5.9 million hours cut in healthcare network: Santé Québec

The number of hours worked in the healthcare network has decreased by 5.9 million over the past five months, according to figures from Santé Québec.

This data, obtained exclusively by The Canadian Press, shows that the vast majority of the decline in these hours concerned independent workers (IWs), at 3.7 million hours. There was also a decrease of 790,000 hours of mandatory overtime, and the number of regular hours fell by 1.3 million hours.

This represents hundreds of millions of dollars in savings ($293 million for the months of April, May, June, and July), the largest share of which is attributable to the network’s gradual divestment of private healthcare agencies.

Independent workers cost the network twice as much as regular-time staff, Sonia Dugas, Vice-President of Finance at Santé Québec, recalled in an interview.

The government agency makes no secret of the fact that this transition allows for the reduction of certain positions, always with the aim of not compromising the quality of care and improving access for patients in mind.

Over the past five years, Quebec has invested 75 million hours, which represents 48,000 more people since 2019. “We couldn’t continue like this,” says Dugas.

Hours worked are a significant expense, and it’s part of Santé Québec’s strategy to maximize them to respect the budget allocated to it by the government. “But we don’t do this at the expense of analyzing our performance. If each provider can see one more patient and I end up needing one less provider on the team, then yes, eliminating the position is a strategy at that point,” explains Dugas.

Improving Access

By measuring several performance indicators, Santé Québec is pleased to have successfully improved access to health services while reducing the number of hours worked in the network and, ultimately, expenses.

The government agency reports that in 2024–2025, more than 450,000 surgeries will have been performed, the highest level since 2018–2019 (before the pandemic, which created a backlog of cases). In addition, 215,000 additional appointments were arranged with a specialized nurse practitioner (SNP) in 2024–2025 compared to the previous year.

Dugas explains how Santé Québec achieved these results while reducing the number of hours worked in the health network.

First, this year, the budget was distributed at the beginning of the year. So, all CEOs knew their budget for the full year from the start. “It may seem trivial, but before, 20 per cent of the envelope […] was communicated to institutions in the form of letters. […] That represented hundreds of funding confirmation letters. There were people processing that, and that alone represents efficiency savings,” she explains.

Previously, institutions began their fiscal year without really knowing how much they would be allocated. The amount was only confirmed mid-year. “But that means we’re managing a little more blindly, whereas now, there’s accountability because […] the targets are clear from the beginning of the year,” explains Dugas.

Another Santé Québec initiative was to identify ten activity centers with significant savings potential. The government corporation analyzed the 162 activity centers, which include, for example, general administration with paperwork, the pharmacy, the operating room, etc.

Santé Québec then compared the facilities to see why some had lower costs than others for the same areas of activity. They reviewed the organization of work, for example, by maximizing the use of the operating room.

“Between two surgeries, there is a time called inter-case, which involves cleaning the room and preparing it for a new user. If I reduce this inter-case time, and ultimately don’t need to work overtime in the evening because I’m more efficient during the day, that hour is completely eliminated, and everyone benefits,” explains Dugas.

MOT: Shifting the Problem

Nurses are the ones most affected by mandatory overtime (MOT). On the one hand, the Interprofessional Health Federation of Quebec – FIQ views the reduction in this category of hours positively, but it points to another problem that this creates.

“It’s positive because at least we know we’ll finish at 4 p.m., or midnight, or 8 a.m. But we’ve simply shifted the problem. In some institutions, instead of imposing mandatory overtime, what’s happening is that they’re not replacing people,” says Julie Bouchard, President of the FIQ.

She gives an example. If we take a surgical department with 40 patients, normally there are four nurses who have to be there in the evening for a ratio of 10 patients per nurse. But sometimes, instead of imposing overtime, only three nurses will work. “So instead of having 10 patients, we’re down to about 13 patients each,” says Bouchard.

This will mean that the initial assessment with the patients will take longer. “And we’re keeping our fingers crossed that we don’t have any patients with complications or emergencies arriving in the department, because that would further increase our workload. This also means that healthcare professionals in the department don’t take their breaks or their mealtimes because they don’t have the time to do everything that needs to be done by adding patients like that because we’re not replacing them,” explains Bouchard.

Regarding regular working hours, the FIQ attributes this in part to service closures. It cites the reduction in the number of hours in maternity wards in Bas-Saint-Laurent. Women then have to travel much further to give birth.

“We can easily see that when we reduce the number of beds or when we partially or completely close an activity center, it reduces the number of hours worked,” comments Bouchard.

The Alliance of Professional and Technical Staff in Health and Social Services (APTS) is also concerned about the decline in the number of regular hours. “This worries us greatly because the needs are always increasing. It also means longer wait times, and a wait list means cases that may not be treated or cases that worsen on these lists,” says Robert Comeau, President of the APTS.

As for investing money in the right places, Comeau says he is “closely monitoring” the rollout of the Digital Health Record (DSN). “There’s a huge amount of money going into this, and we can see the cost overruns that are coming. We’re also seeing a rush to roll out the service when it’s not quite ready yet. Our people are extremely worried about this,” reports Comeau. We don’t want to live through a data loss nightmare… We’re not dealing with driver’s licenses, we’re really dealing with people’s health. When we need information quickly, we can’t afford a computer outage.”

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The Canadian Press’s health coverage is supported by a partnership with the Canadian Medical Association. The Canadian Press is solely responsible for this journalistic content.

–This report by La Presse Canadienne was translated by CityNews