Quebec health managers have been “addicted” to external consultants since the pandemic.
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The University of Montreal Hospital Center has signed contracts with the American consulting firm McKinsey and the National School of Humor.
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Quebec's public health establishments spend millions of dollars on contracts with private firms and consultants to do work usually assigned to their managers. The pandemic and the shortage of executives would be at the origin of this ever-increasing relationship of dependence.
In February, the Chaudière-Appalaches Integrated Health and Social Services Center (CISSS) signed a contract with options, worth $415,000, with an external consultant for a role of medical co-manager. In collaboration with management, this person must notably ensure the management of human, material and financial resources.
When the Sainte-Justine University Hospital Center lost its director of human resources (HRD) last year, hiring a new HR director was not enough. The establishment paid a management coach $50,000 for strategic, tactical and operational expertise to management on the entire human resources management of the organization.
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The CHU Sainte-Justine, in Montreal.
For more than a year, Radio-Canada has listed the contracts awarded to support management by health network establishments. The ease with which they are granted, most of the time over the counter, bothers some public network managers.
The influence of consulting firms
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An executive from a Montreal hospital who does not have authorization to approach this question with us has the impression that his superiors are “addicted” to these consultants.
They don't really trust the internal and only believe what comes from the outside. But, not trusting people is very expensive.
A quote from An executive at a Montreal health establishment
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McKinsey carries out a mandate on behalf of the University of Montreal Hospital Center .
The University of Montreal Hospital Center (CHUM) is already recognized as one of the best Canadian hospitals for its specialized care. But that's not enough for new CEO Frédéric Abergel who intends to rank his establishment “among the best hospitals in the world by 2030.”
For this, in addition to the work carried out internally, he wanted to “enlist the services of professionals to obtain a portrait of the comparison between the CHUM and other similar academic hospitals”. An over-the-counter contract worth $98,808 was signed with the consulting firm McKinsey in August.
The consulting firm McKinsey is well known in Quebec since the pandemic, since it played a central role in the management of the fight against COVID-19 by the government of François Legault.
“Thereafter, the work will continue internally with all the teams,” assures CHUM spokesperson Andrée-Anne Toussaint.< /p>
This year, the CHUM also signed two contracts worth a total of $100,000 with the company Hors Piste for a “mandate of ;support for reflection and strategic positioning” and another for “development of people, organizations and communities”.
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Frédéric Abergel has been CEO of the University of Montreal Hospital Center (CHUM) since February 2023.
Just after the arrival of the new CEO, in March, the CHUM commissioned the National School of Humor, for training called “Humor skills for managers.” The contract, over the counter, cost $60,000.
Over the past year, the Ministry of Health and Social Services (MSSS) has concluded 52 contracts for professional and administrative support services and management support services.
For example, in June, the MSSS retained the services of “a consultant for surgical catch-up.” The department justified the external expenditure of $330,000 “due to the scarcity of resources” available.Last month, the MSSS also mandated a consultant to write “higher complexity and management job descriptions”. Contract amount: $60,000.
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Quebec Minister of Health and Social Services Christian Dubé
The ministry is also currently calling for tenders for a person in charge of external project which must propose “areas for improvement” as part of the management and coordination of the vaccination project.
The CISSS de la Montérégie-Centre has subcontracted the management of the Carignan seniors’ home project to a private strategist, in support and support of senior management. For $94,000, she must plan, organize and coordinate the activities leading to the operationalization of the establishment.
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Model of the future Carignan seniors' home, which should see the light of day in 2024.
Among the neighbors of the CISSS de la Montérégie-Est, it is the firm CIM Conseil which was urgently entrusted, this summer, with the role of project manager for the commissioning of three seniors' homes (Longueuil, Beloeil and Saint-Amable). Amount of contracts: $170,000. The CISSS justifies this need for external help by the departure of the employee responsible for the project.
Even for the clinical management of seniors' homes, the CISSS needed to use a consultant, registered under the name MJPLN investments inc., at a cost of $114,000.
The CIUSSS de l'Ouest-de-l'île-de-Montréal also uses the services of a consultant, at a cost of $88,000, for the seniors' home project.
In recent years, private consultants have really taken on a greater role in dimensions that affect daily life, human resources management, strategy, etc., explains Élizabeth Côté-Boileau , assistant professor at the University of Montreal, expert in health management and strategy.
The fight against COVID-19 has put pressure on public authorities to access broad expertise and make decisions quickly. However, these firms, with their databases, have positioned themselves as the primary source of information for governments during the pandemic (governance, management, analysis, modeling, etc.) and have established themselves as content experts and method experts.
Private consulting firms, during the pandemic, really moved from an advisory role to an operational role in the basic functions of public administration and in strategic governance.
A quote from Élizabeth Côté-Boileau , assistant professor at the University of Montreal, expert in health management and strategy
The phenomenon is not unique to Quebec and is not x27;is not just healthy, recalls the expert.
In June 2022 a study carried out, in part, by researchers from Concordia University and the University of Toronto showed how the pandemic has transformed the relationship between governments and management consultants, helping to strengthen the presence of consulting firms in policymaking and governance.
According to Élizabeth Côté-Boileau, the challenge is to reinternalize these capacities and expertise, especially if we have not contributed to the training of these managers either.
The expert recalls that at the same time, there is a context of human resources crisis for executives who are exhausted.
The issue is to say where the transparency and accountability of governments are when they spend like that. Do we really get a return on our investments?
A quote from Élizabeth Côté-Boileau, assistant professor at the University of Montreal, expert in health management and strategy
Last March, when Minister Christian Dubé declared that he wanted to recruit “top guns» from the private sector to lead the future Santé Québec agency, the Association of Managers of Health and Social Services Establishments had published an open letter to react.
Its CEO, Danielle Girard wrote: There already exist in the public network, Mr. Minister, major managers, worthy of the elite of the sector, and the latter ask nothing better than to be consulted and integrated into the operation of this paradigm shift, as necessary as it may be.
As part of the study of Bill 15, still in progress, AGESSS formally recommended (New window) to the government to provide network managers with the necessary resources, including the addition of network management personnel. human resources, to enable them to achieve the expected objectives, support the return of local managers and, more generally, the management of change resulting from this bill.
The truth is that managers do not have the means to achieve the network's ambitions! Each of them faces issues and challenges that require reinventing themselves daily.
A quote from Extract from an AGESSS press release, December 2022
In its press release, AGESSS wrote that for several years, managers have had to deal with, among other things, a lack of staff, unmanageable working hours, remote management of activities, not to mention the lack of managers, the high supervision rate, the work overload, increasing traffic, etc.
Linda Bambonye, a former manager of St. Mary's Hospital Center, completed four contracts as a consultant for her former employer, the CIUSSS de l'Ouest-de-l'île-de-Montréal. Over the past five years, she has pocketed $218,000. Each time, he was put in charge of the clinical plan of his former hospital.
Last year, the former director human resources assistant for the CISSS Montérégie-Est, Guy Bouffard, was paid by the CIUSSS de l'Ouest-de-l'île-de-Montréal as a “consultant in the retention of nurses”. A $30,000 contract.
We prioritize the hiring of employees rather than the use of consultants, assures the CIUSSS de l'Ouest-de-l'Île-de-Montréal, but the labor shortage that is rife currently requires us to occasionally use them to benefit from their expertise and ensure we offer quality services to our population.
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Francine Dupuis, former deputy CEO of the CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, obtained a contract for her former establishment, as a consultant.
Barely leaving the CIUSSS West-Central Montreal, in the fall of 2022, former deputy CEO Francine Dupuis concluded a $252,000 contract with the establishment for a one-year mandate. year as a consultant for general management. However, the contract was canceled. The CIUSSS mentions an error resulting from a breakdown in communication between two services.
Last month, the CIUSSS concluded a $70,000 contract with a consultant registered under the name Services Experts DF Inc. In the company register, we see that a certain Francine Dupuis is the president.
The CIUSSS du Centre-Ouest-de-l’Île-de-Montréal has growing needs in hand -work and expertise in order to meet our various mandates and responsibilities which continue to grow.
A quote from Carl Thériault, spokesperson for the CIUSSS du Centre-Ouest-de-l'Île- from-Montreal
Using retired managers is a good way to put their expertise and skills to good use, according to expert Élizabeth Côté- Boileau.
The bosses of the public network also need help from their former colleagues to manage finances. In June, the McGill University Health Center (MUHC) mandated a retiree, Antonietta Adipietro, for $50,000 to ensure the continuity of operations at the Financial Resources Department and thus prevent a breakdown in service.
At the CISSS de Laval, Gilles Bernatchez had barely retired two months ago, in September, when he was called back as a consultant to help with budget monitoring of the establishment. Contract amount: $67,500.
The same establishment also signed a $68,500 contract last year with a “budget monitoring consultant”
The CISSS de Laval did not actually have the internal resources to fill these one-off and temporary mandates. The labor shortage also affects administrative staff.
A quote from Marie-Eve Despatie-Gagnon, spokesperson for the CISSS de Laval
Cindy Starnino also retired and returned as a private consultant to her former employer, the CIUSSS Centre-Ouest-de-l’île-de-Montréal, where she was on the management team. Since August 2022, it has been awarded four contracts totaling $287,000. Presented as an expert consultant, she was notably responsible for management consulting services for general management, the preparation of the strategic plan and even… finding ways to ensure the retention of managers.
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