We’re always saying it, the impacts of the organization of work and professional practices on the quality of care are truly significant. In fact, Christian M. Rochefort, professor at Sherbrooke University in the Faculty of Medicine and Health Sciences, adds even more credibility to this statement. The results of his work, which were presented during the last ACFAS (Francophone Association for Knowledge) convention, indicate that human resource management, especially the use of overtime, and the composition of care teams have effects on the care given to the patients. He also demonstrates that there is a correlation between overtime and the mortality risk in hospitals: for every 5% increase in the amount of overtime, the mortality rate goes up 3%.
The systematic use of overtime also has effects on the healthcare professionals themselves. We already know that healthcare professionals who must constantly work overtime are twice as likely to suffer from depression or job dissatisfaction [ 1 ].
Mr. Rochefort’s study also shines a light on the risks associated with another practice that is becoming more and more common in the healthcare network, which consists of substituting healthcare professionals with other types of jobs without taking into account their tasks or the proper organization of work.
The most worrisome aspect in all this is that, when you take a closer look, you notice that the use of these practices is not a fatality. In fact, they are most often a by-product of poor management with lack of planning, vision and analysis, such as budget cuts, job eliminations or an overall lack of understanding of the role of each healthcare professional, etc.
For instance, in the case of the CSSS de la Vieille-Capitale, nurses and licensed practical nurses respectively worked 32,248 and 27,324 hours of overtime in 2014-2015, which represents 20 full-time nursing positions and 17 full-time LPN positions. During this same period, $1,377,799 was spent in the private sector to grant contracts to independent labor services, whereas 121 nurses and 46 LPNs are still waiting for their chance on the list of “occasional part-timers (availability list)”, condemned to a situation of avoidable job insecurity [ 2 ].
Regardless of what the decision-makers in the network say, the management of human resources in health care has direct impacts on the quality of care. In fact, it is for this very reason that, during the negotiations for our new collective agreement, we were able to ensure that concrete measures would be put in place in order to establish the number of patients a healthcare professional should have under her care at a given time by implementing pilot projects, which would allow us to establish minimum ratios and follow-up measures.
Note 1 : Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Health Affairs (Millwood), 31(11), 2501–2509.