Stimulating clinical research in Quebec – The potential with Santé Québec

Redefining criteria for the “university” status for a health care establishment

It was during the 1991 reform that the Quebec government officially granted "university" status to health institutions in Quebec. Indeed, paragraph 10 of the first paragraph of section 2 of the Act respecting health services and social services (LRQR c. S— 4.2) (hereinafter "LSSSS") provides that it establishes a mode of organization of resources intended to promote research and teaching. Sections 88 to 91 of the LSSSS provided that the Minister of Health and Social Services, after consulting either the Minister of Higher Education, Research, Science and Technology, or the Minister of Economy and Innovation, could designate as a university hospital center, university institute, or university-affiliated center a health institution. Ultimately, the institution's board of directors had to ensure that it implemented measures to promote teaching and research, in accordance with section 172 of the LSSSS.

After receiving their designation, in accordance with section 110 of the LSSSS, health institutions had the power to negotiate with universities, subject to prior approval from the agency and the written consent of the minister. The contracts must comply with the conditions established by the MSSS (s.110, para.4 of the LSSSS). According to the 1994-06 circular from the Ministry of Health and Social Services, agreements could take various forms, such as affiliation, service, or association contracts, or a service agreement. The circular outlines the general terms to be observed by educational institutions and universities when entering into such contracts.

These agreements are primarily aimed at training healthcare personnel. They do not provide for obligations regarding research or the evaluation of technological innovations in the health field. This trend probably stems from the historical legacy of our healthcare system. The first links between a hospital and a medical school date back to 1823, when the Montreal General Hospital affiliated with the Montreal Medical Institution, which became the Faculty of Medicine of McGill University in 1829. In 1849, the School of Medicine and Surgery of Montreal (future Faculty of Medicine of the University of Montreal) and the Hôtel-Dieu de Montréal concluded an agreement to train healthcare personnel.

With the adoption of the new Act respecting the governance of the health and social services system (LRQR c. G -1 021 — formely designated as the Act to make the health and social services system more efficient, LQ 2023, c.34) (hereinafter "LGSSS"), the minister retains the power to designate a health institution as "university" institution (articles 426 and 427 of the LGSSS). However, Santé Québec is now responsible for promoting teaching and research, as well as ensuring the fulfillment of these missions (art.421 of the LGSSS, corresponding to art.2, para.1, p. 10, and 172 of the LSSSS). The minister retains the power to define the conditions of contracts (art.424 of the LGSSS). The conclusion of contracts is the responsibility of the institutions (art.422 of the LGSSS).

The arrival of Santé Québec is an opportunity to review the affiliation criteria of hospitals and include other performance indicators other then the training of medical personnel. Examples exist worldwide. There are several international examples, such as the National Institute for Health Research in England, the Karolinska Institute in Sweden, the National Clinical Research Center of the National University of Singapore, and the Sheba Medical Center in Israel. Performance indicators can include the number of clinical trials conducted by a health institution, their integration into care pathways, etc.

In return, incentives could diversify. They would no longer be limited to obtaining government funding from other ministries (Economy and Innovation) or organizations (Quebec Research Fund — Health). The minister and Santé Québec could consider incentives, such as participation in discovery revenues or privileged access to innovative technologies.