For several weeks, the restoration of post-COVID activities in the health network has been in full swing. As a result, waiting lists are not shrinking; they are accentuated. It is difficult for me to affirm here the fact that patients wait unduly to begin their chemotherapy treatment, beyond the notions of urgency and medically required criteria. But that was to be expected, since the health network can no longer adapt, because it is torn apart and lacks the power to develop innovative resources.
Posted at 2:00 p.m.
But the signs were there. Small-scale management never made it possible to establish plans to increase the number of patients undergoing chemotherapy treatment. The number of treatment chairs is insufficient, the staff to prepare and administer the chemotherapy is lacking, the hours of availability are too limited. All this while we are talking based on data available before the pandemic. It is easy to describe the complexity of the situation after two years of neglect.
Hospitals: the problem?
Many criticize hospital-centrism as the cause of the ills that afflict health in Quebec. In their opinion, everything would be too hospital-based. I do not opine in this direction. Hospitals, which are in fact not numerous enough and which do not have enough beds and resources (the pandemic has shown this to us), are the essence of our network. And they are not the cause of deficiencies in pre-hospital and post-hospital care, of the lack of availability and coordination of the first line. In addition, it would be necessary a priori to agree to restrict the term hospital center to places of acute care, excluding residential beds, which do not contribute to the service of this care.
But is there a lack of supervision to optimize the work of hospitals? Absoutely. The doubling of resources for certain specialized care is counterproductive.
The fragmentation of expertise prevents the provision of competent, state-of-the-art diagnostic and care services. The excessive search for local care probably harms quality. The absence of data on the care given and its results prevents the creation of plans aimed at optimizing the services and their quantity. And let’s say it, the mode of remuneration, doctors like other professionals (pharmacists, nurses, physiotherapists, psychologists, etc.), is probably unsuited to certain types of care which should not be exclusively focused on productivity, but of course relevance. On the other hand, this explosive debate must be integrated into the review of the care offered to the population more generally. This point alone cannot be invoked as the cause of all wrongs.
Private: the solution?
Some express that the private is the saving way. Allow me to express reservations. Admittedly, the development of resources in the private sector is significantly faster than in the public sector. But is this care more integrated, better, adapted to needs? We do not know anything. Again, for lack of performance indicators. I’m not saying that it’s not a valve allowing a rapid increase in the amount of care to be offered to Quebecers who are waiting unduly, but let’s remember that surgery clinics, often publicized, represent only the tip of the iceberg. necessities.
I mention chemotherapy in the introduction, but this is also the case for diagnostic measures (specialized laboratories, radiology, scopies, etc.) and therapeutic measures (intravenous treatments, transfusions, rehabilitation, radiotherapy, etc.). Let us specify that the data generated in these places of care should become accessible after the episode of care, which is already difficult to do in public places with a minimal and inefficient Québec Health Record.
head of the hydra
With an already sprawling network, and before changing everything or adding additional arms such as private clinics, shouldn’t we hear leaders show a little introspection? If the network has been underperforming for so long, could it be because of its management? In essence, health professionals in Quebec have recognized training and skills.
As for it, does the Ministère de la Santé et des Services sociaux (MSSS) have the elements to formally direct the network or is it only submitting pious wishes to the actors of the network who are doing what they can with the tools available? The observation is not intended to be specific with respect to the team in place, but to a longitudinal evaluation of the actions of the MSSS for more than 30 years of reforms.
Prime Minister François Legault has always been quick to ostracize doctors and facility managers, afflicting them with oddities in the health system.
He is less quick to denounce the actions of Minister Danielle McCann and her team, which have nevertheless been the subject of various reports and whose shortcomings have been pointed out in the reports of Coroner Kamel and the Ombudsperson, particularly in the file specific to CHSLDs.
I therefore submit that the overhaul of the health network must first and foremost target its ability to lead, to get involved without political control, to propose and apply a master and integrating plan. John Maxwell, an American pastor who took a particular interest in issues of governance, wrote: “A good leader is a person who takes a little more than his share of the blame and a little less than his share of the honor. Mr. Dubé’s action will be more credible if he honestly and sincerely admits the wrongdoings of the MSSS leaders before proposing a resolution of the problems only by denying the contribution of people who invest by vocation in the health of Quebecers for a lifetime.
The novelty by this reform, either. However, let us affirm once and for all that it must also be exercised at the head, by installing a strong, independent, creative, competent, stable direction. Only then will Quebecers accept the proposed changes, whether they include private input or not, whether they are imposed with a health emergency criterion or not. In the meantime, I would like to be advised when patients awaiting chemotherapy will be able to receive competent care in a timely manner…