FIQ (Fédération Interprofessionnelle de la santé du Québec)

Safe healthcare professional-to-patient ratio pilot projects

Announcing the safe healthcare professional-to-patient ratio pilot projects! Thirteen ratio pilot projects will begin by this summer and four more will begin during fall 2018. For more information, check out the frequently asked questions (FAQ), press releases and news feed. The FIQ will keep you informed of any developments throughout the process and regularly update this page.


FREQUENTLY ASKED QUESTIONS

 

What is the objective of the ratio pilot projects?

The objective of the ratio pilot projects is to implement safe healthcare professional-to-patient ratios in 17 units in different regions across Quebec. By summer, 13 of the pilot projects will have begun in units in medicine, surgery and long-term care; in the fall, 4 additional pilot projects will be launched in a private subsidized institution, respiratory therapy, home care and an emergency department.

The purpose of the ratios is to set up conditions that enable healthcare professionals to provide quality, safe care.

The FIQ’s ultimate goal is to achieve guaranteed safe ratios for all Quebec health care institutions, regardless of their mission. The best way to do this is to pass legislation on safe ratios.

Where will the pilot projects take place, when will they begin and how long will they last?

There will be one pilot project in each Quebec region. Implementation of the first 13 pilot projects began on April 19 and will continue until May 30. The pilot projects will run a little over 6 months but it is understood that the ratios could be maintained thereafter.

Medicine

  • Lakeshore General Hospital (CIUSSS de l’Ouest-de-l’Île-de-Montréal)
  • Centre hospitalier régional du Grand-Portage (CISSS du Bas-Saint-Laurent)
  • Hôpital Saint-François d’Assise (CHU de Québec))
  • Hôtel-Dieu de Lévis (CISSS de Chaudière-Appalaches))
  • Hôpital Le Gardeur (CISSS de Lanaudière)

Chirurgie

  • CHAUR de Trois-Rivières (CIUSSS de la Mauricie–Centre-du-Québec)
  • Hôpital du Sacré-Cœur (CIUSSS du Nord-de-l’Île-de-Montréal)
  • Centre hospitalier d’Amos (CISSS de l’Abitibi-Témiscamingue)
  • Hôpital du Suroît (CISSS de la Montérégie-Ouest)

CHSLD

  • CHSLD de Bagotville (CIUSSS du Saguenay-Lac-Saint-Jean)
  • Hôpital général de Québec (CIUSSS de la Capitale-Nationale)
  • Hôpital et centre d’hébergement Argyll (CIUSSS de l’Estrie–CHUS)
  • Centre d’hébergement de Mont-Tremblant (CISSS des Laurentides)
How were the units selected for the pilot projects?

The projects will be run within the unit and not throughout the institution. The provincial joint committee, made up of representatives from the Health Ministry and the FIQ, discussed which units to select. There had to be one unit in each region in Quebec. The units had to cover several mission and institution types and the units had to have the short-term prerequisite conditions for implementing the ratios.

Who will oversee the implementation of the pilot projects?

For each pilot project, a local joint committee made up of three representatives from each union and employer party will be in charge of implementing and monitoring the pilot projects. The committee will be supported by a local project lead and all of the FIQ members within the unit will help to monitor the pilot project in their own way.

What safe healthcare professional-to-patient ratios will be implemented?

The range of ratios determined with the FIQ are based on scientific literature, adapted to the Quebec healthcare model, and are intended to enable the provision of safe care. The ratios could be increased based on the needs of patients in the care units. Many factors need to be set up in order to implement the ratios.

SURGERY RATIOS AND MIXED UNITS

 CARE TEAM
NURSE + LPN DYAD
COMPREHENSIVE CARE (NURSE)
DAY1: 7 to 9 + AIS without a patient load1: 4 to 5 + AIS without a patient load
EVENING1: 8 to 10 + AIS without a patient load1: 5 to 6 + AIS without a patient load
NIGHT1: 10 to 12 + AIS without a patient load (as needed)1: 6 to 7 + AIS without a patient load (as needed)

MEDICINE RATIOS

 CARE TEAM
NURSE + LPN DYAD
COMPREHENSIVE CARE (NURSE)
DAY1: 7 to 9 + AIS without a patient load1: 4 to 5 + AIS without a patient load
EVENING1: 8 to 12 + AIS without a patient load1: 5 to 7 + AIS without a patient load
NIGHT1: 10 to 14 + AIS without a patient load (as needed)1: 6 to 8 + AIS without a patient load (as needed)

CHSLD RATIOS

 CARE TEAM
NURSE + LPN DYAD
DAY1: 20 to 27
EVENING1: 25 to 32
NIGHT1: 37 to 44
What are the main phases of the ratio pilot projects?

a) Set up the local joint committee and initial meeting
b) Pre-implementation phase (calendar, planning, measures) [2 months]
c) Implementation — following ratios [4 months]
d) Final phase — project report and planning long-term measures.

We will use specific indicators to measure the project’s short-term impacts. Some impacts, however, can only be measured over the long-term. If you are part of a unit that will receive a pilot project, you will be called on to document your practice during the implementation of the ratios. Your participation is extremely important to ensuring that the report reflects your reality.

What will happen in the units once the pilot projects are over? And then after the elections?

The FIQ is working to have the ratios maintained after the project is over. In the final project phase, recommendations will be made to maintain the ratios.

As for after the elections, the FIQ is working to get all political parties to firmly commit to pursuing this initiative.

Why weren’t the new ratios implemented throughout the whole health network?

Implementing the ratios is a large-scale project for the health network and needs to be carried out step by step. Just a few months ago, we were hoping to get 1 or 2 pilot projects started and now we are planning 17 ratio pilot projects. The FIQ’s ultimate goal is to achieve guaranteed safe ratios for all Quebec health care institutions, regardless of their mission.

Will the pilot projects generate even more mandatory overtime?

The pilot projects are not intended to generate an increase in mandatory overtime. During the pre-implementation phase of the project, the local joint committee will plan the measures to ensure the ratios are followed, while boosting team stability. The rate of overtime and other indicators of team stability will be monitored throughout the project. Overall, the objective of the safe ratios is to improve work conditions for healthcare professionals and care safety. In other areas of the world where ratios were implemented and legislation passed, measures to attract and retain staff were also added to support ratio implementation.

Why is it necessary to have a law on safe ratios?
  • It’s necessary if we want to guarantee safe ratios—giving and receiving safe care is a right!
  • To take it out of the hands of managers and politicians.
  • To prevent a new minister from back tracking.
  • Because 80% of the Quebec population agrees it should be set down in legislation.