Separation of policy from operations – Creation of Santé Québec Agency
The highlight of Bill 15’s four objectives is the separation of policy from operations at the Ministry of Health, through the creation of the Santé Québec (Health Quebec) agency. New rules for the governance and organization of establishments would enable local management and greater service fluidity.
Specifically, Santé Québec would become a government corporation with its own board of directors. It would be responsible for the operationalization of services by public facilities, and for overseeing and coordinating the activities of private facilities. Santé Québec would serve the facilities by carrying out day-to-day and operational activities.
The Health Minister would henceforth exercise responsibilities focused on strategic planning, such as developing programs and policies, setting broad orientations and assessing performance. In this way, the Ministry would be more responsive to the needs of the population, by resuming its planning role.
Back to local management
Bill 15 would allow for the hiring of a person responsible for each facility, to initiate a cultural shift towards proximity management. The Liberals’ last major healthcare reform in 2015 abolished more than a thousand managerial positions.
The services offered by the various sites would be tailored more closely to local needs and realities. This local management would be personalized to the context of each site. Nevertheless, it remains to be seen to what extent local managers will enjoy real autonomy. Otherwise, decentralization will not be as effective as announced.
Each Santé Québec facility would be headed by a CEO. The Santé Québec Board of Directors would oversee their appointment, which would no longer be subject to the usual public service appointment rules. In this way, the Minister aims to bring in “top guns” to run healthcare facilities.
Improved access to services
To improve access to health and social services, the Minister of Health would review the responsibilities of doctors, strengthen coordination between establishments and consolidate territorial governance of the health network.
Specialist doctors would be subject to the same licensing requirements for specific medical activities as general physicians. This would include, among other things, care, and availability requirements.
Santé Québec would be responsible for coordinating the operations of the healthcare network. It would focus on the user and employee experience to achieve its mission and functions.
Under the bill, the governance of a facility would involve the appointment of a facility medical director and two territorial medical directors.
Appointed by the CEO of a facility and reporting directly to him or her, the medical director is a physician who oversees the supply and availability of medical services.
Under the authority of the facility’s medical director, territorial medical directors for family medicine and specialized medicine would ensure better continuity of health and social services between facilities in a given territory.
Enhanced patient experience
Also in the governance realm, Bill 15 calls for the creation of at least five councils per facility, a facility board, and several committees. Firstly, the interdisciplinary council for the evaluation of clinical trajectories and organization would “evaluate the quality and relevance of clinical care and services”.
It would be made up of various professionals working within the facility. Its central role would be to advise the CEO and make recommendations on the organization of the facility and the distribution of care and services.
Four councils would exercise responsibilities towards the interdisciplinary council: members of the council of physicians, dentists, pharmacists, and midwives would act as advisors to the interdisciplinary council to foster interprofessional collaboration.
Members of the multidisciplinary health services council and members of the council of nurses would also act as advisors to the interdisciplinary committee.
The social services council, comprising professionals from psychosocial disciplines, would act as advisor to the interdisciplinary committee for the evaluation of trajectories and clinical organization.
Secondly, each Santé Québec facility would have a governing board. Appointed by Santé Québec‘s Board of Directors, its membership would be representative of a variety of backgrounds and would include users and the facility’s CEO.
The functions of each governing board would be to evaluate, on an annual basis, users’ experience of the health and social services offered by the facility, and the social and health needs of the communities it serves. It would advise the facility’s CEO on matters relating to service delivery and prepare and adopt an annual report of its activities, with a copy to Santé Québec.
Finally, the Vigilance and Quality Committee would act as a watchdog to ensure the quality and accessibility of services, and that the Governing Board fulfills its responsibilities in this regard.
Users’ committees and residents’ committees would be elected by users to represent them. They would be involved in assessing user satisfaction with the services provided and would submit an annual report to the national users’ committee.
Risk management committees would be tasked with analyzing accident risks and preventing their occurrence, ensuring that support is provided to the victim and his or her loved ones, ensuring that an accident monitoring system is put in place, and recommending measures to the governing board if necessary.