It was on April 29 that the Minister of Health Christian Dubé named with great fanfare the two leaders of what will be Santé Québec. Geneviève Biron will be the “ top gun » of the new state-owned company, while Frédéric Abergel will be executive vice-president of operations and transformation. At best, a herculean task awaits them; at worst, they will have to try to accomplish the impossible.
In addition to what has already been formulated publicly in the form of comments and criticisms, I wanted to highlight other elements which appear to me to be just as important.
The political communication error
While politics in the 20th centurye century has essentially become a communication exercise, it is clear that Minister Dubé was very poorly advised here. The use of the popular aphorism “ top gun » turns out to be rather counterproductive. First, in Quebec, we are very little focused on top guns. These are assimilated to big shots which are, in the eyes of the majority, suspicious and therefore apprehended with suspicion. A historical residue no doubt from the relationship we had with “the English”. Furthermore, what type of message are we sending to other executives at all levels of the network?
Decentralization?
The main goal of the creation of Santé Québec through Bill 15, the minister tells us, is to undertake a decentralization process. However, it is rather a deconcentration that we are witnessing. Clearly, instead of concentrating powers in high places, in the person of the minister, we want to proceed here with a separation of these same powers into two authorities which remain very precisely… in high places.
Rather than decentralizing towards the base, we are creating a new center where powers will be concentrated in parallel with the first.
If it is difficult to qualify this approach, or even to understand it, we can nevertheless agree that for decentralization, we will have to reconsider. This is an astonishing paradox since the minister himself recognizes the need for decentralization. So why not take inspiration from the best? In fact, the Scandinavian health system, the best in the world, is decentralized and democratized since it is managed by the equivalent of the municipal order. There, we trust local authorities and, perhaps above all, the communities that run them to manage the health of the population, and the national Ministry of Health takes care of… the major health guidelines.
The crisis of staff shortages in our network, particularly in the regions, is a flamboyant example of this. Who would be best equipped to handle this kind of crisis? One or a top gun, manager of an entire province, or elected officials from the community? Will we one day have the courage to trust local communities?
The prince of excellent political tactics
Nicolas Machiavelli would be very happy to see that the minister applies one of his favorite tactics: the installation of an underling disguised as a lieutenant. This political tactic consists of manipulating and strategically using subordinates to achieve specific political, or even personal, objectives (getting re-elected, among others), while avoiding having to assume the consequences of the policies implemented.
Indeed, by delegating unpopular tasks, by creating a potential scapegoat, by creating confusion through division and by reserving the role of distributing praise and/or strategic sanctions, the minister will avoid uncomfortable postures, will be able to take credit for the glory delivered by the subcontractor or even play the hero by dismissing a lieutenant who has become troublesome when the time comes. Faced with a crisis of unpopularity or a declining capital of sympathy, he will present himself, have no doubt, in a new light to the electorate by blaming the top guns from yesterday.
It appears that in the short or medium term, the political benefits, if they materialize, will go to the minister, and the inevitable blame… to Santé Québec! Although the maneuver is very clever, the improvement of services to citizens may well wait until the next reform.
With health spending approaching 60 billion and our health system facing the most serious danger in its history, we need to put in place truly courageous measures and abandon political siren songs. Santé Québec will collectively cost us tens, if not hundreds of millions; we hope that the maneuver will not be reduced to vain spitting thrown into the sea foam.