France assos santé carried out a qualitative survey on the conditions for a successful mandate, from the point of view of hospital establishments. According to the first results, their effectiveness remains heterogeneous with variable integration depending on the structures, poorly identified roles and functioning that is too dependent on the actors present. The final results will be released next October, along with recommendations.
According to the first results of this survey, which Santé Mentale was able to consult, “ User Representatives (RU) sit in governance but remain distant from professionals in the field « . « Before, I didn’t (know them) because I wasn’t in management. I was a nurse at the clinic.(…) I think that caregivers don’t understand the connection and the impact of working together. I think that we are not explained that our practices, continuous improvement, all that, in fact, depends on what comes back via users”testifies for example a participant from the private sector. The RUs are known at the level of hospital governance through their formal presence in the bodies, but remain unknown to professionals at the patient’s bedside, reveals the survey, which also notes a variable presence of the RUs in the bodies depending on the establishment. In the most advanced establishments, the RUs are integrated well beyond the users’ commission. “ They participate in the COPIL, the care commission, the Food and Nutrition Liaison Committee, the Pain Control Committee, the Adverse Events Committee, the Ethics Committee and the Disability Committee.“, confides a participant from the psychiatric sector.
A “not very visible” RU referent function
In terms of institutional integration, the function of user representatives remains “ hardly visible in organizational charts “. The absence of a dedicated job description, in particular, weakens continuity – the quality of the mandate depends more on individual commitment than on the organization, underlines the first results of the survey. Finally, the collaboration of teams with the RU varies greatly in frequency depending on the establishment. Gold, ” the intensity of the relationship varies from one establishment to another and directly conditions the impact of the mandate.”
Soft skills, more decisive than technical skills
Professionals agree on this point: the relational attitude takes precedence over regulatory knowledge in the representation of users. » A good RU is someone who knows how to remain neutral, who listens without judging. It cannot be improvised“, testifies one of the people interviewed as part of this investigation.
“Preventive presence” of the RU
The study also surveyed hospital staff on their vision of the role of user representatives. “ The most mature establishments mobilize the RUs upstream, transforming a recourse role into a prevention role“, observes the investigation. “The RUs are doing rounds in the services. They capture tensions before they explode“, testifies a participant (employed by a university hospital). The UK as a trusted third party thus represents “ a powerful lever for defusing litigation« .
UK mandate: disparities between establishments
The Public Health Code provides that complaints and claims addressed to a health establishment, as well as the responses provided, are made available to the members of the Users’ Commission, which includes user representatives (article R.1112-80 CSP). The practical terms of access are left to the discretion of each establishment, while respecting confidentiality rules. If the investigation finds that the RU are still present in the management of complaints and claims, they are “ to varying degrees from one establishment to another“. In the most advanced establishments, thus, the RU “ are no longer spectators but actors in the processing of complaints“. Finally, still according to these first results, “ the formal scope of the mandate masks a highly establishment-dependent implementation“. If the internal regulations indeed set a minimum framework, “ it is the institutional culture that determines the real scope of the mandate“. Furthermore, the presence of the RU on the ground “ remains difficult to deploy but can be organized with appropriate framing“. “In psychiatry, access to the service is complicated. Doctors do not necessarily want to see the RUs arrive, confides a participant from psychiatry.
The number of RUs is set independently of the size or number of sites of the establishments, leaving establishments with too few RUs to carry out all their missions, again recalls the survey which mentions “ a structurally inadequate regulatory framework » with 4 RU for 50 beds as well as for 500.
The final results of this investigation will be disclosed next October and will be accompanied by recommendations, specifies France assos santé.
Panel d'établissements
16 entretiens dont 2 exploratoires
Secteurs MCO, psy, SMR, CLCC.
Statuts : publics, ESPIC / CLCC, Privés.
10 régions de métropole interrogées + 1 Département Région d’Outre-Mer
3 profils Qualité/gestion des risques (GDR), Soins, Relations Usagers
Couverture géographique : Bretagne, Normandie, Pays de Loire, Grand Est, Île-de-France, Centre-Val de Loire, Nouvelle-Aquitaine, Occitanie, PACA, Auvergne-Rhône-Alpes, La Réunion (Outre-mer).Enquête France assos santé : la perception des établissements de santé sur les facteurs de réussite d’un mandat de représentant des usagers
