While waiting for the advent of the “light at the end of the tunnel”, dear to Mr. Legault, other lights should hold his attention. These lights are present in Quebec hospital services and should guide the “refoundation” of the promised care system.
For several years, the centralization of management has guided reforms in the healthcare system. After the regional health agencies, abolished in 2014, the integrated centres, the CISSSs and the CIUSSSs, were born. The centralization of management has taken decisions away from the reality on the ground, or rather the land. We were able to see the tragic effects in CHSLDs at the start of the pandemic. The lack of local management in other health facilities has more insidious, but equally disastrous consequences.
Decentralization should preside over the “refoundation” of the healthcare system. Initiatives have been undertaken in certain hospitals, the Jewish General Hospital or the Baie-Saint-Paul Hospital, for example. Proximity management and attentiveness to staff have led to a significant reduction in the need for compulsory overtime, the use of nurses from private agencies and absenteeism. An increase in caregiver satisfaction resulted. The value of work goes not only through remuneration, but also — and sometimes above all — through an improvement in working conditions. Inspirational lights twinkle.
Local management would also make it possible to lighten the centralized management structures, represented by the enormous Ministry of Health and Social Services, the CISSSs and the CIUSSSs.
It will take courage for the minister to prune these costly organizations, but without it, the health budget will continue to grow unsustainably without improving the delivery of care.
Once decentralization is in place, the Minister can assess the advisability of paying GPs according to the number of registered patients (“capitation”), expanding the role of care professionals other than doctors, increasing the number of beds.
Our healthcare system is seriously ill. It is impossible to solve all the problems at the same time. The minister should set the priorities, as an emergency physician would do in front of a patient suffering from multiple traumas.