HST Poster Bossy V0 .pdf
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OF THE FUTURE IN FRANCE
« Tout travail suivi fait paraître une aptitude » - Alain, éléments de philosophie (1916)
Dr Faïza Bossy,Association HorizonSantéTravail, Asnières, France
CONTEXT (2015 ANNUAL REPORT IN AN INTER-COMPANY
OCCUPATIONAL HEALTH SERVICE)
28.5 million active workers inFrancein2015
TYPES OF VISITS
1.5 million had health problems related to work
750,000 fit to work with restrictions
150,000 unfit to work: that is as many potential unemployed
13% reinstatement visit: the practitioner has to quickly pronounce the fitness to work,and
if the reintegration is possible
Unemployment reaches 10.3 % of the active population in France
2.5% pre-reinstatement visit: this rate is to low, the pre-reinstatement visit is essential to
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
Evolution of society. A new model has to be advanced and implemented on the basis of our scientific knowledge.
Occupational medicine needs to operate on all prevention levels, and not to be restricted to tertiary prevention, or secondary prevention at best.
The occupational practitioner has to initiate a dynamic process focused on the employee.
Marital status: Divorced
Family status: 2 independent children
I independent, tenant
How to shift from“unfit to work”to “fit to work”?
Why pre-reinstatement visits are ignored?
Is good health at work an exclusive preoccupation of occupational medicine services?
Why reinstatement visits are overwhelming after a medical leave?
SS medical advisor
In order to meet this requirement we will present a clinical case using the methodology of AJLP Conseil & Formation.
MATERIALS AND METHODS: CLINICAL CASE
OPTIONAL MEDICAL EXAMINATIONS
Evaluation of professional activity
Meeting the target public
«Go straight»to the source:visit the workplaces
Look after her health: Back pain prevention classes...
Examine hers priorities and her needs
To be actor on a project: personal plan, retirement
Social dialogue/Privileged partnership with OHD*
Diploma: Catering and hotel
Waiter, Maître d’hôtel
Restaurant owner for 10 years
Maître d’hôtel in a Retirement home:
- Working hours:10h-20h,2WE/month,alternates2W-5Dand2W-3D
- Commuting: 1 hour by public transport
4 month medical leave: Radicular/sciatic pain, Muscle strain,
Left hip pain, Medical and physical therapy, Back brace
Medical assessment and functional abilities evaluation
- Employee: back to work without pain, previous life
- Employer: organizational legacy, short-term economy
- Society: reduce economic, social , human costs
Occupational disease:#57 in the official SS table
Other diseases :rachidian, lower and upper limbs pain
5 month medical leave: Spine surgery, Functional
physiotherapy, Medical treatment.
Interview , examen and assessment
Professional future: occupational reclassification or
Advices to employee and employer
Contact with food,Hygiene standards,Service uniform
Fit to work
First pre-reinstating visit
Second pre-reinstating visit
Therapeutic strategies:New model
Activating networks, and Medical monitoring
Present food,Lay tables,Serve at tables
Welcome and install the customer,Guide and take orders, respect diets
Handle a trolley,Manual handling
Clear dishes,Clean tables,Clean the restaurant
Resolve conflicts with patients,families,and colleagues
Fit to work
Accessibility: contact/ referent...
Safeguarding employment Dynamic: contract between
employee and occupational health department( OHD)*
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
- Increase and improve
the working conditions
- Make proposals
- Overall approach
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: regain confidence, support each step in their career, awareness of professional risks (primary prevention), be active about their health at
Work, relay informations to colleagues.
For the employer: support the quality improvement process, train employees, awareness of professional risks, costs prevention are lower than medical leave
/employment break, benefits in terms of image with regard to partner businesses and clients.
For occupational medicine services:
- Primary mission: primary prevention: anticipation of risks, pass informations about professional risks, communicate with employees, employers,medical
And nursing staff, colleagues, in order to delegate and save one’s own time.
- Secondary prevention: activate networks, raise awareness about training, involve the employee to the process, meet the employers in the field, establish
a plan shared by all.
- Tertiary prevention: find appropriate solutions for the workstation, convert the workstation with the cooperation of the employee, maintain the contract
And the employment dynamics, maintain the networks active. Do not give up, try not to declare unfit to work.
If an employee must be declared unfit to work, they must have consented and experienced as a second chance because other solutions have been
Acknowledgements:This work was funded by Association Horizon Santé Travail, the author is employed by this company. Mr Matte (ergonomist) ,Mrs Richardot, Danièle Gounot (Administrative support), Pr Gehano(Guidance)
Dr Robert Bossy (Translation, support), Saunia Chouarfi (Technical support)(layout)
Therapeutic part-time working