Ratios for safe care
During the last negotiations, we obtained that the joint (parity) committee on the task and organization of work will address the pertinence and feasibility of safe healthcare-to-patient ratios by setting up pilot projects. Since then, the work has been well underway and we have every reason to believe that we are moving in the right direction. Yet, for several days, there has been a persistent rumour that Minister Gaétan Barrette was about to impose “his own” ratios, even before the pilot projects started. We know that the Minister of Health has already asked certain institutions to comply with the ratios of Professor Philippe Voyer and his colleagues1.
This perspective is disturbing, first because the minister seems to have decided to cut corners in implementing the pilot projects and secondly because Mr. Voyer’s ratios are not based on an evaluation of the patients’ needs. They are budgetary ratios describing the staffing levels in the CHSLDs in Québec where the quality of the care was better. These ratios are an average established over a three-month period in 2014 by observing a group of about thirty healthcare professionals in only a few CHSLDs.
It is these averages that the minister is proposing to blindly apply to the entire network. In addition, he is ignoring certain other observations of Voyer et al., namely the administrative overload and the poor organization of care which can take up to 46% of the work time of the nurses studied2.
The FIQ is repeating our willingness to collaborate with the government in carrying out the pilot projects and the analysis of the resulting data. We are also prepared to provide the decision-makers in the network with the expertise gathered during the Symposium international sur les soins sécuritaires that we organized last fall and during which several experts came from the four corners of the world to tell us about their respective experience on the subject.
Imposing ratios which would result from a foolish accounting logic is of concern for the services to the population: safe ratios take into consideration an ensemble of variables (organization of work, composition of the nursing team, acuity of the care required by the patients, etc.) and are not calculated by dividing the number of beds by the number of healthcare professionals! Already, some of our members have been told that the positions of healthcare professionals would be abolished, in response to the minister’s order to apply the “Voyer ratios”.
If he decides to officially apply these “ratios”, the minister would be showing flagrant carelessness. Especially since he would be bypassing the several months of discussions between the ministry, the FIQ and the other partners involved in the project. For the FIQ, the purpose of the safe ratios is to ensure quality and humane care, and not to endorse the traditional accounting vision of care.
If the minister is trying to dramatically change this project in order to meet political imperatives, while letting the population believe that he has resolved the problems in the CHSLDs, you can be assured that we will be there to tell it like it is.
1. Voyer, P. (2016) « Pénurie de soins ou pénurie d’infirmières? », Perspectives infirmières, 13(3), p.45-50.
2. Ibid.