Christian Dubé seemed a bit emotional yesterday, at a press briefing, while Santé Québec will enter service on Sunday.
We understand it. A year ago, he passed his law.
Our Minister of Health has a snake charmer side: he is remarkably adept at explaining, or even justifying, his delays or other unachieved objectives.
Whether we agree with his orientations or not, no one can deny the ardor he puts into trying to improve our health system.
Mission impossible? “I wouldn’t say that I’m tired of hearing about the mammoth… but it’s true that this device is difficult to move,” he euphemized yesterday.
Layer and cut
Is he doing it the right way? So far, it feels like his big agency is just adding another layer of wool to the giant animal.
Entrusting “operations” to an agency while the ministry deals with “orientations”, the idea seemed obvious. In reality, the two are often entangled, even inextricable. There will be many duplications.
Mr. Dubé claims that the Agency’s new management team “will better coordinate the work of our 35 CEOs.” That it will bring about a “culture change”. For now, it seems smokey.
The first interviews granted by the big boss Geneviève Biron did not diminish the skepticism.
His four priorities seemed blatantly obvious: 1. access, 2. people, 3. efficiency and 4. causes… Did we really need shock managers to achieve that? In addition, the first year of operation will coincide with budgetary tension: more than $1 billion in accumulated deficit must be absorbed.
“It’s really not ideal,” admitted Mr. Dubé yesterday, before adding: “We are looking at everything to be sure […] that we will be able to minimize […] the impact on services.
The doctors
Why, since 1990, has every Minister of Health (or almost) felt obliged to make a major reform? M.-Y. Côté (putting the patient back at the heart of the system, creation of regional authorities), Rochon (ambulatory shift, rationalization), Couillard (abolition of authorities, creation of agencies), Barrette (abolition of agencies, creation of CISS and CIUSS), and now Dubé (creation of a single agency).
Perhaps to get around the mammoth’s two fundamental problems? First, union rigidity. And then, the singular status of doctors, half-employees, half-entrepreneurs, or self-employed workers.
Assuring that he was not working to get re-elected, Christian Dubé promised not to shy away from any taboo. Already, it has reduced “compulsory overtime” (TSO) and the influence of private agencies, and obtained a certain flexibility (not without great difficulty).
And he opened another important front yesterday by affirming that he wanted to obtain 40% of control over doctors’ salary packages. He currently masters barely 5% of them. The docs’ unions saw it as a declaration of war. But there may be a key to moving the mammoth. To do this, however, Mr. Dubé will have to deploy his best talents as a bewitcher.
