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Denis Soulieres
Hematologist and medical oncologist, Center hospitalier de l’Université de Montréal
This is an idyllic portrait. The medical organization is not so adequately hierarchical to serve the population, for lack of structure and resources. Yes, the health system lacks structure, even if critics call it a big indomitable machine! The paucity of coherent structures originates from the places of decision. Like other ministries, the mission of the health system is shaped by political imperatives rather than needs established on verifiable and compiled data.
Some consider that political leaders must intervene directly with structures to manage their ministry. In my opinion, this is counterproductive. If the leaders of health institutions must act on a daily basis in accordance with policies influenced by opinion polls and headlines, they abandon the coherent management which makes it possible to ensure the integration of actions, or even prepare their organization for pitfalls such as pandemics.
A Hydro-Quebec for health
Electricity production in Quebec is under the governance of Hydro-Quebec. Its organizational model is relatively independent from government and politics, although the board is appointed by the government. However, the mission is clear and defined: to produce and supply electricity to all Quebec households. Through a planned needs assessment, updated through a well-woven distribution network, competently managed, maintained, able to ensure its financing on time and in the long term. Surprisingly, this model does not apply to the health system. Hydro-Québec: a Quebec model of success. It is necessary to be inspired by it to define places of intervention free of political tinge.
Political leaders are not malicious, far from it. However, we must question their role as public administrators.
Because in our political system, the population elects local representatives who are also responsible for ministries. Does being elected invest skills in departments that spend billions a year? Reasonably not, whether the government is CAQ, Liberal, PQ or solidarity.
Medical competence is largely the result of multiple years to acquire the right to practice, competence confirmed over time by a professional order. Infused science does not exist! The same goes for nurses, lawyers, engineers, etc. Conversely, being a doctor, lawyer or teacher is not a prerequisite for becoming a minister of health, justice or education. Self-interested knowledge of issues does not confer the capacity or even the competence to carry out ministries. I clearly distinguish between the management of legal ministries and the duty to formulate orientations and priorities, introduce bills, supervise the actions of civil servants. A politician must guide the actions of the State, but from there to implanting his intentions, there is a chasm to fill!
Gustave LeBon, physician, philosopher and anthropologist, said: Competence without authority is as powerless as authority without competence. The crisis caused by the pandemic highlights this vividly.
Our ministries should organize and plan, while spending too much time answering political questions, to achieve short-sighted goals.
We need ministers who generate ideas, defend budgets, and represent the people by ensuring that the funds invested are productively invested. Why has this last role, historically inherent in the mandate of a Member of Parliament, been increasingly devolved to the Québec Ombudsman?
Why not favor a public service led by state mandarins? Acting with competence and independence of mind, they would be able to ensure continuity despite the passage of governments and ministers, to organize actions and structures, to measure their impacts, without political ulterior motives. The years spent knowing the health network and working there with stakeholders would allow the establishment of a management culture without fear of ministerial lightning.
In this spirit, with the emergence of COVID-19, it would have been wise to form a group of independent experts, respected from all parties, to manage the pandemic, both in its health and economic aspects. The real power is knowing how to let the most competent people take the lead. Due diligence in advance would have raised the risks associated with reliance on external resources for medical supplies, drugs and vaccines. The rulers have responsibilities, but a population that leaves the management of the state to the vagaries of the media and politicians is also responsible.
The functions of minister and prime minister are thankless. The public and journalists ask them to know everything at all times and to act immediately, without time to find out the facts.
Elected officials should exercise leadership rather than investing in the day-to-day work of ministries. Such a change could not happen overnight. It would require a redefinition of roles and responsibilities. Government and events demand that society reinvents itself, it would be good if well-ordered charity began with oneself.
We are looking for leaders who act like good fathers of families (written without sexist thinking). Even fathers make mistakes and have their limits. However, we will still love our parent. Filiation is less unconditional for the leaders of a State, justifying leaving experts to present issues and solutions.
In an open letter to Press on World Cancer Day, the president of the Canadian Cancer Society and two signatories, including Philippe Couillard, suggested that COVID-19 is an opportunity to “build better” in the face of the enormous task of caring for people with cancer cancer suffering while awaiting diagnosis and treatment. Validated options exist, applicable in Quebec, without reinventing the wheel, by ceasing to listen to political instincts alone.
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