Abstracts
Résumé
Les lois françaises de 1982 à 2016 ont élaboré un cadre contraignant pour le secteur médico-social, également incité à se comporter de façon éthique et responsable. Deux logiques se sont affrontées : rentabilité versus recherche de satisfaction des patients. La divergence entre les objectifs des soignants et des gestionnaires s’est d’autant plus amplifiée que les usagers contestent la légitimité des dépenses publiques. Les innovations technologiques favorisent la connaissance des attentes des patients. Le processus devrait être ascendant (des besoins et attentes des patients vers la direction), il est en réalité souvent descendant (des exigences de la direction vers les patients). La réforme de 2018 réintègre la qualité de l’organisation territoriale des soins, mais devra répondre aux exigences d’équilibre, de sécurité, et d’éthique. De nombreux cas vécus par des patients illustrent ces incohérences : la situation semble critique, mais des réponses organisationnelles peuvent être données à défaut de solutions plus onéreuses immédiates.
Abstract
The French laws between 1982 and 2016 have created a compelling environment in the medical and social areas, which are actually expected to behave in an ethical and responsible way. Two hardly reconcilable ideas have come to face each other: a profit-oriented one and a patient satisfaction-oriented one. Thus, it has emphasized the divergence between caregivers and administrators’ goals. Moreover, many users are questioning the public expenses legitimacy. Besides, technological innovations (informatics, databases, interconnecting files, datamining...) have permitted to measure and acknowledge patients’ expectations more precisely (Medical information departments in hospitals, satisfaction surveys...). We should observe an ascending process (from patients’ needs and expectations to management), yet it is often the opposite (from management demands on patients), which works against organizational ethics. A reform announced in July 2018, which focuses on territorial healthcare organizations, seems promising, yet ambitious regarding the means that will be dedicated to it. However, it remains to be seen if mobilization of territorial resources will be balanced, safe, and ethical. Lots of real cases that patients have come through show a lack of consistency, leading to a troubling situation for both patients and their families: the situation seems critical, but organizational solutions can be provided, in the absence of more expensive and immediate solutions.