Will the Dubé reform of the healthcare system trigger World War III, from Gaspé to Aylmer?1 We’ll see.
Posted at 6:00 am
But before hostilities begin, it would be necessary to agree on certain things.
First, the network is sick. Patients are fed up with waiting and employees get sick at work.
Then numerous independent reports (Clair, Castonguay, Savoie) were published and no one believed that pouring the fire with billions was the solution.
After all, our healthcare mammoth is staggeringly complex, with a budget in excess of $50 billion and nearly 300,000 employees. To say that one proposal won’t solve everything is both obvious and outrageous. Any small win would be better than nothing.
Unfortunately, the National Assembly seems to have declared war on nuance. The new Godwin2 point in Quebec politics was quickly reached – comparison with Gaétan Barrette, aka the contemporary incarnation of evil.
However, experts have been repeating the same observations for years. The Ministry of Health needs to focus more on guidance and delegate tasks to local managers, access to frontline care needs to be strengthened, work organization needs to be reviewed, professions should be decoupled and care can no longer be thought of solely with a medical and hospital-centric vision .
Health Minister Christian Dubé is trying to do this with his reform. I stress the verb “try”. Because his huge bill – 308 pages and 1180 articles – raises a multitude of questions.
It’s the starting point, not the finish line. Laws and regulations are not enough to change a culture. It all depends on how you use them.
Was there still a need for reform? The network has been destabilized by the recurring mixing of structures. But if previous attempts have failed, it is partly because they have involved budget cuts or have been implemented too quickly. These pitfalls are avoidable.
The Health and Welfare Commissioner (CSBE) recently analyzed reforms in other parts of Canada. It shows that there is no “good” model. Better be careful with simplistic labels. For example, one can decentralize some activities and centralize others.
Regardless of the model, however, any reform must be built on a solid foundation: reliable and transparent data. Otherwise, the Ministry will not know if its instructions are being followed and local decision-makers will not be held accountable.
This is a primary concern of the Dubé reform. It is true that last fall he introduced a bill to make data easier to access and he created a dashboard. Except that right now we’re measuring volume of care more than patient health outcomes.
A second concern concerns the cooperation of the employees.
The unions are on the defensive. It is both a problem and a manifestation of a problem, that of corporatism.
A good example: The medical association, which has the task of defending its members, is critical, the medical association, which represents the public, is rather positive. Same contrast between the union of nurses and their professional code.
For years we have been promoting hospitals in which nursing staff share unpopular working hours. This would reduce exhaustion leave. However, as this model depends on local collective bargaining, the government cannot generalize it. Another injustice: A professional who moves faces the risk of losing their seniority. For this reason, Quebec wants to reduce the number of union certifications and centralize negotiations.
As for doctors, being self-employed, they manage their own schedules. The vast majority dedicates their hearts and souls to their patients. But a small number can make volume in the clinic with mild cases. According to their professional code, it is normal to demand that the organization of work better suits the needs.
In theory, this equitable distribution would be fairer for caregivers and more efficient for patients. But it all depends on how. For example, general practitioners are already being forced to go to the regions, and the medical association has ruled that this is not working.
You have to negotiate.
It is tempting for the CAQ government to stand up to doctors and unions. But the headquarters are not disinterested either. Quebec reduces union certifications to four. That is less than the current number of unions. During the next raid, at least one headquarters can lose members and a lot of money.
The election of the President of the Quebec Health Authority will be crucial.
The Ministry of Health was never able to develop expertise in planning. The deputy minister has to manage 14 deputy ministers and about 30 directors of institutions, and her deputy deputy ministers are overwhelmed. Involuntarily they are in reaction mode.
Mr. Dubé wants to appoint a “top gun” from the private sector to head the agency. However, health is not a snowmobile factory. If the boss sees patients as screws that need tightening, things might not go well.
Without any illusions, Mr Dubé dreams that his bill will be passed before the summer. Patience would taste better. By studying this huge calculation, we were able to discover pitfalls. And most importantly, it’s just a canvas. The key will be how to apply it.
Mr. Dubé promised that the pillars of the temple would “tremble”. To quote the Peregrine Falcon, if the goal was to get everyone together, that statement wasn’t very “sick”…
It’s time to cut down on the decibels and find a way to better distribute tasks and clarify roles. Because at least one observation should be unanimous: We can do better.
1 I refer, of course, to this shocking statement by Gaétan Barrette.
2 After this half-serious, half-funny sentence, the more a discussion slips, the more likely it is that it will lead to an analogy with the Nazis.