FIQ (Fédération Interprofessionnelle de la santé du Québec)

Safe ratios

What is a safe healthcare professional-to-patient ratio?

It is a team with a required staff minimum caring for a group of patients with similar health conditions. This minimum can be increased to meet patients’ needs.

Ratios are the most promising solution for reducing healthcare professionals’ excessive workload, a main factor contributing to care omissions, partially completed care or care that does not meet professional standards. The purpose of ratios is to set up conditions that are safe for healthcare professionals, and which enable them to provide safe, quality, humane patient 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 create legislation on safe ratios.

Why fight for ratios?

By ensuring sufficient staffing, healthcare professionals will have time to provide safer patient care that reflects their values and be able to use their full range of skills. Evidence demonstrates that ratios reduce workloads, job dissatisfaction, absenteeism, distress, burn out and work accidents.

This solution has already proven effective in California and some Australian states.

What steps have already been taken to achieve safe ratios?

Since the FIQ learned about just how much safe ratios can improve working conditions for healthcare professionals, as well as care quality, it has taken several steps to implement them:

  • Letter of Understanding No. 17 at the last provincial negotiations: the parties agreed to study the relevance and feasibility of safe healthcare professional-to-patient ratios by setting up pilot projects
  • Symposium and a Special Report on safe ratios
  • Training program on patient advocacy
  • 3,000 healthcare professionals filled out Safe Staffing Forms
  • The FIQ published the Black Book of Care Safety, a solid argument in support of safe ratios
  • At the height of the nursing care crisis, the FIQ managed to broaden the scope of Letter of Understanding No. 17: 17 ratio projects, the majority of which are underway

The next step in the process of implementing safe ratios province-wide is clear:

  • Report on the ratio projects and maintain safe ratios in the units
  • Implement safe ratios in all Quebec regions
  • Pass a law on safe ratios

Frequently Asked Questions – ratio projects

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.

Technical section

This section covers information of a more technical nature about safe ratios. The videos and slide presentations presented at provincial councils include the ratios established for the various centres of activities (surgery, CHSLD and medicine on June 12, 2018; respiratory therapists in intensive care, secondary emergency services and home care on December 6, 2018). They also include details regarding all prerequisite parameters and conditions for implementing ratios.

Lettre d’entente n.17 – Suvi


The following tracts were distributed and/or posted in the units with ratio projects to further explain prerequisite conditions or specific tools for the projects.



Ratios and professional practice – Meeting patients’ needs in terms of support and assistance



For more information

On March 29, 2018, the Quebec government announced the implementation of the first safe healthcare professional-to-patient ratio projects.

The Black Book of Care Safety

Read the Black Book of Care Safety and add your voice to the struggle, as a patient, loved one and citizen.

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