Quebec will reward efficient hospitals | The Press

To encourage hospitals in the province to manage their patients’ admissions and discharges more efficiently, Quebec has established a target length of hospital stay for a list of illnesses. Establishments that achieve these goals and improve the fluidity of their acute care will receive financial incentives of up to several million dollars per year for three years.

Ariane Lacoursiere
The Press

The objective of this approach, which was announced in 2019, but whose investments will begin to be paid this year, is to “reduce the length of stay in hospital”, we explain to the office of the Minister of Health. and Social Services, Christian Dubé. In all, $92.5 million per year will be distributed in this way until 2023-2024.

Each establishment will have to “optimize the processes for managing stays in each of their hospital facilities” and report to this effect, can we read in a letter sent Friday by the assistant deputy minister, the D^D Lucie Opatrny, and obtained by The Press.

A list of seven diagnoses is established, and length of stay targets are set for each of them and slightly adapted according to the reality of each hospital in the province. We speak, for example, of patients with chronic obstructive pulmonary disease (COPD), heart failure, myocardial infarction, schizophrenia or stroke. People undergoing knee or hip replacement are also targeted. By intervening on the length of the hospital stay for these patients, “we thus encourage the patient to be at the right time, in the right place,” explains Minister Dubé’s press attaché, Marjaurie Côté-Boileau.

At the Ministry of Health and Social Services (MSSS), it is added that the objective is that these patients do not occupy a hospital bed “when their state of health no longer requires it”.

The sums paid by Quebec “will be allocated according to the level of achievement of the clinical objectives” and will become recurring only when “90% and more of all the targets” will be achieved.

The sums paid to each establishment can be used to improve the care teams. Healthcare establishments are also invited to set up “cross-functional teams for the management and coordination of hospital stays” made up, among other things, of a medical emergency coordinator and a bed manager. This team will have to be able to use an “interactive hospital management dashboard” in order to “ensure a fluid, efficient and real-time decision-making process related to bed management”.

At the University of Montreal Hospital Center (CHUM), such a team has already been created. It is in fact a complete direction bearing the name of “Department of transversal coordination and alignment of structures”. “There is a doctor in charge and a clinical-administrative co-manager whose role is to adjust professional resources according to needs,” explains the CEO of the CHUM, Dr.^r Fabrice Brunett. “The goal is to ensure that bed management is fluid,” adds CHUM Deputy CEO Danielle Fleury.

A “welcome” measure

The MSSS initiative is well received in the hospital network, which is just recovering from the last wave of the pandemic. Because if fewer and fewer patients with COVID-19 are currently hospitalized, surgeries are resuming, “the hospitals are still full and the emergency rooms are still overflowing”, notes the president of the Association des médecins d’urgence du Québec , the D^D Judy Morris.

She notes that there is “a lot of inefficiency within hospitals” and that this incentive for hospitals to increase their performance is “welcome”.

This opinion is shared by the president of the Association of specialists in emergency medicine of Quebec (ASMUQ), Dr.^r Gilbert Boucher, who believes that the financial incentives could well bear fruit.

For the D^D Morris, it is known that Quebec “lacks hospital beds”. “But if we just add more without reviewing our ways of doing things, we’ll just continue to be inefficient,” she says.

The D^r Brunet also welcomes the government’s approach. He assures that there is a way to achieve these objectives without compromising on quality. “The approach should be about quality, not just about speed,” he says. […] We don’t want any incentive to lead to a deterioration in care. This is why the management responsible for fluidity at the CHUM will also monitor the quality of care.

The D^r Boucher says for his part that he is hopeful that the safety of care will not suffer from this new approach. “For any new approach in the health sector, there is always a great emphasis on patient safety. The numbers are important, but patient safety always comes first,” he says.