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OCCUPATIONAL MEDECINE
OF THE FUTURE IN FRANCE
« Tout travail suivi fait paraître une aptitude » - Alain, éléments de philosophie (1916)
Dr Faïza Bossy,AssociationHorizonSanté Travail, Asnières, France
INTRODUCTION
: f.bossy@horizonsantetravail.fr
CONTEXT (2015 ANNUAL REPORT IN AN INTER-COMPANY
OCCUPATIONAL HEALTH SERVICE)
28.5 million active workers inFrancein2015
TYPES OF VISITS
1.5 millionhadhealthproblemsrelatedtowork
750,000 fit to work with restrictions
729 visits
150, 000unfittowork: that is as many potential unemployed
13% reinstatement visit: thepractitionerhastoquicklypronouncethefitnesstowork, and
if the reintegration is possible
Unemployment reaches 10.3 % of the active population in France
2.5% pre-reinstatement visit: thisrate is toolow, thepre-reinstatementvisitis essentialto
calmly plan the reintegration and facilitates the upholding of employment.
The decisions of occupational practitioners directly and indirectly impact the whole society and its economy. The old employer-employee-practitioner scheme fails to address the
evolutionofsociety.Anewmodelhastobeadvancedandimplementedonthebasisofourscientificknowledge.
Occupationalmedicineneedstooperateonallpreventionlevels, andnottoberestrictedtotertiaryprevention, orsecondarypreventionatbest.
The occupational practitioner has to initiate a dynamic process focused on the employee.
53
Whypre-reinstatementvisitsareignored?
Howtoshiftfrom“unfittowork” to“fittowork” ?
Age:59
Gender:Female
Marital status:
Divorced
Family status:
2 independent children
Financial status:
independent, tenant
PRE-REINSTATEMENT VISIT
Habitus
1
0
0
emergency
6
others
employee
occupational
practitioner
total
occupational
disease
0
REINSTATEMENT VISIT
Occupational
health department
BUDGET
PEOPLE
ASSETS
TIME
occupational
accident
sick leave
total
GP
2
recurent leaves
Isgoodhealthatworkanexclusivepreoccupationofoccupationalmedicineservices?
2
9
6
maternity leave
Whyreinstatementvisitsareoverwhelmingafteramedicalleave?
5
SS medical advisor
QUESTIONS
13
employee
total
9
18
employer
In order to meet this requirement we will present a clinical case using the methodology of AJLP Conseil & Formation.
MATERIALS AND METHODS: CLINICAL CASE
35
34
OPTIONAL MEDICAL EXAMINATIONS
Evaluationofprofessionalactivity
Website
Flyers/ Ownpublication
Meetingthetargetpublic
Teammeeting
«Gostraight» tothesource:visittheworkplaces
Employee
Lookafterherhealth:Backpainpreventionclasses...
Examinehersprioritiesandherneeds
Tobeactoronaproject:personalplan, retirement
Employer
Assessment
Management
Socialdialogue/ PrivilegedpartnershipwithOHD*
REQUIREMENTS
Jobpost
Interview, exams, andassessment
Fit to work
Recurrent exam
Interview, exams, andassessment
Professionalproject
Fit to work
MILESTONE M24.
Therapeuticstrategies:Newmodel
Pre-recruitment exam
Diploma: Catering and hotel
Waiter, Maître d’hôtel
Cooker, Chef
Restaurant manager
Restaurant owner for 10 years
Maître d’hôtel in a Retirement home:
-Permanentpositionsince25thJune2012
- Full-time
- Workinghours:10h-20h, 2WE/ month, alternates2W-5Dand2W-3D
- Commuting: 1 hour by public transport
Curriculum laboris
THE CASE
PROJECTS
First pre-reinstating visit
MILESTONE M33.
Therapeutic management,
Activating networks, and Medical monitoring
JOB DESCRIPTION
Teamleader
Presentfood, Laytables, Serveattables
Welcomeandinstallthecustomer, Guideandtakeorders, respectdiets
Handleatrolley, Manualhandling
Cleardishes, Cleantables, Cleantherestaurant
Resolveconflictswithpatients, families, andcolleagues
month medical leave: Spine surgery, Functional
Second pre-reinstating visit 5physiotherapy,
Medical treatment.
Maître d’hôtel
TOOLS
HEALTH CONSEQUENCES
Medicalleaves
Occupationaldisease:#57 intheofficialSStable
Otherdiseases:rachidian, lowerandupperlimbspain
MONITORING
MILESTONE M40.
Interwiew , examen and assessment
Professional future: occupational reclassification or
professional reintegration?
Advices to employee and employer
OCCUPATIONAL HAZARDS
Bio-mechanicalrisks
Chemicalrisks
Biologicalrisks
Sensoryrisks
Mentalworkload
Organizationalrisks
Contactwithfood, Hygienestandards, Serviceuniform
4 month medical leave: Radicular/sciatic pain, Muscle strain,
Left hip pain, Medical and physical therapy, Back brace
Medical assessment and functional abilities evaluation
PRIORITIES
- Employee: back to work without pain, previous life
- Employer: organizational legacy, short-term economy
- Society: reduce economic, social , human costs
Reinstatement visit
MILESTONE M41.
Accessibility: contact/ referent...
Safeguarding employment Dynamic: contract between
employee and occupational health department( OHD)*
TASKS DELAYED
TASKS ON HOLD
TASKS IN PROGRESS
Participatory dialogue with the employer
Medical and psychological exam
Coordinated action: employer, employee, and medical network.
Increase and improve the working conditions
Make proposals
Overall approach
Post-reinstatement visit
MILESTONE M46.
In-situ observation
Objectives
- Increase and improve
the working conditions
- Make proposals
- Overall approach
CONCLUSION
Partnership between the employee and the occupational medicine services using the «Dynamique du maintien en emploi» tool. The employee gave their
informed consent for the support in their professional career.
Rally of a multidisciplinary team of occupational medicine and other services:
Occupational practitioner and their team (ergonomist, social assistant, psychologist)
GP, hospital, physiotherapist (« Ecole du Dos »)
SS medical advisor
Administrative services: SAMETH (skills appraisal, vocational training)
Financial services: AGEPHIP (subsidies)
The follow-up is critical and must be done as a team. Delegation allows to save time.
For the employee: regainconfidence, supporteachstepintheircareer, awarenessofprofessionalrisks(primaryprevention), beactiveabouttheirhealthat
work, relayinformationstocolleagues.
For the employer: supportthequalityimprovementprocess, trainemployees, awarenessofprofessionalrisks, costspreventionarelowerthanmedicalleave
/ employmentbreak, benefitsintermsofimagewithregardtopartnerbusinessesandclients.
For occupational medicine services:
- Primary mission: primaryprevention:anticipationofrisks, passinformationsaboutprofessionalrisks, communicatewithemployees, employers, medical
andnursingstaff, colleagues, inordertodelegateandsaveone’sowntime.
- Secondary prevention:activatenetworks, raiseawarenessabouttraining, involvetheemployeetotheprocess, meettheemployersinthefield, establish
a plan shared by all.
- Tertiary prevention: findappropriatesolutionsfortheworkstation, converttheworkstationwiththecooperationoftheemployer, maintainthecontract
andtheemploymentdynamics, maintainthenetworksactive.Donotgiveup, trynottodeclareunfittowork.
If an employee must be declared unfit to work, they must have consented and experienced as a second chance because other solutions have been
considered upfront.
Acknowledgements:ThisworkwasfundedbyAssociationhorizonSanté Travail, theauthorisemployedbythiscompany.MrMatte(ergonomist), MrsRichardot, DanièleGounot(Administrativesupport), PrGehano(Guidance)
DrRobertBossy(Translation, support), SauniaChouarfi(Technicalsupport)(layout)
Therapeutic part-time working
