Ahen we look once again at the bedside of hospital governance to specify the conditions under which the current director could give way to a “doctor-director tandem”, it seems urgent to specify what could be the common language to caregivers – including doctors – and administrative staff, who on a daily basis unite their efforts in the service of our fellow citizens but sometimes struggle to understand each other. Communication difficulties sometimes turn into real disputes, with each accusing the other of hearing nothing and being indifferent, some of the need for means to treat, some of the balances that allow the sustainability of our health system.
When these disagreements, sometimes exploited and amplified as the temptation to designate a scapegoat remains strong in the face of the difficulties, seem too important, the question of the balance of power between administrators and doctors is put back on the table. Do we need “one boss at the hospital”? And who should win then? Is the responsibility of one worth more than that of the other? What professional knowledge and experience legitimizes being the final decision maker? The regulations then evolve, alter the prerogatives of each other, and the general atmosphere remains that of competition and the balance of power.
And if it were possible to also consider things differently? Today, the training paths for caregivers and administrative staff – including hospital directors – are radically different. Doctors have poor knowledge of how the health system works, which makes their work environment opaque to them. Hospital directors receive a thin veneer of presentation of nursing activities, and have neither a solid scientific culture nor training in or through research.
Each blames the other
Neither of the two professional groups has any real training in public health enabling them to understand all the determinants of health, to take a step back from the French health system by comparing it to others, to describe and understand the professional cultures and their histories, to define the health needs of a population, to evaluate the contribution of such or such organization of care. Neither of the two groups has either sufficient training in the ethical concepts underlying the decisions to be taken to be able to invoke them explicitly and justify their analysis on this basis.
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