This is obviously the subject of the Dubé reform which will dominate the news of the health sector in 2024. At the beginning of 2022, the Minister of Health announced that the reform then in preparation would aim to “rebuild health” and more precisely to rebuild the network by implementing recommendations that had already been formulated in various previous reports. As he himself said, he actually saw the reform as a simple recipe whose basic elements had already been proposed and, by choosing the right ingredients, it was now a matter of properly preparing the dough to make it rise as any good cook can do it. Recipe, ingredients, cook were the key images of the success of this future reform.
The reform bill was made public in March 2023. It was, from the start, the subject of several analyzes specifically questioning the merits of the creation of a new Santé Québec agency which would replace the current organization of the system. The law was approved despite criticism and we are now at the implementation stage. Will it be a success or a failure?
It is obvious that the problems with the current health system are enormous. They are the result of significant management errors and underfunding that have been made by different governments over the past 25 years and which have been highlighted by the aging of the population, by the COVID-19 pandemic and recently by the negotiations not yet resolved for the renewal of collective agreements with employees in the health sector. There is no doubt that the system must be improved, but Minister Christian Dubé unfortunately did not clearly explain how the creation of the Santé Québec agency was justified and necessary compared to other solutions.
Rather than presenting a description and assessment of the current situation, the Minister of Health preferred to proceed in the manner of a marketing influencer, using strong images whose aim was to direct public opinion in a direction. who valued the ideas he put forward. After saying that he wanted to overhaul the system, he warned that he wanted to “shake” the columns of the temple in order to change its components and its functioning. It was a warning to let people know that nothing was safe from his reform.
Culture change
The minister now repeats that his goal is to achieve a profound change in culture, which is not easy to define in an environment where professional action falls within the competence of doctors, who work with the support of health services. increasingly sophisticated treatments and with the collaboration and essential support of nursing staff. He seems to see this change in culture primarily as a management issue arising from the establishment of the agency which will be a multi-level structure, both centralized on the organizational level, but decentralized on the operational level.
Knowing that culture change could take five to ten years to take hold, we cannot help but conclude that this reform appears risky. By proposing such a comprehensive and long-term reform, it is difficult, if not impossible, to predict the extent of its effects and consequences. The biggest risk that could appear would be to see the development of an increasingly extensive private system of parallel care to respond to unsatisfied demand from the population, in the face of a public offer which, for its part, would feel frustrated given the constraints within which it must operate. We will gradually arrive at a multi-speed care system as is the case in education.
Big projects and big management changes in the public sector are never easy to achieve, because the government that starts them is usually not the one that finishes them. Not only are operational and technical questions subject to reassessment along the way, but the political-social perspectives from the beginning also change. Needs are no longer perceived in the same way and the support of the population begins to crumble if this support existed in the first place.
Review The Economist suggests in its December 9 edition a book by Greg Berman and Aubrey Fox: Gradual: The Case for Incremental Change in a Radical Age. The authors analyze changes that governments have made in the United States and the difficulties they encountered. They strongly suggest proceeding in stages rather than trying to do everything at once.
The year 2023 therefore ends in a sort of confusion for the health sector in Quebec. While all the other unions have agreed on proposals to settle their labor agreements with the government, the FIQ has not succeeded in doing so for the health sector. This conflict will have to be resolved, but the employees seem determined to have their requests respected, which they consider to be critical for the proper functioning of the system.
When this step is finally reached, attention will focus on the implementation of the reform, starting with the creation of the Santé Québec agency under financial conditions which will be difficult for the entire public sector, and for many years. Wish you good luck and lots of patience. And welcome to top guns that the minister promised to hire to organize all this. For vulnerable people, it is a period of uncertainty and sometimes even anxiety that continues.