Health Minister Christian Dubé introduced Bill 15 on March 29, which will create the agency Santé Québec, signaling a true revolution in health care for the province.
One year after announcing his plan to make Québec's health system more efficient and humane, Minister Dubé is setting himself up for success with Bill 15: once passed, this legislation will create a central agency, led by a board of directors made up of people from different backgrounds, which will take over the operational management of the provincial health network.
A real culture shift
This move to restructure the entire Québec health network is significant. It is expected that the proposed changes will have a profound impact on the system — from the execution of services, to the management of external contracts, and the coordination of health units.
The COVID-19 pandemic has highlighted several shortcomings in the health-care system, many of which had been known for some time. The government felt that an overhaul was needed to reduce waiting times in emergency rooms, to reduce wait lists for surgery and to ensure that Quebecers receive care from the right health professional in a reasonable amount of time.
A new board of directors
For the board of directors of the new agency, the minister says he wants "top guns" from the private sector to fill the executive positions. The main goal is to inject new blood into an inefficient system. In addition, the minister wants Santé Québec to hire several hundred new managers. The next few years will be interesting for companies that can help the new Santé Québec agency rethink its methods. These changes in structure and management personnel will have an impact on the work of the health-care network's subcontractors.
A new approach to unions
Santé Québec will be the sole employer of the health-care network's 375,000 employees. The directors of the 34 regional centres will report directly to Santé Québec, rather than to local boards. The Ministry of Health will be responsible for policy and planning.
One of the most important changes proposed by the bill is the recognition of union seniority throughout the province. This proposal will finally allow workers to move to another region without losing their seniority.
Minister Dubé's reforms aim to reduce the influence of unions on the health-care network by consolidating the union seniority of workers across Québec. The centralization of operations will merge local collective agreements. This merger will reduce the current number of bargaining tables from 136 to 4, which promises significant efficiency gains.
Changes for medical specialists
The bill also proposes to require medical specialists to travel throughout Québec to serve patients in regions of the province currently neglected by the system.
Specialists will also have to be more available to see patients in the emergency department and accept less favourable hours.
Expected resistance
Reactions came from all sides before and after the bill was introduced. Opposition parties spoke on behalf of Ministry of Health officials and health-care system workers who are concerned about this cultural shift. The minister said that "the pillars of the temple will move" and that opposition will certainly be important.
Looking ahead This is not the first time that Québec has seen a major change in the management of its health-care system, but no previous reforms have gone as far as the shift proposed by the current government. With a large majority renewed by Quebecers last October, François Legault's Coalition avenir Québec now has a free hand to act on its vision.
It remains to be seen whether Minister Dubé's management experience will make the difference and bring this major reform to fruition.