While the impressive bill aimed at making the health and social services system more efficient has just been tabled in the National Assembly, I imagined myself for a moment in the shoes of Véronique Cloutier, who succeeded in influencing Minister Christian Dubé regarding hormonal treatments for women. If I was Vero, what would my demands be?
Mr. Minister, I am writing to you here as a researcher working on the health and social services system for twenty years. Your titanic reform affecting several dozen laws aims to improve the efficiency of care by bringing back the idea of an agency as a safeguard for the quality of services. However, the powers are not all entrusted to the latter since you have chosen to retain, among other things, the power over the reporting of institutions.
I don’t need to remind you that the problems to be solved are as gigantic as your reform: reducing waiting lists in almost all services, speeding up emergency care, in short, restoring access to health care. and social services to all who need them.
I have to remind you that before you, ministers Marc-Yvan Côté, Jean Rochon, Philippe Couillard and Gaétan Barrette all had the same goal of efficiency as you. All have carried out structural reforms, some setting up regional boards and agencies, others abolishing the latter. The structures of the network have therefore changed a lot during these five successive reforms, including yours, over a period of just over 30 years.
The Lean, Toyota and Kaisen methods have been considered by all your predecessors or their advisers as the solution to the ills of the network. However, a significant amount of research shows that this type of management in the public network harms the work climate and creates suffering among workers. It is not for nothing that many leave the boat.
Mr. Minister, if I were Véro, I would tell you that if you want your reform to be a success, you must detach yourself from these management methods which aim to control people working in the network. The implementation of accountability mechanisms of this type satisfies the administration’s need for data more than the assurance of an offer of services to users made possible by new means made available to staff.
The quality of care cannot be based on statistics and performance dashboards which, in the end, do not reflect the complexity of relations with users and which reduce the time spent with them. Continuing in this vein will miss the desired effect.
If I were Vero, I would ask you to build with the staff of the network an accountability that is not based solely on impressive statistics of the work done, but also on qualitative data that truly accounts for the work done. In the midst of negotiating collective agreements for the public network, in a context where employees are leaving the network, you must take into account all the working conditions. Accountability is at the margin of collective agreements, so this decision rests with you. Are you sure you want to make the network more efficient?