Refoundation of the network: when Legault was minister … of Health

In February 2002, when I was a young health journalist, I met the health minister, David Levine. He told me first that he wanted to reduce to 12 hours maximum the waiting time in the emergency room to get his discharge or a bed upstairs.

Eric Yvan Lemay, Le Journal de Montreal

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Twenty years later, the average length of stay on a stretcher in Quebec hospitals is nearly 17 hours. It even exceeds 20 hours in some regions.

Why am I telling you this story? Because it shows how difficult it is to change things in the health network. And because at the time, Levine supported the Minister of Health, a certain François Legault.

The two men had made access to care their priority.

For 20 years, I have seen all the ministers offer their solution to tame the monster that has become the health care system. Despite everything, access to healthcare often remains difficult. There is a shortage of beds in hospitals, in CHSLDs, and a million Quebecers still do not have a family doctor.

Legault’s project

And as if it wasn’t bad enough already, the pandemic hit. The report by the health commissioner, Johanne Castonguay, on deaths in CHSLDs during the first wave of COVID-19 clearly showed the shortcomings of the system.

In response, Prime Minister François Legault promised to “rebuild” the health network. It was a month ago, when Quebec was facing the terrible fifth wave of the pandemic.

Rebuilding health? “Ah well”, I said to myself at first. ” Why not ? There are many things to improve. »

Then I also said to myself: “Ah no, not yet a reform carried out by Quebec, but which will not achieve much in the end. »

However, there are solutions.

Throughout the network, there are ideas worth considering. The Journal did the exercise by talking to about fifteen doctors, managers, unions and researchers to come up with 12 solutions for our health system.

What struck me during these interviews, however, is that the waves of the pandemic are nothing compared to the tsunami that awaits us with the massive arrival of baby boomers who will need to be treated.

In 10 years, this group will monopolize health care. Billions would have to be invested, in particular to increase the number of long-term beds in seniors’ homes and CHSLDs.

“Even if we do a lot, we will not be able to make up for this deficit,” warns the Dr Jacques Morin, of the Association of Geriatric Physicians of Quebec.

Difficult choices lie ahead. The DD Élyse Berger Pelletier, who worked until recently at the Ministry of Health, believes that the way we treat elderly patients will have to be reviewed.

“It doesn’t make sense anymore. The quality of life of our seniors is not there. These are big ethical debates in society, but we will have to look into this, ”she said.

Sweden as an example

According to her, the famous ambulatory shift has not worked and we have to find new ways of doing things.

I was also reminded of the example of the Swedish health system. A country where I went to report in 2003 after a reform that caused a lot of talk.

There, activity-based funding was introduced whereby the hospital is paid based on the operations performed there.

The longer a hospital operated, the more money it received. A competition was therefore created between the hospitals which favored the patients. They could even choose the hospital where they had surgery by comparing the waiting time on the internet. The private also occupies a greater place.

But the biggest difference is that we have decentralized the decisions. Local organizations have much more autonomy.

Quite the opposite of what we did in Quebec.

“We centralized so much with [la réforme du ministre Gaétan] Barrette that we have taken away creativity and the ability to move in hospitals, ”says David Levine, who has become a professor and consultant.

If he wants to succeed in his refoundation, Minister Christian Dubé therefore has every interest in listening to the people on the ground.

“We have to put all the players in the same room to have the real debate, a real refoundation project, not just in Quebec,” suggests Réjean Leclerc, president of the FSSS-CSN.

And that they don’t get out of it until they have found the key to solving the problems that are undermining the health network.


Hospital Bulletin – 2002

Many forget it, but François— Legault briefly held the post of Minister of Health. Its best-known initiative is undoubtedly the hospital bulletin. In September 2002, he presented a bulletin ranking the 105 hospitals in Quebec with letters ranging from A to E. Unsurprisingly, some Montreal hospitals such as Hôpital Notre-Dame and Hôtel-Dieu were rejected for their emergency situation. Hospitals were also rated on their compliance with the budget. Those who had no deficit had the best grades. The newsletter, which Legault refused to call a list, did not survive him.


Creation of CSSSs – 2004

In 2003, Jean Charest had recruited the neurosurgeon by profession to make him his Minister of Health. He is notably responsible for the creation of local health networks (RLS). At the heart of this reform, we also find the health and social services centers (CSSS) created by the merger of several establishments (CHSLDs, CLSCs, hospitals) on the same territory. The idea was to facilitate the patient’s journey within the network and to pool certain resources. However, the CSSSs of a territory continued to report to the regional health agency.


Toyota method – 2008

The one who succeeded Philippe Couillard surprised many when he arrived with the Lean approach, also called the Toyota method. As we had done in car manufacturing plants, the idea was to review all the processes to improve efficiency. Everything was there: organizational culture, employee empowerment and decision-making as close to the action as possible. If certain processes have remained, the expression “Toyota method” has practically disappeared in the network.


Autonomy insurance – 2014

Doctor Réjean Hébert did not have time to implement his autonomy insurance reform during his short term as minister between 2012 and 2014. First presented in a white paper in 2013, the proposal was abandoned after the defeat of the Parti Québécois. A sum of $500 million was to be put by the government in a fund dedicated to autonomy insurance. In particular, we wanted to promote the development of home care for seniors.


Creation of CISSSs and CIUSSSs – 2015

Minister Gaétan Barrette struck a blow in 2015 by introducing Bill 10. This led to the creation of 34 integrated centres, huge establishments bringing together up to forty CHSLDs, CLSCs, hospitals, rehabilitation centers and youth centers. Hundreds of management positions were subsequently abolished, as were health agencies. Appointments of CEOs and some board members now rest with the Minister.

– With the collaboration by Héloïse Archambault

Are we moving towards a Hydro-Santé?

Health workers suggest depoliticizing the health care network and making it a kind of Hydro-Santé du Québec.

Éric Yvan Lemay and Héloïse Archambault, Le Journal de Montréal

“Too many decisions are made politically,” laments the Dr Simon-Pierre Landry, who supports this idea.

It is not yesterday that the subject is on the table. As early as 2006, the former president of the College of Physicians of Quebec, Dr.r Yves Lamontagne, spoke about it.

“The problem is that we are doing politics with health, when we should be doing health policies. We should hand over the budget to a council made up of tax experts, accountants, unions and health professionals,” he argues.

Young Liberals

Last November, the Young Liberals of Quebec adopted a resolution to depoliticize health.

Decisions would be made by a council of citizens, elected officials and managers. The leader of the Quebec Liberal Party, Dominique Anglade, said she would study the question, but did not endorse the proposal.

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