Prof. Claude Lavigne: Hospital Assessment System in France

Expert introduction

Claude Lavigne (Figure 1).

Figure 1 Prof. Claude Lavigne.

Present: Inspector of French National Social Health Department; senior lecturer at Paris Institute of Politics; core member of Paris Institute of Politics and Health Policy Research Center; and special observer of Franco-Sino Health Institute.

Formerly: Dean of Nantes, Narbonne, Thuir, Val d’Ariege Hospital; President of National Agency for Drug Administration, National Health Department; Jury member of National Occupational Physician Examination; and Chairman of French National Family Hospital Association.

Editor’s note

At the Shanghai Fudan University Hospital Management Institute Hospital Discipline Forum and the Announcement Conference of Chinese Hospital Rankings 2016 held on 11 November 2017, Prof. Lavigne, the General inspector of French National Social Healt Department, and the Dean of People’s Hospital, Ariège, France, introduced us to “Hospital Assessment System in France: Methods, Indexes, Software and Labels”. With the assistant Professor Prof. Ping Lei, President of Franco-Sino Health Institute, AME editors got the opportunity to approach Prof. Lavigne to learn more about the assessment system of French hospitals.

Hospital Assessment System in France—“Contract”

According to Prof. Lavigne, French medical system and hospital assessment system differ from that of China to some extent. In France, assessments are carried out mainly by the National Health Department and some official organizations. The entire medical practice of hospitals, the appointment of hospital administrators, and the medical activities of hospitals are decided by the government. Over the past 30 years, French public hospitals have been requested to follow an index, which is to be adjusted every few years. The National Health Department and other official organizations would assess each hospital in accordance with the index and determine whether the eligibility of the hospital would be extended or terminated. Prof. Lavigne pointed out that, over the past few decades, France has gone through an era of medical reformation. Now, hospital administrators, assessors and executives are appointed through three main channels: Hospital Authority, Medical Insurance Bureau, and hospitals together with regional governments. Every year, Hospital Authority and Medical Insurance Bureau will adjust the index and responsibility requirements for each hospital to designate their medical activities. By and large, the government is playing an essential role in the entire French healthcare system.

“Throughout history, France has been using the same set of assessment principles. It is in brief a ‘contract’. Such contractual act can be regarded as a binding between the government and hospitals. This could be a contract formed between hospitals and either the regional governments, National Health Department, or Medical Insurance Bureau,” said Prof. Lavigne.

This contractual act brings a variety of positive outcomes among medical institutions and between medical institutions and the government in terms of the reduction in healthcare related expenditure, better and more efficient operation of hospitals, and more effective integration of medical resources.

We learned from Professor Lavigne that a new assessment system will arise in France starting from January 2018. As an advanced version of the original system, the new system will introduce new contractual principles with the participation of the medical institutions, Medical Insurance Bureau and Hospital Authority as usual. The most important task Prof. Lavigne accomplished this year is to sort out and classify all assessment indexes in order to ensure the new system can be fully activated by 2018. With a new set of indexes, it is, to Prof. Lavigne, a “contract of improved quality of services” which is made up of three constituents: (I) the use of drugs; (II) the reformation of the hospital as a whole; and (III) the improvement of hospital quality. The new system not only emphasizes assessment but also performance management with the implementation of reward and punishment policies, and it may further combine with the overall medical practice and activities.

The public health policies in France have always been advocating the significance of keeping hospitals out of the influence of the assessments. The French government is reluctant to see how hospitals open up specialties deliberately as a means to increase their own competitiveness or ranking, therefore, since 2010, it has set up six national medical university research institutes to raise the overall competitiveness of hospitals. According to Prof. Lavigne, the main purpose of these institutes is to facilitate education, research and assessment. France has formulated its own set of regulations to assess hospitals. The assessment index used to be financially driven 20 years ago. Now, after two decades of reformation and optimization, the index has gradually developed to become operations management-oriented.

Besides, French assessment is highlighted in various national journals that concerns healthcare management. For example, every year, Le Point publishes the assessment results of all French hospitals. Some of the assessment indexes are set by the magazines themselves with two major objectives—to compare different hospitals and let readers know which hospital is better or worse; and to announce the performances of all medical institutions so as to further enhance the comprehensiveness of the entire healthcare service. In 2002, France enacted a medical law focusing on the operations and autonomy of hospitals to carry out better and more comprehensive assessments.

Hospital Assessment System in France—“Label”

The French government designed a number of labels for hospitals, which was first used in late 2016 and is to be renewed every 4 years. Some of these labels have to be nailed to the hospital walls, while some do not. For instance, labels by Paris Public Health Group have to be nailed. The use of these labels represents users’ expectation of the medical institutions, the technological development of these institutions and the quality of the system operation. The assessment criteria are covered in these labels issued by the Paris Public Health Group, and some of these assessments may include the assessment methods used in different systems. These assessments mainly hinge on the users of the medical services, doctors, medical teams, administrators and health departments. Each year, the labels designed by Paris Public Health Group may contain up to 125 assessment indexes. In 2017, the health group has published on its official website the setting of the assessment indexes for 30 service units. Eighty percent of the 39 intra-group hospitals have already participated in and undergone these assessments. Details of the set of assessment rules and the actual situation of hospital’s compliance are available on the official website of the National Health Department.

Moreover, Prof. Lavigne further mentioned the uses of performance assessment tools, which are derived from the supervision, contracts, regulations, and rewards and punishments. In these assessments, France used a variety of management tools, which was used by the assessment teams in accordance with the set of guidelines formulated by the national health assessment department. However, the setting of the assessment indexes is subject to changes and can be adjusted based on circumstances. Hospitals must login and fill in the data through the system promulgated by the National Health Department. Through the use of these assessment tools with the financial support, the functions and performance of different hospitals can be compared. To make it further transparent, the assessment results including the entire operation and the level of hospitals are disclosed on the official website of the department, which further provides links to all other countries’ databases that enable users to access different information.

Finally, Prof. Lavigine stressed that one of the major responsibilities of the French National Health Department is to assess different medical institutions. Not only does it lay emphasis on the assessment of medical practices, but also on the assessment itself. Furthermore, it makes suggestions on new technologies and healthcare policies in the hope of benefitting the medical institutions and enhancing the overall medical quality and medical practices.

Acknowledgments

We would like to show our gratitude to Prof. Ping Lei, President of Franco-Sino Health Institute, for the editorial support.

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Hospital Management and Health Policy for the series “Meet the Professor”. The article did not undergo external peer review.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jhmhp.2018.01.04). The series “Meet the Professor” was commissioned by the editorial office without any funding or sponsorship. Silvia Zhou and Brad Li report that they are full-time employees of AME publishing company (publisher of the journal). The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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(Science Editors: Silvia Zhou, Brad Li, JHMHP, jhmhp@amegroups.com)