After fifteen years as a manager, I left the health network at the time of the last reform. Since then, I have remained indirectly involved through teaching, coaching and research. Always passionate about management, I have developed a rigorous and critical eye towards our network.
I therefore read with interest the report requested by Christian Dubé from his Deputy Minister at the Ministry of Health and Social Services (MSSS) and found my favorite concepts there: autonomy, proximity, support, as well as a contextualized and evolutionary approach that stands out from the one-sided truths and radical changes that characterize too many transformations.
Deputy Minister Dominique Savoie makes it clear that the problems she names in her diagnosis are not new. However, his report brings a new tone, a more introspective look that goes so far as to recognize that the MSSS itself must change its posture.
By revisiting the role of the MSSS, the Deputy Minister proposes to give back more autonomy to the health establishments on the “how”. The last few years have shown us that, in order for CEOs to leave more room for maneuver at the various levels of their organizations, the Department must first of all allow greater freedom of action to its CEOs. The health network is a treasure trove of highly qualified and dedicated people. The complexity that characterizes it means that we must value the contribution of all the stakeholders that make it up. Regardless of the hierarchical status, each person is the “mister or the lady solution” of his field.
Between control and autonomy
What the report does not say, and which will have to be monitored given the accounting thinking of governments, is that the controlling approach of recent years has been operationalized by an energy-consuming and paralyzing accountability. Indeed, under the objective of enlightening decision-making, the intensification of accountability has led to a loss of meaning and extinguished all forms of initiatives (except those to juggle with statistics in order to make them appear better ). It will therefore be necessary to find a balance between control and autonomy which will be at the service of internal innovation, that which comes from the field.
Personally, I am convinced that this balance requires the promotion of local management, a key theme of Ms.me Savoy (hallelujah!).
Since the Barrette reform, management has deserted the scene of operational work, being caught up in time-consuming tasks such as feeding information systems and top-down information meetings (top down). The roles of facilitation, coordination, animation and tension regulation on the ground of first-level managers have thus been neglected. As the Deputy Minister noted, this lack of local leadership has repercussions at several levels, particularly on staff retention.
Local managers are the support walls of our network. Not only can they not be removed without the risk of the building collapsing (the reality of certain CHSLDs during the pandemic has shown this), but we must also ensure their solidity. The accompaniment of the managers towards the reappropriation of this posture of global management and not purely administrative is essential and the report makes mention of it (hallelujah bis!).
Without naming them explicitly, this report highlights two major problems that are slowing down the natural evolution of the network: the devaluation of the role of managers and the omnipresence of external pressures linked to electoral deadlines. Imagine how we could be elsewhere if we left more room for proximity and internal innovation and less for stage managers (to whom we give far too much attention!).