Penalize CISSSO managers for their failures?
Our health system in the Outaouais is mapped into two very different realities: rural hospitals and CLSCs plus the urban, Gatineau, infrastructure. The entire zone, rural and urban, has one top-heavy management, CISSSO, contained entirely within the brick walls of Gatineau. The ministry’s performance reviews, year after year, rank CISSSO among the worst-managed health and social services agency in all of Quebec. Some years ours ranks the absolute worst. If the Ministry undertook a more detailed analysis, they would find Outaouais’ rural services even worse managed, all at-a-distance.
We are discussing management, not the health system itself and especially not the front-line professionals who actually make our health services work as well as they do. Our big problem – the Ministry admits – is management, our region’s closeted management.
And yet, management failures keep repeating. At their most outrageous, CISSSO’s bureaucrats insist “all goes well!” CISSSO refuses to discuss these problems in detail, certainly with public media, and continues issuing communiques on each occasion of closed facilities, missing surgeons, nursing shortages, beds lining the halls, mechanical breakdowns. Week after week, we learn that the Pontiac Community Hospital, serving an area about the size of the Republic of Ireland, cannot provide obstetrics care due to a “shortage” of surgeons. The administrators blame staff, blame nurses, blame specialists, blame politicians and budgets – yet they are in charge. When do we ever hear promises of better management?
We don’t. And, therefore, if Quebec City does not have the resources or the will to intervene, perhaps a look at best practices for management elsewhere is needed, those used in the private sector.
In business, management showing such consistent poor outcomes would have been sacked – procedures streamlined, personnel changed at the top, and penalties imposed on salaries and bonuses. Why does the Ministry not impose salary penalties on consistent management failures?
Is the Ministry of Health afraid its own role in short-changing the Outaouais’ budget will be exposed? Or perhaps the Ministry’s inability to gain control over the number of front-line doctors accredited each year?
When CISSSO announces another collapse of obstetric services in Pontiac or Wakefield, why aren’t management penalties also announced? If a Quyon family were to sue CISSSO for the hypothetical injury to a mother, say, attempting childbirth in her car on the side of the road, will the managers be told to defend themselves in court?
Since when are managers not responsible for their decisions? Each manager accepted the well-paying position, knowing the position’s history and problems. Part of every manager’s job description – by definition – is to solve problems, not blame someone else.
The Outaouais’ situation is serious. Unless measures such as penalties for poor performance are adopted, our problems will continue. Without managerial accountability, the breakdowns will continue. Without cheque-book penalties, where comes the motivation for the difficult changes required?