VIOLENCE WITHIN THE ORGANIZATIONS OF HEALTH AND MEDICO-SOCIAL SECTOR. A COMPARATIVE ANALYSIS OF FRANCE AND ROMANIA.

• Author: Carra, Cecile

1. Introduction

   Violence at work constitutes a social problem at the international level: it is described as a fact of a global society by Chapell and Di Martino (2000), and according to the WHO (2002), it is a global challenge. In the health and medico-social sector, it is increasingly expressed in political, institutional and professional concern. This is the case in the two countries at the heart of this research, France and Romania. Three main questions will guide our exploration: what figures covers this phenomenon in each of these two countries? Can we see social patterns appearing beyond the specificity of these two national contexts? On this side, are specificities emerging? This is a comparison between these two countries that we are considering. The aim of this article is to present the theoretical and methodological framework of the comparison, specifying the segments studied, after identifying possible national particularities in the way of apprehending violence in the health and medico-social sector.

2. A Political, Institutional and Professional Concern

   In France, a feeling of aggravation of the problem has developed over the past two decades, accompanied by a multiplication of institutional measures. (1) In 2012, the Observatoire National des Violences en milieu de Sante (ONVS) is created. Its creation is accompanied by the development of a quantification tool directly anchored on the concerns of professionals. It lists, in 2013, 12,432 reports of attacks on persons and property. Reporting within the framework of the study plan and carried out by staff on 353 establishments in the health and medico-social sector (compared with 11,000 reports in 2012). (2)

   In Romania, public authorities have also committed themselves to taking into account the concerns of professionals through a similar response scheme: to acquire a measurement tool, to facilitate links with judicial and police institutions, and to support victims. (Radu and Sendroiu, 2005) The problem of violence is thus particularly considered by the Directorates General Assistance and Child Protection (DGASPC). The DGPSPC are the main providers of social services at the level of a county (3) of Romania or a sector of the municipality of Bucharest. (4) Their role is to prosecute cases of violence in their sector. The records on cases of violence are made in each unit without being made public. (Burlacu, 2005)

   The principle of the call center for listening to victims is also used here. As from 24 November 2014, the National Agency for Equal Opportunities (ANES) under the Ministry of Labor, Family, Social Protection and the Elderly has been set up a free number whose role is also to facilitate the reporting of violence. It is not specifically dedicated to health workers. Its implementation at the national level was part of the POSDRU (5) project with European funding: "START--A quality life in safety" (Press release START - A life of quality in safety, 2014) and aimed above all the taking into account of domestic violence. The ANES recorded 11,598 cases of abuse in 2014 and 9014 in 2015 (Buna ziua Brasonov, 2015).

   Romanian statistical sources concerning violence are diverse and inevitably lead to the production of statistics that are equally diverse and sometimes contradictory. The government's intention to centralize the data under the aegis of the INS (6) has asserted itself from 2014 onwards, but it has not yet been finalized. Scattered national indicators within the framework of public health measures can be used here and there. (7)

3. Understanding Violence in the Health and Medico-social Sector: National specificities?

   3.1. From occupational risks to the prism of medical

   In Romania, the research on violence has developed in the early 1990s. Although the interest in this topic is finally confirmed at the same time as in the other OECD countries, this appearance is here endowed with a very local explanation. Indeed, before the Romanian Revolution of 1989, the authorities deemed "inappropriate" presentation of statistics could harm the country's image. The political changes could explain the new implementation of a latent interest but previously censored. With the introduction of Law No. 544/2001 on free access to public information, updated in 2016 and Law No. 52/2003 (re-published in 2013) on transparency in decision-making in public administration, things are beginning to change in Romania. Romanian researchers believe that mainly the transparency of decision-making is very well described by Romanian legislation, but the local public administration, are not yet very well prepared to deal with (Androniceanu, 2011). In Romania, as in other central and eastern European countries, reforms have focused on all the functions of the health system--financing, provision, management and development of resources (Anton and Onofrei, 2012). In recent years, however, global financial crisis has influenced almost all sectors of countries, significantly affected the social sectors such as education and health (Androniceanu & Ohanyan, 2016).

   The phenomenon of violence has been politically addressed in occupational health and safety concerns (Birsan, 2015). They were regulated by Act No. 319 of 14 July 2006--Occupational Safety and Health Act. It lays down the general principles for the prevention of occupational hazards, the preservation of the health and safety of workers, the elimination of risk factors and accidents and the addition of social dimensions such as the right to work, Information, consultation, balanced participation, training of workers and their representatives (The Romanian Parliament, 2006). The content of the Romanian laws did not directly refer to violence. It is through the notion of occupational risk that it was first registered until 2012. Law No. 212 published in November 2012, to supplement Law No. 95/2006 on reform in the field Article 641, which stipulates in paragraph 4, subordinate to Title XIV, the offenses constituted by the threats and blows against the medical personnel in the exercise in their service.

   There is therefore a legal balance between the absorption of violence in the field of occupational risks and the emphasis of a specific problem on the one hand and the other on a debate largely framed by the medical field. Let us note for example, the pilot study carried out in March 2015 by the Foundation of the College of Physicians of the Municipality of Bucharest (CMMB (8)). It turned to a measure of the exposure of hospital doctors in Bucharest to attacks. The population consisted of 541 physicians from 22 hospitals. The results show that 85% of respondents reported verbal abuse and 10% were victims of physical assault. This study was the occasion of a campaign of prevention "Non-aggression of the medical personnel" carried out by Federation SANITAS (9) drawing thus a landscape of the violence distributing the roles of victims to the public and aggressors to the public. If the phenomenon of violence in the medico-social field is limited to the image of an institution and its personnel attacked by an outside party in the political-professional dialogue, the literature indicates various forms of violence: economic violence, violence of language, physical violence, psychological violence, violence of the process, intrinsic violence, assumed violence, etc.

   3.2. Between PSR and suffering at work, the question of standards

   In France, this concern for violence in the workplace is the subject of numerous studies, mainly in the broad field of occupational safety and health, as in the case of Romania; It is treated particularly in the prism of this "new social category" of psychosocial risks (RPS) (Lhuillier, Giust-Desprairies, and Litim, 2010). The work on PSR mobilizes the term of violence in empirical definitions or which are intended to be operational, such as the one given by the INRS (10):

   "Psychosocial risks (PSR) correspond to work situations where the following are present, combined or not:

   --Stress: an imbalance between the perception that a person has of the constraints of his working environment and the perception that he has of his own resources to face it;

   --Internal violence committed within the company by employees: moral or sexual harassment, exacerbated conflicts between persons or between teams;

   --External violence committed on employees by persons outside the company (insults, threats, assaults ...)." (11)

   The PSR thus integrates violence into a known and structured world of occupational risk: identification of risk factors, prevention, and treatment of harm. Violence integrates this pattern of thought upstream and downstream. Upstream as a source of stress, downstream as a consequence of stress. The focal point can then be put on particular forms of violence in the encounter between the individual and the organization such as moral harassment at work (Hirigoyen, 1998) or psychological harassment (mobbing, Leyman, 1990, 1996).

   Between sociology and psychology, the 1990s saw the development of research on suffering at work (Bourdieu et al., 1993; Dejours, 1998, 2000). This work is beyond the scope of the PHI, and, for a number, wants to stand out from it. They aim to question the meaning given to work and the values and norms of individuals in relation to the transformation of the expectations of decision makers towards operators. However, risk-based approaches have greatly impacted the construction of the object of violence by offering new perspectives to objectivist approaches in difficulty in the face of the consequences of defining the content of violence on legal bases.

   The apprehension of violence as a transgression of a rule of law leading them on the one hand towards the mere measure of crime, any offense at any given moment in the state of legislation becoming violence, on the other towards the subestimation of...