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Viewing the safety imperative from the French policy perspective
  1. René Amalberti1,
  2. Charles Bruneau2,
  3. Armelle Desplanques4,
  4. Laurent Degos3
  1. 1
    Patient Safety, Haute Autorité de Santé, Saint-Denis La Plaine Cedex, France
  2. 2
    International Affairs, Haute Autorité de Santé, Saint-Denis La Plaine Cedex, France
  3. 3
    Haute Autorité de Santé, Saint-Denis La Plaine Cedex, France
  4. 4
    Head pilot programs DAQS, HAS, Haute Autorité de Santé, Saint-Denis La Plaine Cedex, France
  1. Correspondence to René Amalberti, rene.amalberti{at}wanadoo.fr

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1. France has been slower than other European countries and the USA in developing a national concerted strategy for patient safety

French citizens can choose their doctors and specialists (despite a soft gatekeeper mechanism installed in 2005), can access both public and private hospitals, and are free to move from one physician or institution to another, regardless of location, as often as they want. The country ranks among the best Organisation for Economic Co-operation and Development countries for many global healthcare performance markers, such as life expectancy and the rate of amenable mortality.1 Comparisons of consumer satisfaction across Europe place France among those nations with the highest rates of satisfaction.2

For all of these reasons, patient safety has not been a subject of national political debates.3 The press have highlighted and commented repeatedly on major crises where patient safety was compromised such as HIV-contaminated blood administered to haemophiliacs in the 1980s, surgical site infections in the 1990s, the heat wave in the summer 2004 and radiation overdoses in 2008. These have led to individual blames, domain-dependent technical corrections, new guidelines, new agencies and even new laws for enforcing patients’ rights. Only recently has there been a political vision for a centralised governance of patient safety addressing a national transversal plan incorporating features such as a national adverse event (AE) reporting system or the need for incentives to accelerate the acquisition of a safety culture by medical actors.

2. Patient safety results in France are not that good

These results on the global performance of the healthcare system and on public satisfaction should not hide the reality of the figures of patient safety in France. The 2004 National AE study indicated that the rate of AEs in hospitals was similar to that in other countries including the USA.4 A similar study is being duplicated in 2009. Personal communications from the authors suggest that progresses are at best limited. Furthermore, there …

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