Good treatment and mistreatment in healthcare facilities: a major societal issue

The issue of good treatment and mistreatment within healthcare facilities has become a major societal issue in France. Despite the numerous quality improvement initiatives implemented, a significant portion of the population expresses concerns about the risks of mistreatment for themselves or their loved ones. This guide to improving practices from the HAS (French National Authority for Health), validated on October 3, 2024, aims to encourage the dissemination of good professional practices in the health, social care, and social sectors by offering common benchmarks for better understanding these complex and subjective concepts. It is intended for all professionals working in these establishments, recognizing that respectful treatment and the fight against mistreatment are everyone's responsibility. [Image: A caregiver gently holds the hand of an elderly person, smiling.] src="https://cdn.prod.website-files.com/61f1c5bbc327ec3679e7457c/67d94162982298f0b07092ba_700b0c828ab74ee2ff8f9d471b389e8a7ed5b3085f284f01dbd6f7774caa6885.png" width="auto" height="auto" loading="auto">

Understanding the fundamental concepts: positive treatment and mistreatment

The distinction between positive treatment and mistreatment is crucial for guiding practices and policies within healthcare facilities.

Mistreatment, legally defined in Article L. Article 119-1 of the French Social Action and Families Code (CASF), in effect since 2022, applies to any person in a vulnerable situation when a gesture, word, action, or inaction compromises or harms their development, rights, fundamental needs, or health, within the context of a relationship of trust, dependence, care, or support. It is important to note that mistreatment can be occasional or ongoing, intentional or unintentional, and originate from an individual, collective, or institutional source. Violence and neglect can manifest in multiple and combined forms. There are seven types of mistreatment:

• Physical
• Sexual
• Psychological
• Material and financial
• Neglect, abandonment, or deprivation
• Discrimination
• Exposure to a violent environment

It is essential to differentiate between mistreatment and violence. Mistreatment implies a helping relationship between the person and the perpetrator, while violence occurs in the absence of this helping relationship (for example, between two people in care or between professionals themselves).

Positive treatment, on the other hand, is a positive and holistic concept. It corresponds to a care of the person and their entourage which meets their expectations and needs, while allowing respect for their rights and freedoms. Positive treatment is a culture that inspires individual actions and collective relationships within an institution, aiming to promote the well-being of the user while remaining mindful of the risk of mistreatment. It involves: Personalizing support; Informing the person of their rights; Assessing their communication needs; Ensuring that the action meets their expectations; Supporting autonomy; Working "with" and not "for" the person; Regularly reflecting on practices; Respecting fundamental rights; Maintaining a social, cultural, and family life; and Building alliances with caregivers and representatives. Users

Quality human interaction is at the heart of trust and satisfaction for all stakeholders.

The challenges of mistreatment and the fundamental importance of positive treatment

Preventing mistreatment in healthcare facilities raises numerous issues, affecting individuals, institutions, and society.

Societal challenges

• Aging population and increase in vulnerable people
• Strong public fears regarding the risks of mistreatment

Quality and safety challenges

• Risk prevention and signal management
• Healthcare facility certification and evaluation Social and medico-social establishments and services (ESSMS)

Public health issues

• Harmful consequences of mistreatment (depression, cognitive decline, premature death)
• Need to train professionals to better identify and prevent these situations

Ethical issues

• Reflection on the autonomy and self-determination of the people being cared for

Legal issues

• Respect for the fundamental rights of vulnerable people
• Legal obligations of establishments

Political issues

• National Strategy to Combat Mistreatment
• Policy for Healthy Aging and Autonomy

Positive treatment is not limited to the absence of mistreatment; it constitutes a comprehensive and proactive approach aimed at promoting respect for the rights and freedoms of users from the moment they are received.

Identifying and preventing situations of mistreatment: a collective commitment

Identifying and preventing situations of mistreatment requires the mobilization of all staff at all hierarchical levels.

Risk factors

• Related to the residents
• Related to staff (lack of training, excessive workload, deteriorating conditions)
• Related to the facility and environment

Early warning signs

• Sudden changes in behavior and mood
• Sudden deterioration of health
• Complaints from the resident or their family

All signals must be taken seriously, reported to management, and recorded in the resident's file.

Implementing respectful care: principles translated into concrete actions

Guaranteeing freedom of choice and empowerment of residents people being cared for

• Involve the person in decisions
• Promote their autonomy and self-determination
• Ensure understanding of their rights from the moment of arrival

Help professionals reflect on their practices

• Continuing education
• Lessons learned sessions
• Spaces for team discussion

Engage the entire institution

• Formalize the commitment in the institution's project
• Identify positive care coordinators
• Promote a culture of Reporting

The Key Role of Reporting and Processing Signs of Abuse

Reporting any situation of abuse or warning signs is a crucial step.

Legal Obligations

• Professional secrecy lifted in cases of proven abuse
• Obligation to report to the competent authorities

Internal Procedure

• Alert to management
• Safety of the victim
• Analysis of the facts and implementation of corrective actions

Lessons Learned (RETEX): A tool for learning and continuous improvement

Lessons learned (RETEX) allows us to take a step back and identify the root causes of situations of mistreatment.

Analysis methods

• ALARM method
• Lessons learned meetings

Objectives

• Identify areas for improvement
• Implement preventive measures

Institutional Commitment: Evaluation and Perspectives for a Sustainable Culture of Positive Treatment

Institutions must ensure:

• Rigorous management of reports
• Monitoring of action plans
• Continuous evaluation of practices
• Regular training of professionals

Continuous improvement of practices and investment in training are essential levers to guarantee quality and respectful support for all.

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Source: HAS

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