Dr. Raja Hatem says getting a new cardiac device into his Sacré-Coeur lab used to take about two weeks. Now, he says, it can mean repeated emails and layers of approval.
Santé Québec was created to make Quebec’s sprawling health network more efficient by putting day-to-day operations under one provincial organization. Less than two years later, the Parti Québécois has promised to abolish it and return more authority to the regions. The reality inside hospitals is less tidy.
“Please give power back to the people who are doing the actual work with the patients,” Hatem said.
Hatem, an interventional cardiologist at Sacré-Coeur Hospital, recently tried to introduce a Ringer perfusion balloon, a device used during complex coronary procedures. Before Santé Québec, he said, he could submit a local request, assess it with colleagues and, if they wanted to adopt it, have it available within weeks.
Now, because the device falls outside existing purchasing arrangements, the request is on hold.
“If I keep pushing and I keep yelling and writing emails, I’m going to end up getting my product,” Hatem said. “I’m losing so much time just for pure administrative reasons.”
Centralized buying can save money, Hatem said, but he argues province-wide rules can be too rigid for specialized hospitals.
“Every single hospital has a completely different population, completely different expertise,” he said.
At a Quebec City hospital, a clinical nurse described the pressure from another part of the system.
“Nurses are tired and some take sick time for their health, so the already low resources become even lower,” she said.
Health care isn’t numbers; there are lives behind them.
Clinical nurse
The nurse said her hospital has frozen the hiring of new nurses, leaving existing staff increasingly being asked to do more with less.
“The administration tries to cut expenses everywhere they can, and the patient is the person who bears the brunt of it: We can’t deliver the quality of care they deserve.
“It seems like they make decisions just looking at the numbers, but health care isn’t numbers; there are lives behind them.”
Santé Québec gives a different account of its first years. In a statement to The Gazette, the agency said it has improved access to care, reached budget balance, reduced duplication within health institutions and made progress on surgical waiting times.
“We have simplified bureaucracy to give time back to care,” it said.
It also warned that abolishing the agency would once again disrupt network operations and a transformation still underway.
PQ Leader Paul St-Pierre Plamondon has pledged to dismantle the agency if his party forms government after the Oct. 5 election, while keeping some functions centralized and returning more management decisions to regions and institutions.
At Sacré-Coeur, Dr. Yanick Beaulieu has experienced Santé Québec differently.
“We haven’t felt much of a difference,” said Beaulieu, a cardiologist and critical-care physician. “Neither good nor bad.”
The most significant change in his intensive-care unit has instead been Quebec’s new Epic-based Dossier santé numérique, or DSN, which launched in May in the Nord-de-l’Île-de-Montréal and Mauricie–Centre-du-Québec networks.
“You have the nutritionist, the pharmacist, the physiotherapist, the doctor, and then everyone was just trying to fight to have one file,” Beaulieu said of the old, paper-heavy way of working.
Several professionals can now consult the same digital chart at once. The difference is particularly clear when patients move between Sacré-Coeur, Jean-Talon and Fleury hospitals, which use the same system.
“It’s a continuation,” Beaulieu said.
At the Jewish General Hospital, which is not yet using the DSN, a doctor who asked not to be identified said clinicians can lose time tracking down information from another institution. In some cases, the doctor said, work may be repeated because information from previous care is not readily available.
The contrast raises a question that goes beyond whether Santé Québec survives the election: What actually benefits from being run province-wide, and what needs to remain local?
“I think what works is when you listen to the people on the field, and you tailor the budget and the financing to the specific needs of each hospital,” Hatem said.
Beaulieu pointed to operating-room capacity as one example. Scheduled rooms often wind down in the late afternoon, he said. Extending some activity later could allow more procedures to be done, but only if a hospital can also provide the nurses, technicians and other staff needed to keep them running.
“It has to be also decentralized for each hospital,” he said.
The system, Beaulieu said, should work “bottom up and not top down.”
Fresh scrutiny over SIFA, a separate finance-and-procurement modernization project, has added another dimension to the debate. Radio-Canada reported this week that a confidential analysis by Quebec’s Cybersecurity Ministry and accounting firms KPMG and MNP estimated the project, initially budgeted at $96 million, could ultimately cost more than $1 billion.
“We’re way behind in Quebec, technologically speaking,” Hatem said.
He said the problems reported with SIFA should not become an argument against modernizing the network.
“I don’t think you should throw out the idea just because an accountant or an analyst didn’t do their job properly,” he said.
That same reluctance to start over shapes Hatem’s view of Santé Québec itself.
“The health system in Quebec is so huge, nobody can turn things around in a year and a half,” he said.
“We have a tendency sometimes to just want to switch things, switch things, switch things, and every new government has a new reform.”
Beaulieu’s answer to the prospect of another multi-year restructuring was simpler.
“Please, can we just treat patients and not change the system again?” he said. “Optimize it, but please don’t put us through a multi-year change in architecture all over again.”
I’m a reporter at the Montreal Gazette, covering breaking news and the issues affecting communities across Montreal. I believe some of the most interesting stories begin with an ordinary conversation.
amclaughlin@postmedia.com