Quebec's Minister of Health Christian Dubé promised to "shake the pillars of the temple" through his new health reform - but "without causing a big explosion".

After drafting his health reform bill during 2023, the minister will lay the foundations for the new Santé Québec Crown corporation in 2024.

But even with the "best leaders" at the helm, many observers expect significant disruptions.

The "Law to make the health and social services system more efficient" was enacted under a publication ban order in the early hours of December 9. The massive Bill 15, which contained 1080 articles at the time of submission, ended up with more than 1600 articles due to incomplete analytical work despite spending nearly 300 hours in the parliamentary committee.

Also, although Dubé repeatedly mentioned that reengineering the network would improve access to care and working conditions for professionals, Quebec residents should not expect immediate effects.

In fact, during the vote to adopt Bill 15, the minister took care to reassure network employees, saying he wants to implement the transformation "transparently" and "cautiously" and at the speed that suits them. He said: "I believe we need to recognize how often reforms can be successful, and how often they can be less successful."

At the heart of Dubé's reform is the creation of a government corporation to coordinate the operations of the entire Quebec healthcare network.

Alberta and Nova Scotia adopted a similar model. In both cases, the transition did not go smoothly, according to a research report written by Quebec’s Health and Wellness Commissioner Joan Castonguay.

The commissioner warned of the "limits of the rigid structural approach to governance transformation". Opposition parties have tried their best to portray the Coalition Avenir Québec (CAQ) project as "just another structural reform".

This criticism was also expressed by the FMOQ, or Fédération des médecins omnipraticiens du Québec (Quebec Federation of General Practitioners).

Also according to Commissioner Castonguay, "culture plays a crucial role". She warns that "structural change (...) may have limited contribution to achieving results if the mindsets of the players in this system do not align with the intended goals."

Undoubtedly, this explains why Christian Dubé focuses so much on his desire to instill a "culture change" in hopes that the network will embrace his "results-oriented" vision.

This philosophy is well reflected in the increase of performance indicators implemented by the minister, including the famous online dashboard.

Nevertheless, this "commitment" to change, described by the commissioner as a crucial element of the transformation strategy, is not inevitable, according to Lys Goulet, head of the Health Solidarity Alliance and advisor to the CSQ union.