In his speech delivered last week in Montreal, the Minister of Health and Social Services, Christian Dubé, promised that his bill on the efficiency of the health network, which he intends to present early this spring, will “shake” the columns of the temple. This bill will not be limited to the creation of Santé Québec, an agency that redefines the role of the department and the minister by taking them away from the realm of the cows.
While his colleague, the Minister for the French Language, Jean-François Roberge, was launching an advertisement in Franglais in which it is about an endangered species, the peregrine falcon, Christian Dubé came to support, in a way, quite involuntarily , one can believe, the ironic message of the government.
In front of the participants in this forum placed under the theme of innovation, Christian Dubé affirmed that his Health Plan, launched last year, “is going to ask a lot, but from everyone”, whether it is from the unions – from this On that side, a certain resistance, especially among the burnt-out nurses represented by the Fédération interprofessionnelle de la santé du Québec (FIQ), has manifested itself – to doctors or managers.
Already, in 2008, Claude Castonguay recommended the creation of such an agency. According to him, the ministry was too involved in the micromanagement of the network, decisions were top-down, cost control was short-sighted, and the missions of the establishments were poorly defined, as Deputy Minister Dominique Savoie reminds us. in its June 2022 report on the changes to be made to the health network.
The daughter of the former minister and current Health and Welfare Commissioner, Joanne Castonguay, agreed with her father in her 2022 report. The mission of the department must focus on defining the objectives and strategic orientations, performance evaluation and monitoring of results.
But this agency, which establishes a greater distance between the politician – the minister – and the day-to-day management of the network, cannot be a panacea. As Christian Dubé also recognizes, other pieces of the puzzle — this is the image used in the Health Plan — will have to be added. And even if the agency provides the Minister with a form of buffer zone, his responsibility will not fail to be invoked in the event of failures or if the promised improvements are not, once again, at the rendezvous. As pointed out in Duty former CEO of the Montreal Health and Social Services Agency David Levine, health is a “very political” and “highly publicized” area. The minister will not be able to take refuge behind this structure if the mess in an establishment makes the headlines.
In this sense, the computer fiasco at the Société d’assurance automobile du Québec (SAAQ) is an eloquent case in point. Even though it is an independent government corporation, with its own board of directors, the Minister of Transport, Geneviève Guilbault, to whom the SAAQ reports, had to lend a hand while her colleague Éric Caire was doing his Pontius Pilate. It was not very successful for the Minister of Cybersecurity and Digital.
Clearly defining the respective missions of the ministry and the network is certainly important. But restoring “local management”, to use the minister’s expression, is just as important. This floor of local managers had been removed by former minister Gaétan Barrette. An error, the latter maintains today, caused by the unjustified cuts imposed by the Treasury Board. Equally crucial is the digital transformation of the network, including the computerized patient record and the development of timely management information.
Innovation seems to be the end word. In the case of another election promise of the CAQ, the project to open two private mini-hospitals, one in Montreal, the other in Quebec, is indeed an experiment. The government has requested notices of interest before launching the calls for tenders, waiting for the promoters to propose their formulas. While there is no doubt that medical specialists will flock to these establishments, which are both superclinics and high-volume surgery centers, one wonders where their nurses will come from, if not from the public network.
Thus, Christian Dubé wants to shake the columns of the temple. The expression refers to the tragic fate of the biblical character Samson. Even though the traitor Dalila cut his hair, depriving him of his phenomenal strength, the man managed to bring down the columns of the building, which however collapsed on top of him. Not sure that this metaphor is the most appropriate to inspire the Minister. Be that as it may, a year after the launch of its reform, the results of the Health Plan are modest — “small victories,” says the minister — and the bulk of the work remains to be done.
