High patient satisfaction but too-low flu vaccination levels among healthcare staff: These are some of the major points highlighted in a new report on the state of French healthcare.
The report by national health authority la Haute Autorité de Santé (HAS), was released on December 18. It provides an overview of the quality and safety of healthcare given in France’s health establishments.
Main findings
Overall, the report was positive.
It said that patient satisfaction continued to be high and that 86% of establishments reported good or very good results. In contrast, it said that not enough healthcare workers were being vaccinated against the flu.
In a statement, HAS president Professor Lionel Collet said: “These results provide a snapshot at a given point in time of the level of quality of care, once treatment has begun.
“They do not, however, enable us to identify problems of access to care or tensions within establishments.
"These are issues of which the HAS is fully aware and which it takes into account in its recommendations for good practice. In this context, it is all the more important for professionals to take stock of their practices, their difficulties and also their successes.”
He also said that the HAS’ Qualiscope online service enables the public “to find out the quality level of establishments in their area at the click of a button”.
Prof Collet added that patients who had helped the HAS by taking part in its surveys “once again praise the unfailing commitment of the people who work every day to look after their health”, and said he joined them in “saluting the efforts of these thousands of professionals”.
Patient satisfaction
In the HAS’ 2024 patient satisfaction survey, a total of 1.35 million patients responded (a good response level of 25% of those asked). The results showed:
The patient satisfaction and experience score is:
79.5% for surgery and short hospital stay (up 0.6 points compared with 2023)
76.7% for medical and rehabilitation care (up one point)
74.8% for medicine, surgery and obstetrics lasting more than 48 hours (up 0.5 points).
Across outpatient, inpatient, surgery and obstetrics care lasting more than 48 hours, patient satisfaction and experience are also high.
Medical care: 82% satisfaction in 2024 (compared with 81.7 in 2023)
Paramedical care: 82.3% (compared with 81.9 in 2023)
Procedures prior to hospitalisation: 83.4%
Medical care on the day (e.g. of surgery): 85.5%
Welcome and reception in the establishment: 82.3%.
However, satisfaction scores were lower for:
Areas falling short of expectations, improvement needed
Postoperative pain
This was identified as an area for improvement, the report states.
“This remains a frequent cause of early re-hospitalisation and anxiety when it is poorly controlled postoperatively, and anticipating it by prescribing painkillers before admission is a major challenge in outpatient surgery,” it said.
It said that “scores for anticipating pain management remain inadequate” with fewer than 4 in 10 patients receiving a prescription for painkillers before admission.
Low life expectancy for severe psychiatric disorders
Life expectancy for a patient suffering from severe psychiatric illness is 20% lower than for the general population, the report states.
People with severe psychiatric disorders are also “disproportionately” likely to suffer from cardiovascular and respiratory diseases, which have a co-morbidity rate of between 30% and 60%.
However, the HAS stated that there has been some progress in these fields.
Cardiovascular and metabolic assessments for adult patients were carried out in 69% of patients (up nine points compared to 2021)
Gastrointestinal assessments were carried out in 46% of patients (up 17.5 points)
65% of patients (up 10.6 points) were identified and offered help to stop using drugs
Preventing healthcare-associated infections
Hygiene, especially hand hygiene, could be better in hospitals, the report states. It looks at the consumption and use of hydroalcoholic solutions (e.g. alcoholic hand sanitiser) to measure this.
The use of these solutions “is both rapid and effective” and “helps to control the risk of cross-transmission of microorganisms carried by the patient…and the rate of healthcare-associated infections and the spread of emerging multi-resistant and highly resistant bacteria”, the HAS said.
Yet, their use has fallen for the second consecutive year.
Similarly, it said that the target for all hospitals is 100% cleanliness, but the figure now stands at 79% (down three points compared to 2023 and down 16 points compared to 2022).
The percentage of establishments achieving a satisfactory level when it comes to 100% cleanliness, to reduce the risk of healthcare-associated infections, fell to 28% in 2024, from 33% in 2023.
The HAS states that “the decline in this indicator since 2021 can certainly be explained by the relaxation of measures following the [Covid] health crisis”.
“The HAS expects rapid progress in this area, and action on the ground needs to be stepped up,” it said.
Surgical site infections
Surgical site infections after knee replacement are on the rise, the HAS said.
Infections for hip replacements dropped, however.
“These infections are challenging complications for these surgeries, and attention should be paid to these results”, the HAS said.
Flu vaccination for healthcare workers
The HAS particularly drew attention to a lack of flu vaccinations among healthcare workers.
“Only 19% of establishments have reached or exceeded an intermediate level In France,” it said, while pointing out that “seasonal flu affects between two million and six million people every year and is responsible for an average of 10,000 to 15,000 deaths”.
“In hospitals its transmission represents a major risk not only for the most vulnerable patients, but also for healthcare workers.”
Although mandatory flu vaccinations for healthcare professionals were suspended in 2006, the World Health Organization (WHO) still recommends that at least 75% of healthcare professionals be vaccinated every year.
“However, vaccination coverage remains inadequate among staff in healthcare establishments,” said HAS.
Hospitals are classified according to five levels, ranging from a very low level of vaccination coverage (<20%) to an exemplary level (>75%, i.e. the WHO target).
During the winter of 2023-2024:
“Organisational improvements are expected to promote flu vaccination,” said the HAS, adding that it had issued recommendations in favour of flu vaccination for healthcare workers in July 2023.
Certification of healthcare organisations
The certification (classification or quality) of healthcare establishments (run by the HAS for 20 years) is an independent and compulsory assessment for all public and private healthcare establishments, carried out every four years by healthcare professionals appointed by the HAS.
Certification is based on a regularly updated set of certification standards which healthcare establishments can use as a benchmark for their own quality procedures.
Majority show good results
The most recent certification results show:
87% of establishments report good or very good results
Healthcare teams tend to view the certification process positively.
23% of all establishments obtained the highest ‘High quality of care’ rating and will only be certified again in four years
13% of hospitals did not meet the quality of care requirements.
9% of hospitals were certified conditionally, meaning they must now demonstrate rapid improvement within the next six and 12 months.
This tends to work; at the time of their second visit, four out of five facilities that had been given a conditional certification had demonstrated enough improvement in that time and were therefore certified.
The HAS provides support solutions to help these hospitals improve, it stated.
Disparities between types of establishment and regions
University hospitals and cancer centres obtained the best certification results, the HAS said, with more of these awarded the ‘High quality of care’ label than other establishments.
Other types of hospitals are experiencing more difficulties, it said, particularly:
Specialist psychiatric facilities
Hospitals in Normandy, and the French overseas territories, which had significant differences compared to the national average.
