Introduction

Over the past two years as CEO of the Montreal Health Authority I have participated in the preparation and now the implementation of what I consider the first real reform in healthcare since the beginning of Medicare in 1970. In my opinion Quebec is undergoing a second “quiet revolution” in healthcare as important as the first one, a revolution not in structure but in the philosophy of how healthcare is provided to its population.
In December 2003, the Government of Quebec adopted draft bill 25, which launched a major reorganization of Quebec’s health and social services system. Initially, the regional boards were abolished and replaced by new regional bodies called Agencies for the Development of Health and Social Services Networks. In January 2004, these agencies were given the mandate to propose a new way of organizing services on their territory, based on the concept of integrated networks, with the goals of bringing services closer to the population, facilitating case management and helping vulnerable patients obtain the care and follow-up they require.

In the spring of 2004, the Montreal agency held a widespread public consultation involving the population, providers of healthcare services and other partners in healthcare delivery. In April, a proposal was made to the Minister of Health, Mr. Philippe Couillard, based on an organizational model of 12 Health and Social Service Centres (HSSC) on the island of Montreal. In June 2004, the agency’s proposal was approved, thus creating 12 out of a total of 95 HSSCs across Quebec. In July 2004 letters patents were issued and the members of the boards of directors of the new HSSCs were appointed by the Minister for a two-year transition period. Since then, the framework required to deploy a new way of seeing and doing things in the area of health and social services has been in place.
The 12 new HSSCs, on the island of Montreal, were formed from the merger of 54 institutions, the abolition of their boards and the selection of 12 new CEOs. Each HSSC was formed from the merger of local community health centres, local community hospitals, long-term care centres and certain rehabilitation centres, such that each HSSC would have the resources necessary to carry out their new mandate. With a responsibility for a population ranging from 100 to 250 thousand, the 1.8 million people of the island of Montreal were divided among the 12 new networks.

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