Work and employment in hospitals in a context of reforms

Abstract

in recent years, hospitals have changed their management of employment and work organization because of a series of reforms to adapt them to changes in the demand for care and control expenditure. The introduction of activity pricing (T2a) has transformed the funding of healthcare institutions, in particular of public hospitals, the allocation of budgetary resources becoming dependent of care production. a qualitative survey conducted in 2009 among hospital executives, administrative and doctors, showed that the surveyed institutions, encouraged to increase their activity while saving resources, adjust their workforce more closely the care provided. The establishment of a financial control by revenue and a payroll management led to a new employment management. it aims to minimize the cost of labor, which accounts for about two thirds of the cost, by varying the volume and composition of the workforce. This employment management is combined with various constraints that may come increase the work. The pressure on employment can lead to deficits of caregivers or to intensify the rhythms or the workload. The search for flexibility in the management of the workforce may cause employee reallocations based on need, a stricter management ofschedules and leave, overtimes, etc. The sustainability of reforms then encountered the question of working conditions of caregivers.