France puts public hospitals on the ‘Road to Performance’

John Brosky reports

One year after boldly launching a far-reaching programme for reforming France’s troubled hospitals a newly created French agency has surprised its detractors and created a way forward.

No one broke out Champagne for the first anniversary for the Agence Nationale d’Appui à la Performance (ANAP). It’s not the kind of government agency that inspires parties. Charged with moving France’s hospitals onto what Health Minister Roselyn Bachelot calls the ‘road to performance’, ANAP nonetheless can report that one year after its creation it is receiving plenty of telephone calls from hospital directors.

‘Thirty major hospitals are currently working with us, plotting a road map to meet performance objectives,’ reports Ayden Tajahmady, responsible for the ambitious ANAP work programme. Four of the country’s leading medical centres have already signed a contract to fulfil their plan, a formal ceremony attended by the Health Minister and leading political leaders, including former Prime Minister Alain Juppé at the ceremony in Bordeaux.

In addition to the sprawling university hospital at Bordeaux (CHUBordeaux), the other three hospitals now working on a three-year programme to meet performance goals are CHU Nantes, the massive Hospices Civils de Lyon, and the Centre Hospitalier de Mulhouse. ANAP has also successfully asserted itself in a central role of support for advancing 262 information system projects that had been launched as part of France’s Hospital 2012 plan, many identified as struggling or at risk of failing.

Another sign of credibility for the start-up agency is the over-subscription for a programme to bring 100 hospital line managers into a structured coaching programme, which asks them to set performance objectives for their operations and then trains them in the skills required to reach those objectives. ‘We aren’t offering assistance only to build a managerial community, we want to assist service line improvements with defined projects that directly touch patient’s lives,’ Ayden Tajahmady said. ‘Performance is often seen as having a financial component, but its greatest potential is for improving the quality of services being delivered, as well as improving the working conditions for care providers.’

ANAP was created in late October 2009 as part of a controversial healthcare reform law that consolidated an alphabet soup of existing agencies. (See European Hospital Issue 2, 2009) At the same time the new law restructured decision-making by giving new powers to 26 regional health authorities. ANAP works hand-in-hand with these regional authorities to affect change, for example, recently launching an emblematic programme to coordinate social and medical services for dependent people in three of these regions. Ayden Tajahmady explained that the goal is to establish best practice cases in this pilot programme that will guide the other 23 regional authorities in making similar service delivery changes. ‘This programme is a key to helping hospitals move services outside their walls and to connect with the surrounding region’ -- including private care facilities and government medical and social service agencies.

Surgery theatres are another focus of this strategy, he added. ‘An operating room is more complex than running an airport, yet we are hardly at that level of organisation. One of the central pillars for change we have identified is shifting the focus of hospitals to being centred on the patients and increasing the appreciation within the hospital walls on the impact of actions for a complete system of care in a community. ‘The hospital staff knows best where there are dysfunctions; they are aware of the problems,’ he said. ‘Our task is to help de-dramatise the change and advance the performance. ‘Medical practice today has little in common with what it was 20 years ago, and in another 20 years it will have changed again,’ he added. ‘We are creating the tools and changing the culture to adapt to this change and optimise the use of the public monies that fund healthcare services.’ To accompany hospitals and care facilities on the road to performance measurements, ANAP encouraged the creation of five consortiums of private sector companies to bid on consulting contracts.

These contracts cover the diagnostic phase for hospitals drawing up a road map for performance. ‘It’s not enough for the consortium to file a report and then fold its arms,’ he continued. ‘They are also required to identify a pilot programme and demonstrate their advice is credible and works.’ Perhaps the greatest accomplishment of the first year for ANAP is having created a performance culture within a government agency, Ayden Tajahmady suggested. ‘We’re aware that we’ll be held to the same standards that we’re teaching to hospital directors and managers.
It will not be enough for ANAP’s people to be consistent with these standards; we need to be exemplary to be credible.’

‘We are a staff of 80-some people and soon to be 120-some,’ he added, ‘and each one is engaged, working long hours without watching the clock, taking the hits and bumps in the road, yet continually advancing. Today we can tell our board of directors how much a project is going to cost, how many people it will require and the results they can expect from the effort,’ he confirmed. ‘Very few public sector agencies can say that.’

28.10.2010

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