to hospital services. This social movement highlighted the major issues facing public hospitals, in particular staff shortages. In 2020, nearly 31% of healthcare establishments indicated that they were encountering major difficulties in recruiting paramedics. As many as 62% said they were encountering such difficulties for occupations in shortage (FHF survey, Faire face à la seconde vague de Covid-19, November 2020). These recruitment difficulties are also becoming more acute in the medical professions. 32% of physician positions were vacant in public hospitals on January 1, 2021 (FHF survey).
The health crisis has amplified the problems faced by the healthcare sector, leading to an over-mobilization of caregivers. After the first wave, departures of paramedical professionals increased. A survey by the Direction générale de l'offre de soins, published in December 2021, put the number of departures at 1,245 nurses over one year. That's around two resignations per establishment in one year. 54% as a result of resignation, and 38% for leave of absence or long-term leave. Measures were taken during the crisis to limit this disengagement and curb it upstream. These included limiting the placement of student nurses and medical interns in departments under high pressure. However, the consequences of this lack of resources are becoming increasingly complex to manage. Increasingly, they are leading to the closure of beds and places.
A shortage of professionals, worsening working conditions...
- The number of training places is limited. The end of the numerus clausus will not have an impact on the number of doctors for another ten years. The increase in paramedical training places will only bear fruit in 3 to 5 years. The limited number of places is combined with an increase in the number of people dropping out during the course. Two months after the start of the 2021 academic year, 13% of nursing students had dropped out, according to the Comité des instituts de formation du paramédical's Etude 2021. These drop-outs can be explained by a significant gap between students' expectations, the training provided and the reality in the field.
- The policy of improving performance in healthcare establishments has worsened working relations and conditions. The difficulty of coping with this change has added to the already heavy constraints of certain professions... which has made them even less attractive.
- Finally, while remuneration has risen since the Segur measures, it still doesn't seem sufficient. Especially to compensate for the arduous nature of jobs in both the public and private sectors.
... and a general lack of interest in the healthcare professions
- Recruitment and retention problems are also the result of a failure to anticipate the company's cultural evolution. On the patient side, the growing use of medical care and the demand for an immediate response to their needs are accentuating and straining relations with caregivers.
- For caregivers, this trend towards medical consumerism means a 54% increase in emergency room visits between 2002 and 2019 (DREES data). This worsens the conditions in which they provide care... and is a further constraint on the already numerous aspects of their jobs: staggered working hours, considerable pressure... At the same time, the search for a better work-life balance is an additional obstacle to attractiveness.
- In the past, these constraints were more readily accepted, as the care professions were associated with a commitment to community service, and were viewed positively by both caregivers and society. The loss of collective commitment and sometimes of a sense of usefulness is a major problem today. It's felt as early as the training phase: drop-outs during the course of studies are frequent. And in the course of a career, part-time work and resignations also contribute to a reduction in resources.
LEVERS TO BE USED TO RESPOND TO THE RESOURCE CRISIS
Answers from Ségur de la Santé: good progress to be continued
The Ségur de la santé mobilized players in the healthcare system from May 25 to July 10, 2020. The consultation identified four pillars for modernizing the healthcare system.
The first of these pillars aims to «To »transform professions and enhance the status of those who provide care". It has resulted in salary increases for care professions and hospital practitioners. A budget of around 10 billion euros a year has been earmarked for this, along with an increase in the number of paramedical trainees. Welcomed by healthcare professionals, these measures are nevertheless insufficient to address the sector's deep-seated difficulties.
President, Fédération Nationale des Associations d'Aides-Soignants (FNAAS)
President, Fédération Hospitalière de France (FHF)
Short- and medium-term: improving working conditions
Measures to increase medical and paramedical resources will not take effect for several years. In the short and medium term, therefore, solutions must enable current resources to be maintained... while aiming for qualitative rather than quantitative improvements.
Increasing the value of pay
The Ségur measures have made it possible to catch up with average European salaries. They still need to be completed to respond to the crisis of commitment and the constraints of the healthcare professions. While the Ségur bonus is being extended to new beneficiaries, certain professions that are essential to the operation of the structures remain excluded. This is particularly true of administrative, technical and logistical professions, which are also affected by an attractiveness crisis.
Creating intermediate professions
The development of intermediate professions within healthcare establishments is essential. These new professions are based on delegation of certain medical procedures to trained paramedics. This delegation would enable a much-needed rebalancing of the workload pending the effects of the end of the numerus clausus.
Developing managerial practices
The evolution of practices and management must also receive special attention. Work on leadership and team management would improve quality of life at work. To improve the distribution of tasks by giving new responsibilities to certain care professions.
Improving territorial organization of supply
We need to continue our efforts to improve the territorial organization of our offer. The introduction of coordination mechanisms (access to care services, coordination support systems, etc.) and the development of initiatives that enable people to work in several structures and/or practice in several different ways are all factors that can boost the attractiveness of the professions in this field. offering a more flexible working environment on the same territory.
Restoring meaning and reputation
The value and meaning of caregiving in society must be reaffirmed. Communication about the professions must be strengthened in order to to restore the nobility of the care professions.
Improving access to training and career management
Improving access to training and managing the careers of healthcare personnel are essential for offer clearer and more attractive career prospects.
In the long term: developing the healthcare system
Increasing the number of medical and nursing resources, combined with the solutions outlined above, should provide a partial solution to the problem of staff shortages, on a constant care consumption basis. However, they may not be sufficient to meet the structural increase in the population's healthcare needs.
- So, in addition to these HR actions, more systemic measures aimed at transforming usage and limiting recourse to the healthcare system will necessarily have to be implemented to guarantee its sustainability and attractiveness over time. Work must continue on prevention, regulating the use of care and territorial organization in order to develop coordinated practice and strengthen links and the balance of care between town and hospital.
- Assurance Maladie, itself affected by attractiveness issues, will have to contribute to these structural reforms. by putting in place the financing framework required for these transformations, and in particular by strengthening its own actions in terms of prevention and medical risk management. In particular, ’outreach« schemes could be developed on a wider scale, to meet the needs of policyholders with a view to prevention and orientation within the system.
- These changes will involve major business transformations that will have to be co-constructed with teams to facilitate acceptance of this change and ensure that resources are maintained.
DISCOVER THE REPLAY OF THE DEDICATED WEBINAR
The Eurogroup Consulting webinar hosted by Nathalie Rolland - Associate Director - Eurogroup Consulting, on March 31, 2022 as part of the Les Ateliers de la Transformation Publique cycle gives the floor to :
- Marie-Gabrielle Dubreuil - Director of Human Resources for the Networks - Caisse Nationale de l'Assurance Maladie (French National Health Insurance Fund)
- Pascal Durand - Director of Primary Care - ARS Occitanie
- Jérôme Goeminne - General Manager - Centre hospitalier de Verdun Saint-Mihier, Cœur Grand-Est support facility
