\u201cPlease give power back to the people who are doing the actual work with the patients,\u201d Hatem said.<\/p>\n
Hatem, an interventional cardiologist at Sacr\u00e9-Coeur Hospital, recently tried to introduce a Ringer perfusion balloon, a device used during complex coronary procedures. Before Sant\u00e9 Qu\u00e9bec, he said, he could submit a local request, assess it with colleagues and, if they wanted to adopt it, have it available within weeks.<\/p>\n
Now, because the device falls outside existing purchasing arrangements, the request is on hold.<\/p>\n
\u201cIf I keep pushing and I keep yelling and writing emails, I\u2019m going to end up getting my product,\u201d Hatem said. \u201cI\u2019m losing so much time just for pure administrative reasons.\u201d<\/p>\n
Centralized buying can save money, Hatem said, but he argues province-wide rules can be too rigid for specialized hospitals.<\/p>\n
\u201cEvery single hospital has a completely different population, completely different expertise,\u201d he said.<\/p>\n
At a Quebec City hospital, a clinical nurse described the pressure from another part of the system.<\/p>\n
\u201cNurses are tired and some take sick time for their health, so the already low resources become even lower,\u201d she said.<\/p>\n
Health care isn\u2019t numbers; there are lives behind them.<\/p>\n
\t\t\t\t\t\t\tClinical nurse<\/p>\n
The nurse said her hospital has frozen the hiring of new nurses, leaving existing staff increasingly being asked to do more with less.<\/p>\n
\u201cThe administration tries to cut expenses everywhere they can, and the patient is the person who bears the brunt of it: We can\u2019t deliver the quality of care they deserve.<\/p>\n
\u201cIt seems like they make decisions just looking at the numbers, but health care isn\u2019t numbers; there are lives behind them.\u201d<\/p>\n
Sant\u00e9 Qu\u00e9bec 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.<\/p>\n
\u201cWe have simplified bureaucracy to give time back to care,\u201d it said.<\/p>\n
It also warned that abolishing the agency would once again disrupt network operations and a transformation still underway.<\/p>\n
PQ Leader Paul St-Pierre Plamondon has pledged to dismantle the agency if his party forms government <\/a>after the Oct. 5 election, while keeping some functions centralized and returning more management decisions to regions and institutions.<\/p>\n At Sacr\u00e9-Coeur, Dr. Yanick Beaulieu has experienced Sant\u00e9 Qu\u00e9bec differently.<\/p>\n \u201cWe haven\u2019t felt much of a difference,\u201d said Beaulieu, a cardiologist and critical-care physician. \u201cNeither good nor bad.\u201d<\/p>\n The most significant change in his intensive-care unit has instead been Quebec\u2019s new Epic-based Dossier sant\u00e9 num\u00e9rique, or DSN,<\/a> which launched in May in the Nord-de-l\u2019\u00cele-de-Montr\u00e9al and Mauricie\u2013Centre-du-Qu\u00e9bec networks.<\/p>\n \u201cYou have the nutritionist, the pharmacist, the physiotherapist, the doctor, and then everyone was just trying to fight to have one file,\u201d Beaulieu said of the old, paper-heavy way of working.<\/p>\n Several professionals can now consult the same digital chart at once. The difference is particularly clear when patients move between Sacr\u00e9-Coeur, Jean-Talon and Fleury hospitals, which use the same system.<\/p>\n \u201cIt\u2019s a continuation,\u201d Beaulieu said.<\/p>\n 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.<\/p>\n The contrast raises a question that goes beyond whether Sant\u00e9 Qu\u00e9bec survives the election: What actually benefits from being run province-wide, and what needs to remain local?<\/p>\n \u201cI 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,\u201d Hatem said.<\/p>\n 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.<\/p>\n \u201cIt has to be also decentralized for each hospital,\u201d he said.<\/p>\n The system, Beaulieu said, should work \u201cbottom up and not top down.\u201d<\/p>\n Fresh scrutiny over SIFA, a separate finance-and-procurement modernization project, has added another dimension to the debate. Radio-Canada reported this week<\/a> that a confidential analysis by Quebec\u2019s Cybersecurity Ministry and accounting firms KPMG and MNP estimated the project, initially budgeted at $96 million, could ultimately cost more than $1 billion.<\/p>\n \u201cWe\u2019re way behind in Quebec, technologically speaking,\u201d Hatem said.<\/p>\n He said the problems reported with SIFA should not become an argument against modernizing the network.<\/p>\n \u201cI don\u2019t think you should throw out the idea just because an accountant or an analyst didn\u2019t do their job properly,\u201d he said.<\/p>\n That same reluctance to start over shapes Hatem\u2019s view of Sant\u00e9 Qu\u00e9bec itself.<\/p>\n \u201cThe health system in Quebec is so huge, nobody can turn things around in a year and a half,\u201d he said.<\/p>\n \u201cWe have a tendency sometimes to just want to switch things, switch things, switch things, and every new government has a new reform.\u201d<\/p>\n Beaulieu\u2019s answer to the prospect of another multi-year restructuring was simpler.<\/p>\n \u201cPlease, can we just treat patients and not change the system again?\u201d he said. \u201cOptimize it, but please don\u2019t put us through a multi-year change in architecture all over again.\u201d<\/p>\n
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