Mission impossible for the top gun at Santé Québec?

Who will be the top gun of Santé Québec?

This spring we should know the name of the first CEO of Santé Québec, this new government agency which will manage the mammoth that is our health system. The call for applications will begin next week.

In memory, we cannot recall a government appointment where the person chosen would have so much pressure.

The expression top guninspired by the film Top Gun with Tom Cruise and which here refers to a haloed manager of the private sector, stuck in public opinion.

Result: this top gun, who will earn at least $540,000 per year, as revealed by Radio-Canada (an amply justified salary, moreover), will appear to arrive as a savior for our very damaged health system. The emergency room occupancy rate (134.9%) has never been higher in five years1. One wonders if the top gun will not inherit a mission impossible, to borrow the title of another successful Tom Cruise film franchise.

Because I am wary of the myth of the savior CEO.

Generally speaking, in the business world, the importance of CEOs is often exaggerated. Let me be clear: a competent, valued and effective CEO is essential for any organization. Its values ​​percolate within its organization. His good and bad decisions have concrete consequences.

But we tend to glorify his role a little. If Apple survived the death of the most important CEO of its time, Steve Jobs, we can conclude that no CEO is indispensable…

Let’s take the most scrutinized manager in Quebec: the Canadiens’ coach, Martin St-Louis.

The coach certainly plays an important role in the success of a hockey team. An incompetent coach or one at war with his locker room will not obtain good results. But his influence on the team’s results is not infinite. If CH replaced Martin St-Louis (a good coach) with Jon Cooper or Jim Montgomery, the two best coaches on the Bettman circuit, the team would still be far from making the playoffs…

Like Martin St-Louis, who inherited one of the worst teams in the NHL, the top gun of Santé Québec will inherit one of the least efficient health systems in the world for access to a doctor. Even though it is one of the best funded systems2.

In these circumstances, no one can work miracles in the short term. Especially since the top gun will often have his hands tied.

It is not he who will determine the number of doctors trained, their remuneration and the incentives for them to see more patients. It’s the government of Quebec.

He will not be the one to decide on financing. It’s the government of Quebec (and the federal government).

It is not he who will decide on the main directions of the network, the place to be given to home care and preventive medicine. It’s the government of Quebec.

On the threshold of its sixth year in power, the Coalition Avenir Québec has high hopes for this administrative reform which will further centralize the health system. The CEOs of the 34 CISSS and CIUSSS will now have a single real boss, Santé Québec. The integration will take place next fall.

In theory, it could work. We must hope that Santé Québec, which will become the largest employer in the country with 300,000 employees3, will make the network more efficient, that best practices and reforms will be systematically applied at the provincial level. But there are plenty of skeptics in the room. With good reason: Quebecers have heard many promises like this for decades.

“The easiest thing is to change the structure. It is very rare that we have seen a structural change profoundly transform the culture of an organization,” says Marie-Soleil Tremblay, professor at the National School of Public Administration, who co-signs a letter that we publish in The Press.

In an interview Thursday with Paul Arcand, at 98.5 FM, the Minister of Health Christian Dubé clarified his thoughts somewhat. There will not be a single top gun at Santé Québec. There will be several top guns from the private sector in the new management team, which will also include experienced network managers.


Quebec Minister of Health, Christian Dubé

“I am looking for a team of top gunsor rather a team of good managers,” also told The Press Mr. Dubé, who cites the example of Top Gun: Maverick. In this film released last summer, Tom Cruise’s character leads a team of several talented young pilots for a particularly perilous mission.

When we read between the lines, we understand that the future CEO of Santé Québec should come from the private sector, and number two (the head of operations) from the health network (or vice versa, but that would be surprising). The CEO will have a five-year contract. We must not change top gun all the time, as is the case with the Alberta Health Agency.

We will also have to ensure that this new agency does not allow the Quebec government to abdicate responsibility for network problems, or to use Santé Québec as a lightning rod.

Christian Dubé swears that he does not want to abdicate responsibility. “The minister will always remain responsible and accountable,” he said.

So much the better.

Because the ultimate top gunthe one that will be judged on the results will always be the government elected by Quebecers.

3. The federal government has approximately 357,000 total employees across the country, but that includes 86,000 employees in different federal agencies.

reference: www.lapresse.ca

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