[Field 3. Structural and managerial skills for improvement in safety practice. French-speaking Society of Intensive Care. French Society of Anesthesia and Resuscitation].

ICU activity has to be authorized by regional hospital agencies. The structural aspects of ICU have been defined in official text in 2002. Thus, quality related to structural issues should be settled in the next future. The challenge is now focused on team building and managerial skills that should be developed in ICU in order to improve quality and security. Every effort should be developed to improve motivation and self-accomplishment of personnel working in ICU (period of integration for new nurses, basic and continuous education, clear tasks identification, formal interviews). It is important to follow alert indicators (absenteeism, important turn over) in order to detect burn out and take preventive measures. It is necessary to develop a new culture, team-oriented, with common goals. This new quality-security oriented policy must be supported by the institution. The volume-outcome relationship has been demonstrated across a wide range of medical and surgical procedures. On average, higher volume is associated with higher quality and better outcome.