This narrative review of the literature highlights the way in which health crises have encouraged the emergence of a new actor: the patient-actor, accompanied by new semantics concerning the power of the patient. The patient occupies a specific place in the field of safety of care. In collaboration with healthcare professionals, the patient must constitute a resource to improve patient safety. The various contributions of patients are described and an analysis of the acceptability of patient participation is proposed.
Résumé Cet article cherche à renouveler l’analyse des dynamiques professionnelles dans le champ de la santé en appréhendant celles-ci dans leurs interactions avec les logiques portées par les acteurs gestionnaires (au sens de financeurs et/ou régulateurs). Ces interactions y sont abordées à travers la question de la coordination dans les réseaux de santé et, plus précisément, celle de l’injonction à mettre en place un mode particulier de coordination : une coordination formalisée. Trois points sont développés pour aborder cette question : la définition à un niveau national d’un cadre politique et institutionnel à la coordination ; l’impact des impératifs gestionnaires sur les mises en forme de la coordination observées sur nos terrains d’étude ; et le marché du travail et les carrières émergeant autour de la coordination.
Résumé. Face à l'exigence grandissante de qualité des soins, l'autonomie de la profession médicale peut sembler menacée. Cependant, la procédure d'accréditation des hôpitaux laisse une marge de manœuvre aux médecins qui peuvent faire un usage stratégique des démarches qualité. De nouveaux acteurs collectifs émergent dans le champ médical, animés par des médecins sensibilisés aux démarches qualité. Ces dernières peuvent alors servir des stratégies de différenciation sur un marché des soins en concurrence, ou de défense d'une discipline ou d'un service hospitalier.
Objective: Few studies to date have explored the question of the safety of a hospital stay from the patient's point of view. The aim of this study was to describe patients' own perspectives on the safety of the surgical care they received. A qualitative study was conducted based on interviews.Methods: Semidirected interviews were conducted by a sociologist with adult patients admitted for hospitalization in 2 orthopedic and in 2 digestive surgery wards in 4 hospitals.Results: Eighty interviews were transcribed and analyzed. The patients surveyed averaged 61.7 years old (SD, 16.0 y). Forty-eight percent were men (n = 38). The issue of the safety of care, as defined by professionals, is little apprehended by patients. In their view, sense of safety was related to the trust in the surgeon, which is a requisite condition for a sense of security and is based on interactions with the surgeon and on their communication style. Sense of safety was also related to the preoperative consultation, in which the procedure is explained and illustrated and to a postoperative encounter with a person who participated in the operation.Conclusions: Patients' sense of safety is linked to the amount of trust they have in their surgeons. New strategies to improve language practices and surgeon-patient interaction should be developed, along with organizational improvement guaranteeing that participants of the surgery debrief with the patient.The study has been registered at ClinicalTrials.gov (identifier: NCT02820545).
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