The hyper-centralized management of the health system harms the quality of care provided to the population and is largely responsible for the ills that threaten the integrity of the system on several fronts: staff shortages, staff demotivation, relocation of services, overflows and emergency closures, long-lasting waiting lists for surgery, etc.

Exacerbated by the recent health emergency, the many manifestations of the profound illness that plagues our ability to provide quality care within a reasonable timeframe unfortunately too often make the headlines.

If the diagnosis is clear, so is the cure.

Local management must be re-established in health establishments, more particularly acute care hospitals, and entrusted to managers who are closer to the field and to the reality of medical staff and patients.

We are nearly 800 doctors who practice in all regions of Quebec to experience these problems on a daily basis. We demand the decentralization of the health system, the cause for which we formed the Regroupement québécois de médecins pour la decentralization du system de santé (RQMDSS).


We know that we have an attentive ear on the part of the Minister and the Ministry, who are already sending positive signals as to possible changes which, in one form or another, would come closer to health management better suited to reality. ground.

The words of the newly appointed Deputy Commissioner for Health and Welfare, Dr.r Denis A. Roy, reported by the review, give us hope: “We must move from hierarchical governance focused on production to shared and responsible leadership, focused on results. “

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We hope that this is a sign of change and not just a statement of intent.

We would also like to welcome the recent decision of Lise Verreault, appointed by Minister Dubé himself as interim president and CEO of the CISSS de la Montérégie Ouest, to provide two of the hospitals in her region with a local deputy director general each.

From our point of view, this is an example to follow, a step towards a modus operandi better suited, a mode of operation that promotes the efficiency of care centers, while sending a positive signal to those who treat patients on a daily basis.


Proximity management is in short a better way to implement solutions adapted to local reality and to encourage initiatives in this direction. It is also an excellent way to promote the commitment and the feeling of belonging of the personnel, which should inexorably increase their retention rate.

Decentralized management should not only improve the quality of care, but also restore the desire to invest more and stimulate this pride in being part of a team that can make the decisions necessary to offer the best care in the context. specific to each establishment.

To achieve this, we offer in particular:

1. That a responsible, autonomous and accountable deputy director general (DG) be attached to each establishment;

2. That the local professional services management (DSP) function be re-established with full autonomy and authority;

3. Ditto for a local council of physicians, dentists and pharmacists (CMDP), it is an essential function for these establishments;

4. The presence of independent heads of service and department with decision-making power is also desired in order to obtain, if necessary, the necessary latitude to adapt the offer of care to the specific needs of the population served by each of the establishments.

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To improve the quality of service and the efficiency of the health system, we maintain that we must rely on the good judgment of those who have their finger directly on the pulse of Quebeckers who need health care, and put their expertise to good use.

* RQMDSS Board members: Dr Daniel Kaud, Dre Isabelle Lepage, Dre Ruth Vander Stelt, Dre Marie-Claude Blouin, Dr Philippe Rola.

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