“The pillars of the temple will tremble. These terms, recently used by Christian Dubé, clearly reflect the impact that Health Quebec and the new law will have on healthcare efficiency.
Posted at 5:00 am
The law will hit very hard, according to information I have received from various reliable sources in the Legault government. Among other things, Quebec will pool union seniority across Quebec employees, force medical specialists to practice in the regions, end regional boards of directors, and appoint chief executives at all major facilities.
Specifically, the bill creating Santé Québec will be tabled on Wednesday or Thursday. This central organization to manage the network will have its president, human resources, technology and other vice presidents, and a board like Hydro-Québec.
Once in place, the 34 directors-general of the regional centers – the CISSSs and the CIUSSSs – will report directly to Santé Québec and no longer to the local governing councils or to the deputy minister responsible for the Ministère de la Santé et des Social Services1 .
From 136 to 4 trading tables
As a result, the network’s 375,000 employees ultimately have a single employer, Santé Québec, rather than the 34 local employers. Eventually, this centralization will bring together local collective agreements, whose administration has become a shambles, with their specificities.
Instead of the current 136 negotiating tables with the trade unions, the law will reduce them to just 4 national negotiating tables. This reform will greatly simplify the next negotiations (which will follow the ongoing negotiations) and the organization of work is expected by the government.
By reporting to a single employer, employees’ seniority is recognized across the network and not just in their CISSS or CIUSSS. For example, an experienced nurse from Laval or Gaspé could be hired in Montérégie or elsewhere without losing her tenure and seniority, which is not currently the case.
The goal isn’t to force employees to change regions, but to make the network more efficient by improving mobility, I’m told.
Last October, columnist Patrick Lagacé reported on the pathetic case of a young girl with a rare syndrome who became the victim of union rules. With the move from Ahuntsic to Laval, 8 km away, the little girl came within a hair’s breadth of losing her extremely dedicated nurse, who lost her union cards moving from one CISSS to another23. The law will have the effect of correcting these types of problems.
PHOTO ROBERT SKINNER, LA PRESSE ARCHIVE
“Currently, a nurse with a bachelor’s degree earns a starting hourly salary just $1 more than a nurse with a DEC from CEGEP,” states our columnist.
The new law will complement other measures wanted by the government, such as: B. Salaries, which vary significantly for nurses depending on the region of work, training or hours worked.
The introduction of these differentiated wages is one of the government’s demands in the ongoing negotiations, but the majority of the unions reject this, judging that everyone should be treated fundamentally equally.
Currently, a nurse with a bachelor’s degree earns a starting hourly salary just $1 more than a nurse with a DEC from CEGEP. Additionally, current public premiums do not greatly encourage night or regional work, which would partially explain why private agencies have been able to hire so many nurses who rely on this type of premium.
The new law is also part of Quebec’s desire to prioritize competency over seniority for certain key positions, a highly contentious issue. The government wants 10-15% of the jobs in the network to be filled on a skill first basis, one of my sources tells me.
This element must be supported by the unions in the ongoing negotiations, but the eventual sharing of union profits across Quebec, which the law will allow, would lead to a better alignment of positions.
In April 2021, in one of my four columns entitled “La Maison des fous”, I reported on the case of a clinic that had suffered greatly under this strict seniority rule when filling its day care worker.
Neither merit nor technical ability could be considered, only seniority of the local union took precedence. This requirement forced the hiring of nurses who were overwhelmed by the function, which in turn led to their termination, disrupting the operations of the clinic and patients for several months4.
In another column, a doctor claimed union rules prevented her from having a competent secretary. “We must confront the union and leaders are afraid to confront the unions. We help the incompetent stay in place,” she said.
Requirements for medical specialists
Another thunderbolt: the law obliges specialists to a population responsibility, which forces them to practice in certain neighborhoods and certain regions, as is the case with general practitioners.
PHOTO MARTIN CHAMBERLAND, ARCHIVE LA PRESSE
“The law obliges medical specialists to have a population-based responsibility that forces them to practice like general practitioners in certain neighborhoods and certain regions,” reports our columnist.
According to my information, the government wants doctors to take on more responsibility, in parallel with the law, in order to improve the efficiency of the network. For example, specialists are currently no longer required to be present in the emergency room after 4:00 p.m., which is helping to increase patient waiting times.
The ministry believes that the non-compulsory practice in the regions for specialists is one of the reasons that explains the popularity of specialist medicine among young people at the expense of general medicine, a phenomenon that the law could stem.
Local Boards of Directors
In addition, the law will put an end to the local governing bodies of CISSSs and CIUSSSs as we know them. The role of these municipal councils is being redefined. Prime Minister François Legault mentioned this three weeks ago in an interview with La Presse, where he spoke of tapping into his “reserve of courage”5.
From what I have learned, these “facility councils” will consist of their respective CIUSSS executives, as well as people from the community and patients. Whether they will only have an advisory role or some decision-making power is currently not foreseeable. According to one source, they would have to give the population some kind of annual account of the functioning of their CUSSS.
On the other hand, for local management, Quebec will appoint a responsible general manager in June 2022 in each large facility (hospital and others), as proposed in the Savoie report. This type of appointment was made for CHSLDs during the spring 2020 pandemic wave.
For example, the Maisonneuve-Rosemont Hospital and the Santa Cabrini Hospital currently have only one general manager. After the changes, everyone will have their own boss in charge, I’m told.
Around 80 managers are to fill these positions. In the end, the Legault government under Christian Dubé will have appointed 400 executives, a difference of around 900 to the roughly 1,300 ousted executives under Gaétan Barrette.
In another of my columns on ‘La Maison des fous’, a former chairman of a CIUSSS denounced the nests of corporatism in these bodies, where everyone defends their territory. According to him, the current boards of directors are an award without real powers, since the evaluation of the CEO of the CUSSS is, among other things, the prerogative of the minister. “Quality managers are paralyzed in an indescribable bureaucracy,” he wrote to me6.
Similar story from another former CISSS President in this column. “Bureaucracy stifles initiative and creativity. If the health network were a private company, it would have been bankrupt long ago. »
The full impact of the new law will take a few years, probably after the next contract renewal in three or four years. This delay should allow the parties to gradually assimilate the changes.
The law will therefore attack the “union straightjacket” in the health sector, I am told, and there will no doubt be strong criticism. Disputes are likely to be initiated by unions – both nurses and doctors – particularly around the sacred cow of seniority and competence.
One has to wonder whether this centralization of some of the network’s governance will reduce or increase bureaucracy. Will the new councilors’ complaints be heard?
Be that as it may, the Legault government appears determined to move forward once the compromises are incorporated into its bill and make the network more efficient. He believes that given his strong popular support in the last election, he has a unique opportunity to make this important cultural shift early in his tenure.
1. Currently, the 34 CEOs report de facto to Deputy Minister Dominique Savoie, who also reports to 14 Deputy Ministers, at a level considered unbearable. Taking the day-to-day management of the network out of the hands of the Ministry of Health was particularly recommended as early as 2001 by Michel Clair’s report, according to which the Ministry should rather focus on strategic orientations and performance assessments. The June 2022 Savoie Report came to similar conclusions.