A paramedic loads his stretcher back into the ambulance after bringing a patient to the emergency room at a hospital in Montreal, on April 14, 2022.Ryan Remiorz/The Canadian Press
It is hard to imagine a more daunting management assignment than the one Quebec is preparing to hand to the still-to-be-chosen head of the province’s new health care superagency.
Under legislation adopted in December, Santé Québec is set to become the province’s largest employer with more than 325,000 employees, and with a mandate to make the $60-billion health care sector more efficient and innovative.
The new chief executive officer will be expected to apply private-sector management practices and measurement tools to a sector more accustomed to command economy diktats and constraints. And all for a fraction of a private-sector salary.
The person that Health Minister Christian Dubé is seeking to run the new Crown corporation faces a colossal task transforming a health care sector that operates in silos run by career bureaucrats into a unified entity that puts patient services first.
While other provinces have undertaken similar restructurings in recent years, Quebec’s reforms appear to be the most ambitious yet. The new arm’s-length superagency will oversee all aspects of health services. More than 1,500 health care institutions, from hospitals to long-term care homes, will fall directly under its umbrella.
Mr. Dubé, who was formerly a senior executive at forest giant Cascades, has made it clear he is looking to recruit a “top gun” from outside the health care bureaucracy to run Santé Québec. The new CEO is expected to instantly become the public face of the Quebec health care sector. They will be held to account for emergency-room overcrowding and surgery waiting lists.
The new CEO will also oversee outsourcing of more services, as Quebec increasingly turns to private for-profit clinics to reduce waiting lists for elective surgeries and diagnostic procedures that have ballooned since the COVID-19 pandemic.
For taking on this task, the new CEO will be paid a base salary of $567,000 a year, with a 15-per-cent top-up (to $652,000) during the first two years in the job.
While that is almost twice the amount the province’s top health care bureaucrats are paid, it is far less than most senior executives earn in the private sector. Why would any corporate “top gun” even apply?
Indeed, the new boss will face stiff resistance from powerful health care unions. The law creating Santé Québec also provides for a reduction in the number of bargaining units in the sector from 136 to just six. The move is aimed at facilitating labour mobility between health care institutions and regions. But union leaders see it as a power grab.
“Exorbitant salaries for ‘top guns’ who are going to manage our network like a business” and leave “the door wide open to privatization,” is how Réjean Leclerc, president of the Fédération de la santé et des services sociaux, a union affiliated with the Confédération des syndicats nationaux, summed up the reforms earlier this month.
According to media reports in the province, Ivanhoé Cambridge CEO Nathalie Palladitcheff and former Videotron chief Manon Brouillette are among those being considered for the top post at Santé Québec – though taking the job would mean a big drop in income for them.
Ms. Palladitcheff is set to leave Ivanohoé Cambridge in April once a move by Caisse de dépôt et placement du Québec to integrate its main real estate affiliate into its own operations is complete. In 2022, Ms. Palladitcheff’s pay package at Ivanhoé Cambridge amounted to $3.16-million, about five times what she would earn as CEO of Santé Québec.
In her final full year as Videotron CEO, in 2017, Ms. Brouillette earned $4.8-million. In 2022, as CEO of U.S.-based Verizon Consumer Group, her total compensation package (including stock awards) amounted to almost US$9.3-million. She is currently a strategic partner in Inovia Capital and has also served as the chairperson of Hydro-Québec since June.
That the names of Ms. Palladitcheff and Ms. Brouillette have circulated as possible candidates to run Santé Québec suggests Mr. Dubé is serious about turning to an outsider to shake up the province’s health care system.
Santé Québec will manage a huge real estate portfolio (which has been Ms. Palladitcheff’s bailiwick at Ivanhoé Cambridge) and provide services to a hard-to-please clientele (which is sort of what Ms. Brouillette did at Videotron). But neither candidate has direct experience in the health care sector or in the bureaucracy. That may be their main appeal for Mr. Dubé and his boss, Premier François Legault, a former businessman and co-founder of Air Transat.
Given the media attention Mr. Dubé's reforms have generated, Santé Québec’s first CEO will face mountain-high expectations and relentless public scrutiny. For want of a private-sector salary, whoever takes the job will deserve a medal.