Over-Mobilization, Poor Integration of Care Groups: The French Hospital System in the Face of the Pandemic

Abstract In France, the health system is characterized by both a centralizing State and strong market pressures (liberal medicine, pharmaceutical industries, etc.). Within the framework of budget reduction policies, this confrontation has led to savings on the productive wage bill within the public hospital rather than on medical fees or industrial profits, resulting in the elimination of beds and a reduction in the number of permanent staff, while administrative employment has increased for management staff. In the face of the pandemic, the mobilization of health care workers was able to demonstrate its effectiveness, compensating for the deficits in equipment and organization from above. Mutual aid is highly contextualized, based on local logics and interaction configurations. If mutual aid prevailed overall, exhaustion was spreading among the troops before the second wave and then the third wave. At the same time, the management did not involve the healthcare teams more in the decisions, contrary to certain participative attempts in the past. The management team, which was not involved in the crisis, tended to reassert its presence as if nothing had happened, even though a distinction had to be made between a type of management that was close to the patients and a type of management that was in control and enforced the hierarchy.