HST Poster Bossy V0 .pdf


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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,AssociationHorizonSantéTravail,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 million had health problems related to work
 750,000 fit to work with restrictions

  729 visits

 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.
Occupationa lmedicine needs tooperate 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.

53

 Why pre-reinstatement visits are ignored?

 How to shift from“unfit to work”to “fit to work”?

 Age:59
 Gender:Female
 Marital status:
Divorced
 Family status:
2 independent children
 Financial status:
independent,tenant

PRE-REINSTATEMENT VISIT

Habitus

0

0

emergency

1
others

6
employer

occupational
practitioner

total

occupational
disease

0

REINSTATEMENT VISIT

Occupational
health department

 BUDGET
 PEOPLE
 ASSETS
 TIME

occupational
accident

sick leave

total

GP

2

recurent leaves

 Is good health at work an exclusive preoccupation of occupational medicine services?

2

9

6
maternity leave

 Why reinstatement visits are overwhelming after a medical leave?

5

SS medical advisor

QUESTIONS

13

employee

total

9

18

employee

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

 Evaluation of professional activity
 Website
 Flyers/Own publication
 Meeting the target public
 Team meeting
 «Go straight»to the source:visit the workplaces

Employee

 Look after her health:Back pain prevention classes...
 Examine hers priorities and her needs
 To be actor on a project: personal plan, retirement

Employer

 Assessment
 Management
 Social dialogue/Privileged partnership with OHD*

REQUIREMENTS
 Job post
 Interview,exams,and assessment

 Fit to work

Recurrent exam

 Interview,exams,and assessment
 Professional project

 Fit to work

MILESTONE M24.

 Therapeutic strategies:New model

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
- Working hours: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
 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

month medical leave: Spine surgery, Functional
Second pre-reinstating visit  5physiotherapy,
Medical treatment.

Maître d’hôtel

TOOLS

HEALTH CONSEQUENCES
 Medical leaves
 Occupational disease:#57 in the official SS table
 Other diseases :rachidian, lower and upper limbs pain

MONITORING

MILESTONE M40.

 Interwiew , examen and assessment
 Professional future: occupational reclassification or
professional reintegration?

 Advices to employee and employer

OCCUPATIONAL HAZARDS
 Bio-mechanical risks
 Chemical risks
 Biological risks
 Sensory risks
 Mental workload
 Organizational risks
 Contact with food,Hygiene standards,Service uniform

 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: 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
considered upfront.

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


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