Le benchmarking : une méthode d’amélioration continue de la qualité en santé

Le benchmarking, démarche managériale de mise en œuvre des meilleures pratiques au meilleur coût, est un concept récent dans le système de santé. Les objectifs de cet article sont de mieux comprendre ce concept et son évolution dans le secteur de la santé, de proposer une définition opérationnelle et de décrire quelques expériences françaises et internationales dans le secteur de la santé. À cette fin, nous avons réalisé une revue de la littérature explorant le contexte d’émergence d’une telle approche dans le milieu industriel, son évolution, ses champs d’application et des exemples d’application de cette méthode dans le secteur de la santé. Le benchmarking est souvent considéré comme la comparaison d’indicateurs et n’est pas perçu dans son entièreté, à savoir comme un outil fondé sur une collaboration volontaire et active entre plusieurs organisations en vue de créer une émulation et de mettre en application les meilleures pratiques. La principale caractéristique du benchmarking est son inscription dans une politique globale et participative d’amélioration continue de la qualité. Les conditions de réussite s’axent essentiellement sur la bonne préparation de la démarche, le suivi d’indicateurs pertinents, l’implication du personnel et la conduite de visites entre structures. Par rapport à des méthodes antérieurement mises en œuvre en France (programme d’amélioration continue [PAC] et projets collaboratifs), le benchmarking comporte des spécificités permettant de considérer cette approche comme innovante en santé. Elle le sera tout particulièrement pour les établissements de santé ou médico-sociaux car le principe des visites inter établissements n’est pas inscrit dans leurs cultures. Une évaluation de sa faisabilité et de son acceptabilité est donc nécessaire avant toute promotion de cette démarche.The benchmarking, a managerial process of best practices implementation at the best cost, is a recent concept in the health system. The objectives of this paper were to define the concept and its evolution in the healthcare sector, to suggest an operational definition and to describe French and international ways of implementing benchmarking in healthcare. A non-exhaustive literature review was carried out in the industrial and service sectors to answer the first two objectives and in the healthcare sector the latter one. Benchmarking is most often used for the comparison of indicators. It is yet not perceived as a tool based on a voluntary and active cooperation among several organizations to build emulation and implement best practices. The main characteristic of a real benchmarking approach in indeed to participate in a global and participative continuous improvement. Among the key factors of success, are an appropriate and thorough preparation of the project, a monitoring based on relevant indicators, frontline staff involvement and inter-healthcare organisation visits. Compared to methods previously implemented in France (Breakthough series and Collaboratives), benchmarking includes specificities which enable this approach to be considered as innovative in healthcare. Specifically, its implementation by healthcare or social organisations will be perceived as new because the principle of visits inter-institutions do not belong to the local culture. An evaluation of its feasibility and acceptability is therefore necessary before generalisation

The ResTO-TerRiN Project: Contribution to the Systemic Modeling of Technical and Organizational Issues of a Territory Exposed to Natech Risk

International audienceThis paper presents a brief summary of work being carried out under the Franco-Japanese research project ResTO TerRiN. The main goal of the project is to produce relevant knowledge and effective methods and tools to improve the resilience of a territory against Natech accidents (chemical accidents triggered by natural hazards) especially those due to flood / tsunami. The work is based on a posteriori (in Japan and France) and a priori analysis of the industrial as well as the local governments' emergency management to the Natech accidents during the Great East Japan earthquake and tsunami (GEJET) and during severe flooding events in France. Survey questionnaires in Japan and France are being applied to chemical facilities, to government agencies, and to citizens in France and Japan The data collected are used to model the impact of the natural hazard events on the facilities and the safety barriers, as well as the community and overall social impacts. These results are then used to understand societal and territorial resilience to these complex disasters and propose a Natech resilience model. In this paper we present the preliminary results of the ongoing work in Japan

Sensitivity of Five Rapid HIV Tests on Oral Fluid or Finger-Stick Whole Blood: A Real-Time Comparison in a Healthcare Setting

BACKGROUND: Health authorities in several countries recently recommended the expansion of human immunodeficiency virus (HIV) antibody testing, including the use of rapid tests. Several HIV rapid tests are now licensed in Europe but their sensitivity on total blood and/or oral fluid in routine healthcare settings is not known. METHODS AND FINDINGS: 200 adults with documented HIV-1 (n=194) or HIV-2 infection (n=6) were prospectively screened with five HIV rapid tests using either oral fluid (OF) or finger-stick whole blood (FSB). The OraQuick Advance rapid HIV1/2 was first applied to OF and then to FSB, while the other tests were applied to FSB, in the following order: Vikia HIV 1/2, Determine HIV 1-2, Determine HIV-1/2 Ag/Ab Combo and INSTI HIV-1/HIV-2. Tests negative on FSB were repeated on paired serum samples. Twenty randomly selected HIV-seronegative subjects served as controls, and the results were read blindly. Most patients had HIV-1 subtype B infection (63.3%) and most were on antiretroviral therapy (68.5%). Sensitivity was 86.5%, 94.5%, 98.5%, 94.9%, 95.8% and 99% respectively, with OraQuick OF, OraQuick FSB, Vikia, Determine, Determine Ag/Ab Combo and INSTI (p<0.0001). OraQuick was less sensitive on OF than on FSB (p=0.008). Among the six patients with three or more negative tests, two had recent HIV infection and four patients on antiretroviral therapy had undetectable plasma viral load. When patients positive in all the tests were compared with patients who had at least one negative test, only a plasma HIV RNA level<200 cp/ml was significantly associated with a false-negative result (p=0.009). When the 33 rapid tests negative on FSB were repeated on serum, all but six (5 negative with OraQuick, 1 with INSTI) were positive. The sensitivity of OraQuick, Determine and Determine Ag/Ab Combo was significantly better on serum than on FSB (97.5%, p=0.04; 100%, p=0.004; and 100%, p=0.02, respectively). CONCLUSION: When evaluated in a healthcare setting, rapid HIV tests were less sensitive on oral fluid than on finger-stick whole blood and less sensitive on finger-stick whole blood than on serum