Health network | Advance, mammoth, advance!

As much to tell you right away, this editorial will test your resilience. We are going to talk about structures and decentralization in the Quebec health network, in the wake of the report on governance by the Deputy Minister, Dominique Savoie.

See? Some of you have already rolled your eyes.

Rest assured. It’s perfectly normal. Among other things, because the last time a Minister of Health proposed governance reform was Gaétan Barrette, in 2015.

The perverse effects of his reform overshadowed everything else. We especially keep a bitter taste, which goes hand in hand with the headaches that it still causes.

It is among other things to repair the broken pots that it is important to look again at governance and structures and to welcome the report made public on this subject on Wednesday.

It was the Minister of Health and Social Services, Christian Dubé, who had called for such a diagnosis and he approved the recommendations offered. We should rejoice.

Note that even Gaétan Barrette had made a mea culpa last year, announcing his withdrawal from political life. He admitted to having “definitely cut too many middle and senior managers”.

The pandemic will unfortunately have made it possible to confirm how much some of its decisions have hurt the network.

On reading Dominique Savoie’s document, we quickly see that the idea is not to reinvent the wheel. It is not a question of making a “revolution”, it is specified. We prefer to speak of the “natural evolution of the network”.

The report is therefore in line with that published by the Commissioner for Health and Welfare of Quebec, Joanne Castonguay, last January. She too pleaded for a transformation of governance.

This desired change in the organization of work is so unavoidable that Quebec did not wait for these reports to begin to act. Let us remember that the health crisis forced Mr. Dubé to urgently appoint a responsible manager within each CHSLD.

It is this kind of adjustment “towards more local governance” that the report advocates above all. A decentralization which will promote local management and which will require the hiring of a few hundred more executives.

As the minister pointed out on Wednesday at a press conference, it is not normal that there is not currently, within each hospital, a manager whom the various health professionals can call on in the event of a problem.

This is one example among others of the dysfunctions of the network in terms of work organization that seem to irritate Christian Dubé. He himself is an experienced manager. And he seems determined to change things.

Dominique Savoie’s report also calls for an urgent redefinition of the roles between the Ministry and the network. We are outright advocating the creation of a new body. The idea remains vague, but it will be necessary to find (finally) ways to improve the coordination between the various actors and to distinguish for good the strategies (which fall under the Ministry) from the operations (which should essentially belong to the network).

You may be wondering how all of this impacts your life?

If the last decade has taught us one thing in Quebec, it is to what extent governance and structural changes have a major impact on the quality and accessibility of care.

And on the labor shortage, too, recalls the report. If we bring decision-making closer to network employees and make their managers more accessible, we “will promote better support for the teams, an important factor in loyalty, in addition to better supervising and coordinating the delivery of services offered to the population on the territory “.

All these reforms still need to be implemented successfully.

It is healthy to be skeptical. However, let’s leave the cynicism in the locker room, it will not be useful to anyone.

Let’s hope instead that the — credible — plan for refounding the system piloted by Minister Dubé, which is consolidated by this new report, will finally put the health mammoth back on its feet and move it in the right direction.