Directeur d'Hôpital (EHESP / CNG) common mistakes
Directeur d'Hôpital (EHESP / CNG) · Understand the traps and how to avoid them.
Reciting the legal hierarchy (Constitution, loi, règlement) in the abstract without applying it to the concrete case posed, e.g. discussing whether a décret can derogate to a loi instead of testing the specific arrêté or circulaire in the scenario against its actual author and legal basis.
Candidates revise the sources of law as a list to be memorised and never practise the reflex of identifying, in a given text, its author, its rank and its contested provisions, so the answer stays descriptive when the question asks for a qualification.
What to do instead
For every legal text encountered in a case, build a three-line grid before writing: author (Premier ministre, ministre, préfet, directeur), rank in the hierarchy, and the superior norm it must respect. Practise on past case subjects by writing only the qualification paragraph and having it checked against the corrigé, so the reflex becomes automatic under time pressure.
Treating the hospital's internal regulations, the règlement intérieur and the projet d'établissement as interchangeable, or citing the wrong instrument for a given decision (e.g. invoking the projet d'établissement to justify a disciplinary sanction or a change in working hours).
These instruments are studied in separate chapters and candidates retain their names without their function, their adoption procedure or their legal effect, which differ sharply between a document approved by the conseil de surveillance and one adopted after consultation of the CSE.
What to do instead
Build a one-page comparison table with columns: instrument, who adopts it, who is consulted, what it can and cannot regulate, and the legal remedy against it. Rehearse by classifying ten typical decisions (sanction, planning change, admission rules, investment) into the correct instrument before writing any answer.
Producing a financial analysis limited to restating the compte de résultat figures, without computing or interpreting the key ratios (taux de marge brute, délai moyen de paiement des fournisseurs, taux d'endettement, CAF, capacité de remboursement) and without linking them to a management decision.
Candidates from non-financial backgrounds fear the calculation and hide behind commentary, while others compute ratios mechanically without saying what level is worrying or what action follows, so the answer never reaches the diagnostic expected of a directeur.
What to do instead
Drill a fixed five-ratio routine (CAF, marge brute, BFR en jours, endettement, délai fournisseurs) on anonymised hospital accounts and impose a three-sentence template per ratio: value, comparison to sector benchmark, managerial consequence. Time yourself so the arithmetic takes under ten minutes and the interpretation gets the remaining space.
Confusing the EPRD (état prévisionnel des recettes et des dépenses) with the EPRE and presenting the EPRD as a purely accounting document, omitting that it is a forecast budget subject to approval by the conseil de surveillance and to the regional ARS control, and that its vote triggers specific rules on the result and on carry-over.
The two acronyms differ by one letter and are often revised together, so candidates retain the name but not the object: one is the forecast budget of the establishment, the other the forecast state of revenue and expenditure used in a different context. The approval chain is rarely rehearsed.
What to do instead
Write, from memory, the full budget calendar of a hospital (preparation, consultation of the CTE and CSE, vote by the conseil de surveillance, transmission to the ARS, corrections, execution) with the instrument named at each step. Then answer three past questions on the budget in a row and check specifically whether the approval chain and the treatment of the result were present.
Answering an epidemiology question by describing the study design and then asserting a causal conclusion from an observational association, without distinguishing association from causation, confounding, or the limits of the measure of effect used.
Candidates learn designs and effect measures as definitions and reproduce them, but the exam asks them to interpret a result; the reflex of checking for confounding, selection bias and the appropriateness of the odds ratio versus risk ratio is not trained.
What to do instead
For each design (cohort, case-control, cross-sectional, trial), practise a fixed critique grid: population and sampling, exposure and outcome measurement, main biases, effect measure and its interpretation, and whether a causal claim is permissible. Apply it to one short abstract per session and write the conclusion sentence explicitly.
Confusing incidence and prevalence in a quantitative question, or computing a rate with the wrong denominator (using total population instead of person-time for incidence, or including prevalent cases in a cohort at baseline).
The two notions are defined in the same chapter and candidates remember the formulas loosely; under time pressure they pick whichever formula surfaces first, and the arithmetic then looks correct while the epidemiological meaning is wrong.
What to do instead
Memorise the two definitions with their denominators and practise ten short calculations alternating the two, each time writing the numerator and denominator in words before computing. Add a check: does the question ask about new cases over time (incidence) or all existing cases at a moment (prevalence)?
Treating the CPOM (contrat pluriannuel d'objectifs et de moyens) as a simple administrative formality, describing it as a funding agreement without identifying its role as the instrument of the regional health project, its negotiation with the ARS, its link to the projet d'établissement and the consequences of non-execution.
The CPOM is often reduced to a signature date in revision notes, so candidates cannot articulate how it binds the establishment's strategy to the regional priorities or how it interacts with the budget and the performance indicators.
What to do instead
Reconstruct the chain from the projet régional de santé to the CPOM to the projet d'établissement, naming at each link the document, the signatory and the deadline. Then take a real or past CPOM summary and write three paragraphs: what is contracted, how it is monitored, what happens if objectives are missed.
Answering a human resources question with general principles of labour law while ignoring the specific statutory framework of the hospital (statut général de la fonction publique hospitalière, corps and grades, positions of the agent, disciplinary procedure with its stages and guarantees), or applying private-sector rules to public agents.
Candidates revise the statut and the code du travail side by side and, in a case, apply the rule they remember best rather than the one that governs the agent concerned; contract agents and titulaires are treated as interchangeable.
What to do instead
Before answering any HR case, write one line identifying the agent's status (titulaire, contractuel, stagiaire) and the applicable text. Then rehearse the disciplinary procedure as an ordered sequence with the role of each body (conseil de discipline, commission paritaire) and the rights of the defence at each stage.
Producing a management answer that lists tools (SWOT, PESTEL, balanced scorecard, lean) without applying one to the case, or proposing a plan of action with no sequencing, no actors, no resources and no evaluation criteria.
Tool names are easy to memorise and give an impression of competence, so candidates name them instead of using them; the absence of a concrete action plan reflects a lack of practice in writing operational recommendations under time constraints.
What to do instead
Impose a fixed structure for every management answer: diagnosis with one named tool actually applied to the facts of the case, two or three prioritised objectives, actions with responsible actor and deadline, resources needed, and at least two evaluation indicators. Write it once per week on a past subject and check that every action names an actor and a date.
Writing a note or dissertation without the expected administrative form: no heading, no reference to the legal basis, no explicit and justified decision at the end, and a plan that does not answer the question asked (e.g. a catalogue of everything known about the topic).
The exercise is judged on its form as much as its content, but candidates prepare knowledge rather than the genre; they also misread the instruction (note de synthèse versus note d'aide à la décision versus dissertation) and produce the wrong deliverable.
What to do instead
Before writing, decode the instruction and state in one sentence the decision the reader must be able to take after reading. Impose a house style: heading, context, legal framework, analysis, options, recommended decision with justification, implementation. Practise full timed papers and have the form assessed separately from the content.