Needed: a healthier climate in our hospitals

Administrative reforms have taken toll on personnel, Brian Gore says.

Why have so many of my patients working in health care in the Montreal area experienced a disturbing level of emotional distress? Their stories are compelling and illustrate how deeply our health-care professionals and non-professionals have been affected by outgoing Health Minister Gaétan Barrette’s Bill 10 administrative reform.

A nurse working in a large chronic-care hospital broke down sobbing during her visit to my office. Her stress was palpable. She bemoaned the extra shifts for colleagues calling in sick, increased overtime when staff shortages occurred, reduced direct physician availability to a half-day weekly, more care responsibilities, less time to spend with each needy resident and the demotivating attitudes of her colleagues. She felt she could barely provide proper care. Those colleagues approaching retirement were counting down their remaining days. The morale of staff had plummeted. Disability leave was on the rise. Patients’ families were struck by the changes and complained bitterly.

This nurse was expressing her feeling that the vastly enlarged CIUSSS management “no longer seemed to care about the residents.” Solutions were seldom forthcoming, as many local management positions had been closed or transferred off-site. Finding who was responsible when a problem arose took on a new and often frustrating dimension.

This same pattern of dismay prevails among far too many employees of our public health-care institutions. Some resign themselves. Others try to cope. Some cannot adapt, developing their own health issues. Even senior administrators feel the negative pervasive effects that Bill 10’s centralization of Quebec health care has brought upon our institutions.

Beyond the enormity of the legislative changes abolishing local institutional governance, the direct human impact of the reform, in my opinion as a former director of professional services in a large Montreal CHSLD (chronic-care hospital), has been neglectfully under-evaluated and is frankly deplorable.

Six major health-care reforms have been implemented since 1989 by successive ministers of health, from Marc-Yvan Coté, Jean Rochon, Philippe Couillard, Yves Bolduc, Réjean Hébert to our now-outgoing minister Barrette. His health-care reform is the most unpopular and autocratic in last 30 years.

Premier Philippe Couillard has announced Barrette will not retain the health portfolio if the Liberals are re-elected. An astute move: Barrette’s unpopularity would have likely guaranteed the government’s defeat. His leadership style and brazen negotiating practices have left considerable acrimony.

This pattern of successive system transformations with little regard to the toll on providers and, inevitably, upon patient care, has removed both personal and team incentives that had enabled a number of our institutions to stand out. We have dumbeddown all too many excellent smaller centres by removing their administrators and instead centralized management decisions to a level of mediocracy at best. These large integrated centres now control all aspects of local care and are directly answerable to the minister.

A centralized ministerial approach is essential for public health, distribution of medical manpower and services, provincial technological and IT directives and global budgets. However, the attempt to micromanage all aspects of local and regional care has demotivated far too many of our care providers.

It’s up to the next health minister to make amends: Foster the development of local and regional expertise, adapt care to community demographics, allow and encourage local and regional initiatives to address the health and social realities on the ground. Restore in whole, or in part, local governance that rewards the more innovative and productive institutions. Provide them with the resources to serve as advisers to those needing help. Permit our best practices to be seeded across the province.

Ending this atmosphere of malaise that the Barrette reform created must be a priority. We need to re-establish a healthier and more collaborative climate in our healthcare institutions. Our care providers deserve better. The time is now to convey this message to whoever the next minister of health in Quebec may be.

Brian Gore is a family physician in Westmount.