🔍💡 Occupational health: how to transform SPST into real innovation actors rather than mere regulatory executors, despite the medical shortage and a closed market.🛠️📊 Governance, digital, nursing delegations, performance indicators: this IGAS 2025 report outlines a very concrete roadmap for field teams and public decision-makers.🔍➕ This report is directly useful to SPST management, occupational physicians, occupational health nurses, IPRP, and prevention managers to drive innovation in a context of medical shortage and ongoing reform.
It provides a framework for analysing barriers (governance, regulation, closed market, digital inequalities) and concrete levers (delegation, digital tools, performance indicators, listening to beneficiaries).
Regional decision-makers, ARS, Dreets, and social partners can use it to guide their action plans, arbitrate priorities, and structure cooperation with health insurance and MSA.
Source: 📒 Innovation in Occupational Health
📜🔗LINK
1. ANALYTICAL SUMMARY
1.1 Context and Issues of Innovation in Occupational Health
The mission entrusted to IGAS in May 2025 focuses on organisational and technical innovations in occupational health and prevention services (SPST: SPSTI, SPSTA, SSTA), in a context of rapid reform succession and strong pressure on the medical workforce.
SPSTs must both maintain individual monitoring, develop collective prevention, integrate public health (law of 2 August 2021) and comply with a certified baseline offer, even as performance indicators remain poorly stabilised and largely focused on regulatory compliance.
The report highlights the French specificity of a highly medicalised, structured and procedural system, with a strong focus on legal obligations, but with still limited ownership of prevention by the companies themselves.
International comparisons (EU-OSHA, ESENER 2024) show that a high level of medicalisation does not automatically translate into better measured overall performance or a shared prevention culture within organisations.
In this context, innovation is not only technological: it concerns governance, regulation, task delegation, structuring multidisciplinary teams, and the use of digital technology as a lever for equity and efficiency.
Finally, the mission notes the absence of a legitimate national body capable of validating, capitalising on and disseminating innovations, as well as the burden of a regulatory system that combines approval, Cpom and certification, in a largely closed market.
1.2 Operational contributions for field actors
The report proposes a first synthetic index of performance and innovation of SPSTs, constructed from annual DGT data (collective prevention, individual visits, prevention of professional disengagement, maturity of information systems, participation in public policies) and discussed as a decision-making aid tool, not as a fixed ranking.
It formulates 22 hierarchical recommendations, ranging from a "regulatory pause" to allow the effects of the laws of 2016 and 2021 to take effect, to the creation of an innovation fund financed by the SPST, including the explicit inclusion of innovation in the future occupational health plan No. 5.
For field teams, the report provides concrete suggestions to strengthen delegations to nurses, structure multidisciplinary teams, develop telemedicine and digital services, while ensuring the interoperability of occupational health medical records (DMST) with the DMP.
On the side of public authorities, it suggests relaxing certain regulatory tools (non-systematic Cpom, accreditation more focused on performance and innovation), while enhancing information sharing (certification reports sent to the Dreets, improving the quality of DGT data).
The report also emphasizes the need to better listen to beneficiaries (employers and employees) through systematic satisfaction surveys and regular national studies on needs, with explicit integration of employees in the measurement of satisfaction.
Finally, it outlines the prospect of a national coordination body for the SPST, equipped with technical and political means, to steer the digital strategy, pool expertise, support innovative projects, and harmonise practices across the territory.
2. KEY POINTS OF THE DOCUMENT
An intense but heterogeneous reform dynamic among SPST
The last fifteen years have seen a succession of reforms aimed at broadening professional profiles, establishing multidisciplinary approaches, developing task delegations, and strengthening prevention, with a pivotal role played by the law of 2 August 2021, which directed SPST towards public health and the transparency of the core offer. (p. 14‑29)
Structural barriers to innovation: governance, regulation, closed market
The report highlights the absence of a legitimate national body for validating innovations, the overlap of regulatory tools (accreditation, Cpom, certification), and a largely closed market for SPSTI that limits the choice of companies and the entry of new operators, which hinders the innovation dynamic. (p. 37‑47)
Digital technology as a major but unequal lever
Digitalisation, significantly accelerated by the 2021 law, allows for the provision of new services (telemedicine, management tools, online services) but the interoperability of information systems remains unfinished, with strong uncertainties regarding the timeline and significant disparities between SPST based on their size and software. (p. 48‑52)
A first synthetic index of performance and innovation of SPST
Building on the annual surveys from the DGT, the mission constructs a composite score integrating collective prevention activities, individual visits, prevention of professional disengagement, digital maturity, and participation in public policies, demonstrating the determining effect of software choice and service size. (p. 53‑57)
A package of 22 recommendations focused on innovation and performance measurement
The recommendations cover the stabilisation of the regulatory framework, the inclusion of innovation in the PST 5, the creation of a national body and a dedicated fund, the revision of the governance of SPSTA, the evolution of Cpom and accreditation, the regulation of medical time, the strengthening of digital tools, and the systematisation of listening to beneficiaries. (p. 6‑9)
3. ACTION TRACKS FOR LOCAL ACTORS
Structure and document nursing task delegations
Formalise collective delegation protocols between occupational physicians and occupational health nurses for information and prevention visits, periodic visits, and certain mid-career visits, relying on identified areas for improvement (delegation rates vary significantly according to SPSTI, SPSTA, SSTA). (p. 20‑23, recommendations no. 6 and 18 p. 7‑8)
Invest in interoperable and prevention-oriented information systems
Prioritise the choice of a business software compatible with future interoperability reference frameworks DMST-DMP, and use the functionalities for tracking collective actions, PDP, and prevention of professional disconnection to support local management based on performance and innovation indicators. (p. 48‑52, recommendations no. 19-20 p. 8)
Strengthen the listening to employers and employees
Implement annual satisfaction surveys among member companies and, where possible, employees, in line with specifications 2217 and 2218 of the certification, in order to guide service priorities and identify unmet needs (schedules, accessibility, contact methods, digital solutions). (p. 3‑4, 6, recommendations no. 21-22 p. 8)
Articulate the action of the SPST with health insurance and local public policies
Develop operational partnerships to coordinate mid-career visits, health assessments "My prevention assessment" and targeted prevention actions on occupational risks, positioning the SPST as active contributors to regional occupational health plans and AT-MP priorities. (p. 25-27, 39-44, recommendations no. 4-5 p. 7)
Use the performance index as a tool for internal dialogue, not as a ranking
Adopt the logic of the proposed synthetic index (collective prevention, individual monitoring, PDP, digital, public policies) to build a local dashboard, co-analyzed with teams and governance, in order to identify areas for improvement rather than putting services in competition. (p. 53-57, recommendations no. 9-10 p. 7)
4. ADDITIONAL REFERENCES
🔍➕ For more information, see the articles referenced by "Health Practices" on the theme of health and work ➡️🔗https://pratiquesensante.odoo.com/4-3-sante-et-travail
AFNOR – "Certification of SPSTI" (online file, updated after 2021)
Detailed presentation of the SPSTI certification framework, specifications, certification levels, and impacts on the structuring of the core offer.
URL :https://certification.afnor.org/services/certification-des-spsti
Ministry of Labour / DRIEETS / INRS – Resources on prevention and occupational health services (updated 2025-2026)
Summary page on the missions, accreditation, structuring, and obligations of the SPST, complementary to the IGAS report for operational regulatory implementation.
URLs :
5. CROSS-ANALYSIS — PRACTICAL VALUES IN HEALTH
Literacy: The report remains technical, without specific measures to adapt the information to varying levels of literacy, but it clarifies the key concepts (core offer, delegations, indicators) for professionals.
Empowerment: Beneficiaries (employers and employees) are mainly seen as targets for satisfaction surveys and needs studies, rather than as co-designers of actions, although integrating their voice is recommended.
Participation: The text emphasises consultation with social partners, PRST, and the joint governance bodies of SPSTI, but describes few mechanisms for co-construction with employees at the micro level.
Community health: The collective dimension appears through the prevention of professional disconnection, collective prevention actions, and anchoring in public policies, without explicitly mobilising the concept of community health.
Ethics: Ethical issues are raised regarding technological innovations (screening, AI, biomarkers) deemed potentially problematic in terms of scientific validation and respect for public health principles.
Human rights: The report mainly addresses equity of access to a SPST and territorial coverage, without explicitly developing a human rights framework, but integrating the issue of equity into the certification reference framework.
Intersectorality: Cooperation is encouraged between SPST, health insurance, MSA, Dreets, ARS, EU-OSHA, reflecting an intersectoral approach to occupational health policies.
Partnership: Collaboration models are formalised through Cpom, multi-year service projects, agreements with Carsat and MSA, although the report criticises the heaviness and irregularity of Cpom.
Fight against discrimination: The document does not directly address discrimination related to gender, origin, disability, or sexual orientation, but indirectly discusses the issue of equitable access and service disparities.
6. EVALUATION OF RESOURCE RELIABILITY
Scientific relevance
The report comes from IGAS, relies on recent data from DGT (annual surveys 2022-2023), EU-OSHA (ESENER 2024), Dares (SUMER survey 2017), and field visits in different types of SPST.
The methodology combines literature review, quantitative data analysis by the data unit, interviews, and case studies, which strengthens the robustness of the findings, even if the synthetic performance index is cautiously presented as a first proposal to be refined.
Operational relevance
The 22 recommendations are dated, prioritised (priorities 1 or 2), assigned to responsible authorities (DGT, CNAM, DNS, DGOS, social partners), and cover concrete levers (delegations, Cpom, approval, medical time, digital, satisfaction surveys).
The report provides numerous field illustrations (examples of services, digital innovations, screening experiments, delegation practices) allowing local actors to position themselves and transpose the lessons to their own context.
7. MCQ — 5 QUESTIONS
PART 1 — MCQ (without answers)
Question 1 (pp. 2-3)
What is the main objective of the mission entrusted to the IGAS in 2025?
a) Evaluate the quality of hospital care
b) Study the organisational and technical innovations of SPSTs
c) Reform the labour code on chemical risks
d) Establish a new unemployment insurance
Question 2 (p. 20‑23)
In 2023, which type of service has the highest rate of delegated visits to nurses?
a) Autonomous SPSTs (SPSTA)
b) Hospital occupational health services
c) Agricultural occupational health services (SSTA)
d) Private occupational health practices
Question 3 (p. 48‑52)
What is the main issue identified around the information systems of SPSTs?
a) The free provision of software for employees
b) The interoperability of systems and medical records
c) The elimination of paper medical records
d) The total outsourcing of data abroad
Question 4 (p. 53‑57)
On which dimensions does the synthetic index of performance and innovation proposed by the mission rely?
a) Only the volumes of annual medical visits
b) Collective prevention, individual visits, PDP, digital, participation in public policies
c) Operating budget and payroll
d) Ranking of psychosocial risks in the sector
Question 5 (p. 6‑9)
Among the following proposals, which one is part of the mission's recommendations?
a) Remove the accreditation of SPST by the Dreets
b) Create an innovation support fund financed by the SPST
c) Prohibit any experimentation in occupational health
d) Reduce certification requirements for SSTA
PART 2 — Commented correction
Question 1 (pp. 2-3)
✅ Correct answer: b) Study the organisational and technical innovations of SPST.
📝 Explanation: The mission letter of 21 May 2025 tasks the IGAS with analysing innovations in the field of occupational health, particularly in prevention and occupational health services, in order to measure their performance and identify barriers and levers to innovation.
Question 2 (p. 20‑23)
✅ Correct answer: c) Agricultural occupational health services (SSTA).
📝 Explanation: The report specifies that in 2023, SSTA carried out 56.5% of delegable visits via nurses, compared to 48% in SPSTI and 25.8% in SPSTA, making it the most advanced network in terms of delegation.
Question 3 (p. 48‑52)
✅ Correct answer: b) The interoperability of systems and medical records.
📝 Explanation: The text highlights that the interoperability of information systems and the ability to transfer medical records in occupational health (DMST) to the DMP is a central issue, still unresolved and fraught with significant uncertainties.
Question 4 (p. 53‑57)
✅ Correct answer: b) Collective prevention, individual visits, PDP, digital, participation in public policies.
📝 Explanation: The synthetic index incorporates the three missions of the core offer (collective prevention, individual monitoring, prevention of professional disengagement), the maturity of information systems, and participation in public health policies, in order to approach performance and innovation.
Question 5 (p. 6‑9)
✅ Correct answer: b) Create an innovation support fund financed by the SPST.
📝 Explanation: Among the 22 recommendations, the mission proposes the creation of a fund to finance innovation in prevention and occupational health services, funded by their contributions, in addition to stabilising the regulatory framework and establishing a national body.
8. FREQUENTLY ASKED QUESTIONS (FAQ)
Which services does the IGAS report on innovation in occupational health focus on? (p. 2‑3, 11‑14)
The report covers all prevention and occupational health services: inter-company SPST (SPSTI), autonomous SPST (SPSTA) in companies with more than 500 employees, and agricultural occupational health services (SSTA) integrated into the MSA.
What are the main effects of the law of 2 August 2021 on the SPST? (p. 25‑29)
The law strengthens the prevention dimension, introduces public health into the missions of the SPST, formalises a certified core service offer, extends multidisciplinary approaches, and accelerates the digitisation of organisations.
How are task delegations to occupational health nurses evolving? (p. 20‑23)
Delegations are increasing but remain very heterogeneous: in 2023, 48% of delegable visits are carried out by nurses in the SPSTI, 25.8% in the SPSTA, and 56.5% in the SSTA, with still significant room for improvement.
What does the proposed synthetic index of performance and innovation consist of? (p. 53‑57)
It is a composite score calculated from DGT data, including collective prevention, individual visits, prevention of professional disconnection, the maturity of information systems, and participation in public policies, interpreted with caution.
What barriers to innovation are identified in national governance? (p. 37‑41)
The report highlights the absence of a legitimate national body to validate and disseminate innovations, the weakness of the operational scope of the occupational health plan, and the fragmentation of responsibilities between the State, health insurance, and professional networks.
What does the mission propose for medical time under pressure? (p. 14‑18, 7‑8)
It recommends defining a national range of employees per full-time equivalent occupational physician, strengthening delegations to nurses, promoting dual practice with other specialties, and better coordinating mid-career visits with health insurance prevention measures.
What are the expectations regarding satisfaction surveys and listening to beneficiaries? (p. 3‑4, 6, 8‑9)
The report recommends making satisfaction surveys for members systematic, integrating employees into these surveys, and conducting regular national studies on needs, adjusting the specifications of certification.
9. REWRITING IN EASY TO READ LANGUAGE
9.1 Summary in Easy to Read Language
Title: What is the report about?
The report is about occupational health in France.
He is looking at how occupational health services are changing and innovating.
These services are called SPST and they support employees at work.
Why this report?
There are few occupational doctors today.
Recent laws require more prevention and more teamwork.
Services must also make greater use of digital technology.
What the IGAS mission does
The mission looks at what works well and what is blocking progress.
It uses data, surveys, and field visits.
It proposes ideas to improve occupational health services.
The main ideas of the report
We must give reforms time to work.
Services and control tools need to be better organised.
We need to listen to employers and employees.
9.2 Key points FALC
Point 1: Services are changing a lot
The SPST have changed with several recent laws.
They are working more in teams with various professions.
Nurses are making more visits instead of doctors.
Point 2: There are blockages
There are many rules and sometimes they are burdensome.
Companies do not always have a choice of their service.
There is a lack of a national team to coordinate innovations.
Point 3: Digital technology is important
The SPST use software to track employees.
The systems need to communicate with each other to track the individual.
Not all services have the same level of digital capability.
Point 4: A new index for measurement
The report creates an index to measure performance.
It looks at prevention, visits, digital aspects, and public projects.
This index serves to see progress but must be used with caution.
Point 5: Concrete recommendations
The report provides suggestions to improve public health services.
It proposes a pause in major reforms.
It advises creating a fund to support innovative projects.