The Governance of Health and Social Services Institutions in Quebec

Ensuring Healthy Governance

A group of experts issues a report on corporate governance in the healthcare system and proposes concrete measures for improving the oversight of health and social services institutions in Quebec ?

Improved performance within the healthcare system requires the boards of directors of healthcare institutions to have broader powers and clearer responsibilities so they can provide more effective service and cost control.

This is the conclusion drawn by a Working Group on the governance of health and social services institutions. The Group maintains that the oversight of Quebec’s healthcare system must be decentralized rather than remaining under the nearly exclusive control of the Ministère de la Santé et des Services Sociaux (MSSS), as it has for the past 35 years.

Before any consideration can be given to injecting more money into the system, and without prejudging the role of the private sector in healthcare, the Group stresses that it is essential that changes be made in the way these public institutions are run in order to improve their performance. The Working Group is made up of 10 experts who have met many times over the past year, at the initiative of the Institute for Governance of Private and Public Organizations (IGPPO).

Chaired by André Bisson, former chair of the Hôpital Notre-Dame board and current chair of the board of directors of the CIRANO interuniversity research centre, the Working Group has issued nine recommendations, which should serve as starting points for the improvement of oversight practices for healthcare institutions. Following are the highlights of its report:

• The majority of board members must not be employees of the institution and must be chosen for their management and other relevant expertise. Each board must have a majority of external board members who are qualified, credible, competent, attentive to the concerns of the general public and able to contribute to the decision-making process of an organization with a budget in the hundreds of millions.
• The current system of electing board members is not a true expression of democratic ideals. It needs to be replaced with a rigorous system of appointing independent board members.
• Boards must have no more than 15 members. The ideal composition would be five members chosen by internal stakeholders, two members from regional bodies and eight independent members appointed by way of an internal board process.
• Board members should receive a modest level of compensation designed to foster responsibility and accountability. The Group recommends a director’s fee of $300 per meeting.
• For greater efficiency, boards should set up committees to study the more complex aspects of corporate governance in healthcare institutions.
• The Working Group is of the opinion that boards must focus their attention on four core priorities :

– Appointing and assessing the performance of the executive director and setting the corresponding salary based on his or her ability to achieve specific objectives.
– Guiding, reviewing and approving strategic objectives to be integrated into annual action plans. Strategic partnerships should be considered a priority.
– Assessing the performance of programs and services based on objective data on the quality of care and services provided, user satisfaction and the attainment of budgetary objectives.
– Appraising the performance of the board of the directors on a yearly basis.

• Boards must implement stringent reporting practices. The more self-sufficient institutions wish to be, the broader their responsibilities. Boards must ensure full public transparency and accountability with respect to certain service- and budget-related performance indicators.