A minister in the red

On his dashboard, Christian Dubé sees a lot of red, and that’s not a metaphor.

The Minister of Health has created a table to monitor the network and what he sees must worry him.

Dozens of indicators relate to emergencies, primary care, human resources, surgical procedures and hospital activities. Among them, there are positive aspects, such as the new frontline access counter. But on the whole, the portrait is not encouraging. Red (retreat) is more present than green (improvement).

A few examples: increase in the wait since the fall for an operation, increase in the waiting time for triage care, increase in the average length of outpatient stay, decrease in employees in the network since last winter and increase in use of private employment agencies since 2021.

For the moment, Mr. Dubé enjoys a strong capital of sympathy. According to a Léger poll published in December, 59% of Quebecers have a good opinion of him, against only 20% who see him unfavorably. This is the best ratio of all elected officials.

Last May, the minister tabled a plan that incorporates the major consensus established by the experts. The caquistes repeat that Quebecers would be “lucky” to have him as minister, but if we question the patients who wait in the emergency room and the caregivers on the verge of exhaustion, the word “thank you” is perhaps not the first that comes to mind.

In his reform, Mr. Dubé proposes to restore “accountability” in the health care system. He wants to decentralize the network, in particular by creating a Health Agency. The Minister would provide the guidelines to the CEOs of the institutions, who would then be responsible for applying them. They would be incentivized to become more effective through results-based funding and data that drives best practices.

So much for the theory.

Mr. Dubé does not want to spend his time putting out fires, and that is understandable. When emergencies overflow like those of Maisonneuve-Rosemont, local managers must also be held accountable. The abolition of middle management positions has not helped either – since then, decisions are taken further from the floor, by people who sometimes do not even know the caregivers whom they force to do “compulsory overtime”.

The fact remains that if the wait continues in the emergency room, if access to a family doctor remains difficult, if the labor shortages do not disappear, the minister must also explain himself. Because it is by this overall portrait that one will evaluate his work.

His plan is still young. Mr. Dubé gives himself the “horizon” of 2025 for the changes to materialize overall. But he does not control the patience of Quebecers, which could be shorter than expected.

At Maisonneuve-Rosemont Hospital, the rubber band has already broken.

This establishment receives a large volume of patients compared to its capacity and it cannot close. A manager was also challenged there – she was reassigned elsewhere. And the union and management failed to agree on the self-management of their schedules.

Even if the case is special, the crises in Jonquière, in the West Island and elsewhere show that there are many exceptions. And even if the nursing staff renegotiates their collective agreement, this is not enough to explain the sit in exhausted nurses.

We reread Mr. Dubé’s plan and wonder what he will succeed in changing.

For example, how far will he go with private agencies? The Minister is open to legislating – we guess that he will reduce their employment without prohibiting it, in an approach adapted to the needs of the regions.

There are also patient-to-nurse ratios. On the one hand, it is useless to tighten the ratios if it is understaffed. On the other hand, without these ratios, nurses will shun advertised positions. Like the self-management of schedules, this will have to be settled in collective agreements, by taking out the checkbook.

Finally, will Mr. Dubé make sure to properly measure the mandatory overtime to include episodes where financial pressure is put on a nurse to agree to extend her day?

The longer the response is delayed, the more trust in Mr. Dubé will be likened to an act of faith.

In October, the Federation of Medical Specialists sounded the alarm. “In 30 years of practice, I have never seen the network in such bad shape”, declared then its president, Dr.^r Vincent Olive. More than 30 presidents of affiliated medical associations supported his exit.

The crisis existed before Mr. Dubé. He did not create it, nor will he fix it in a few months. But the danger for him is that this realism ends up resembling a little too much the usual fatalism.

Because if the situation exceeds him to this point, why would he do better than the others? The color will have to change on its dashboard.