From 18 May to 29 June 2020, at the start of the first progressive decontamination, Res publica, in partnership with Le Quotidien du Médecin and Décision et Stratégie Santé, conducted a survey of 1,000 doctors, using Jenparle, Res publica's collaborative dialogue and consultation tool.
"Of the thousand professionals who responded, many expressed surprise and dismay at the sudden onset of the crisis. Most stressed the unpreparedness of the health system as a whole. And a good number report new ways of working, more or less guided by necessity or constraint, which one perceives could really change the situation in post-Covid France. "
Le Quotidien du Médecin
In the summer of 2020, doctors debated online 46 proposals for improving health after Covid-19. These proposals concern health governance, care and treatment solutions, human resources and training, and equipment. Among these proposals, the need to give back their place to carers by changing the governance of hospitals stands out. In this respect, the lack of proximity and the excessive centralisation of hospitals are deplored.
We draw three conclusions from this survey that can be made operational quickly:
On the one hand, in the world of health as in many others, the crisis has revealed that it is possible to operate differently, with more flexibility, more trust, more reactivity and inventiveness. While some fear a probable return to the past, notably because necessity has imposed its law, we must not overlook the fact that many health actors, whether they are caregivers or not, have experimented with other ways of doing things and have found them attractive.
On the other hand, among the possibilities, health has experienced a period of decompartmentalisation which reveals the complementarity of approaches. Some were already known, such as the enlightening exchanges between the patient and the doctor; others were ignored, such as the logic of co-production between the different categories of carers, who are less hierarchical, while still others were simply neglected: the articulation of the action of all the health actors in a territory, with a particular role for the territorial authorities (from the commune to the department).
Finally, it appears that the future of these "novelties" is largely dependent on the way in which the new articulations between health actors will be maintained in the coming months. Pillar 4 of the Ségur health plan, "Federating health actors in the territories to serve users", must still be implemented by relying on local and regional dynamics and by organising dialogue with all the actors concerned.
The quality of health services at the territorial level will depend mainly on the quality of the dialogue between all the players in this field. dialogue between all the players in this field. Building territorial health strategies will make it possible to give actors more flexibility to organise the response to a territory's health needs in an agile and reactive way, to clarify and make more fluid the organisation of the regulation of unscheduled care and emergencies, and to structure local care and the interface between the city and the hospital.
Collaborative dialogue is an expert practice that is the only way to guarantee useful and effective discussions that will enable the implementation of operational change. The world of health could be inspired by it to initiate the transformation that will guarantee a quality service, at the right price, under the right conditions for better health of citizens.