The Hospital Authority (HA) provides public healthcare services to the people of Hong Kong through the Head Office and seven hospital clusters:
Head Office and Cluster Reports present an overview of the performance of HA Head Office and Clusters under six corporate strategic intents and also achievements in contributing to a friendly environment.
The HA Head Office (HAHO) aligns corporate values and directions. It plays a strategic role in leading corporate development and supporting hospital clusters through interactive collaboration of seven divisions, namely Cluster Services, Corporate Services, Finance, Human Resources, Information Technology, Quality & Safety, and Strategy & Planning.
The HAHO initiated some 125 corporate targets in 2013-14 under six strategic intents outlined in the HA Annual Plan.
To allay staff shortage, HA implemented enhancement measures to attract, motivate and retain a quality workforce through the recruitment of 291 resident trainees, 12 non-local doctors, 2,097 nurses and 529 allied health professionals during the year.
300 students enrolled in the Higher Diploma in Nursing Programme while 100 were trained as enrolled nurses. 26 specialty courses and 270 competence enhancement programmes were organised for nurses. 1,600 newly recruited nurse graduates were trained on preceptorship programmes. To meet escalating demand for maternity services in public hospitals, midwifery training programmes with an annual intake of 75 midwife trainees were launched.
26 candidates were offered 3-year overseas scholarship in the United Kingdom with a view to alleviating inadequate local supply of podiatrists and diagnostic radiographers. 68 programmes were designed for allied health and pharmacy professionals to meet service needs and to enhance professional competence.
Training and development initiatives were enhanced both locally and overseas to strengthen clinical and management competence and provide career development opportunities for doctors, nurses and allied health professionals. Development posts for job rotation at senior management level were offered to senior nursing and allied health staff to foster succession planning. A total of 46 frontline doctors were promoted to associate consultant positions.
Clinical skills of doctors were enhanced through 20 simulation training programmes. Central Orientation Programme was designed for intern doctors, covering both personal competence and technical skill training with scenario-based patient safety components and procedural skill practices.
HA’s endeavour in training and people development was commended by the Employee Training Board as ‘Manpower Developer’ for the second year. Training courses for 1,020 frontline managers and 3,719 supporting staff continued to strengthen people management capability and personal and functional skills respectively. About 300 online training programmes offered web-based learning resources for staff.
120 healthcare workers completed formal mediation training and 1,000 frontline staff were trained on complaint management and conflict resolution with an aim to build up HA’s capabilities in improving patient relations and conflict resolution.
HA increased service capacity in priority areas and enhanced management and secondary prevention of chronic diseases with an aim to better manage growing service demand.
Hospital capacity was strengthened in 2013-14 with an addition of 287 beds, including 157 acute beds and 130 convalescent beds to address the service needs for high needs communities, such as Kowloon East Cluster, Kowloon West Cluster and New Territories West Cluster.
HA was also committed to managing high demand life threatening diseases. Cardiac care was enhanced with expansion of emergency percutaneous coronary intervention service from eight to 12 hours in United Christian Hospital, Princess Margaret Hospital and Prince of Wales Hospital. Clinical treatment for stroke patients was strengthened with 24-hour thrombolytic service in Pamela Youde Nethersole Eastern Hospital, Queen Elizabeth Hospital and Prince of Wales Hospital. Transient Ischaemic Attack clinics were set up in Hong Kong East Cluster and New Territories East Cluster, where patients were managed promptly by teams of neurologists and nurses for proper diagnosis and early treatment, hence reducing the likelihood of future stroke events. 28 additional hospital haemodialysis places were provided for patients with end stage renal disease. Cancer service was enhanced with strengthened radiation therapist manpower as well as the use of high technology radiotherapy in cancer treatment.
Management and prevention of chronic diseases was enhanced with anti-vascular endothelial growth factor treatment offered to around 500 new patients with age-related macular degeneration and specialist eye services for 4,000 new patients of diabetic-related eye diseases, including sight-threatening diabetic retinopathy.
For better management of increasing demand in elderly medical care, HA refined the integrated care model (ICM) for supporting elderly patients with high risk of hospital readmission. Implemented measures included an enhanced electronic platform for information sharing with different specialties, and training courses for around 100 ICM team members, including case managers, to strengthen their trans-disciplinary knowledge and skills. The Community Health Call Centre (CHCC) service was strengthened to support high risk elderly patients and diabetic patients.
Service for psychiatric inpatients were improved with strengthened workforce of nurses and allied health professionals in all hospital clusters to provide recovery-oriented treatment programmes to facilitate early discharge and community re-integration. Community care for psychiatric patients was strengthened through extending the case management programme to three more districts to provide intensive and personalised support for around 2,800 patients with severe mental illness. The programme covered a total of 15 districts in the territory, serving 15,000 patients.
HA managed increased workload during high season of flu epidemic of December 2013 through coordinated effort among hospital clusters and augmented buffer capacity in acute and convalescent wards. The arrangement was communicated to the public through different channels such as press conference, television and radio interviews as well as issuing daily service statistics during the Chinese New Year period.
To better manage waiting time, HA enhanced cross-cluster collaboration by establishing a centrally coordinated mechanism to pair-up clusters so that suitable patients of certain specialties of longer waiting time could be referred to those of shorter waiting time. Capacity for services with pressing issues of waiting time and access was increased, such as providing 15,000 additional haemoglobin (HbA1c) tests in four clusters and prenatal screening for Down Syndrome for all eligible expectant mothers.
Public-Private Partnership (PPP) in healthcare services fosters healthy competition and cooperation among service providers. PPP optimises the use of resources in both public and private sectors, consequently shortens waiting time for public healthcare services. Over the past few years, the pilot PPP programmes of purchasing cataract surgeries, primary care service and radiological investigation service from the private sector were implemented. In 2013-14, over 3,000 patients benefited from three pilot PPP programmes. 20 patients in public hospitals were also offered HD treatment under PPP programme.
In strengthening HA’s preparedness and emergency response for disasters and crisis intervention, governance structure on disaster psychosocial services for healthcare staff was established. During the year, six hospitals obtained full accreditation status by the Australian Council on Healthcare Standards, making the total number of accredited hospitals in HA to 12.
Safer service models were developed. The aseptic dispensing facilities in Queen Mary Hospital and Princess Margaret Hospital were upgraded to meet environmental control requirements in aseptic compounding process and improve medication safety. Information technology system was enhanced to support clinical workflow and reduce errors in medication prescription to facilitate service delivery. Paediatric clinical pharmacy service was implemented in eight public hospitals. Medication orders for general paediatric inpatients were screened by clinical pharmacists while drug consultation service was provided for high-risk patients to enhance drug management and compliance.
New software was developed for Unique Patient Identification devices to enhance safety of blood administration procedures by meeting the International Society of Blood Transfusion global standard (ISBT 128) for identification, labelling and information transfer of human blood.
The new In-patient Medication Order Entry system implemented in Princess Margaret Hospital enhanced clinical workflow efficiency and reduced potential medication prescription errors. The next phase of Clinical Management System has commenced to enhance clinical communications and workflow.
HA adopts modern technology and new treatment options to enhance quality and safety. The scope of HA Drug Formulary was widened in the second quarter of 2013 to cover more drugs with accumulated scientific evidence on clinical efficacy. Two self-financed cancer drugs were repositioned as Special Drugs in the HA Drug Formulary for treatment of head and neck cancer as well as malignant pleural mesothelioma. The clinical applications of two therapeutic groups of drugs were expanded for treatment of colorectal cancer and advanced Parkinson’s disease.
Cancer diagnostic service was modernised by providing 130 additional patients with cytogenetic tests and conducting 500 additional predictive molecular tests. Minimally invasive surgery technique was used in 60% of hysterectomy surgeries for suitable gynaecological patients. Bipolar transurethral resection of prostate was available in 16 HA hospitals. 27 suitable patients with advanced Parkinson’s Disease received deep brain stimulation treatment. A total of 91 patients underwent robotic assisted surgery under cross cluster collaborative programme with mult-idisciplinary input.
HA continually upkeeps the standard of medical equipment to ensure safety for patients. With continual funding support from the Government, 612 pieces of medical equipment items were procured. Reserved recurrent subvention was utilised to speed up additional replacement of 362 pieces of medical equipment. All hip prosthesis has been replaced with modern implants.
Patients and community partners were engaged throughout service improvement in public hospitals. A pilot hospital-based patient experience and satisfaction survey was conducted in seven major acute hospitals. An information system was also developed to manage patient complaint and feedback.
HA adopts patient-centred approach in communication with patients and carers. 30 patient resources stations or information kiosks were set up in phases in all hospital clusters to facilitate information sharing on peer support for patients and carers. Around 300 hospital volunteers were trained. Guidelines were promulgated to facilitate visually impaired persons with guide dogs to access public hospitals and clinics.
A proactive approach was adopted to maintain rapport and communicate with the media and community stakeholders to keep them abreast of the latest development in HA policies and services. During the year, 339 media activities were organised, 540 press releases issued, 230 articles contributed to various media platforms, 1,800 media enquiries and 180 community enquiries handled. Community roving exhibition was organised at 16 locations in the territory to arouse public awareness on infection control.
The Government continued its staunch support for public healthcare, with subvention to HA reaching HK$45.5 billion in 2013-14. As a responsible public organisation, we continue to undertake prudent measures on financial management to ensure resources are properly safeguarded and appropriately deployed.
To facilitate value-for-money delivery of quality patient care, HA stays vigilant in revisiting and monitoring resource management to optimise output and performance. Through continuous engagement with different stakeholders in HA, the internal resource allocation framework was modernised with information on resource needs from a total patient journey perspective as an additional reference for resource allocation.
In 2013-14, HA recorded a surplus position mainly due to underspending from manpower shortfall despite measures had been taken to recruit and retain healthcare professionals. Looking forward, manpower shortage in the market and continual brain drain to the private sector remain major challenges for HA.
In respect of long term financial sustainability, HA has discussed medium term resource requirement with the Government and supported the long term fiscal planning exercise by estimating the resource need to meet challenges of ageing population and rising service demand.
With funding support from the Government and Hong Kong Jockey Club Charities Trust, the fleet of Non-emergency Ambulance Transfer Service (NEATS) vehicles was further strengthened with replacement of nine vehicles and addition of 15 environmental-friendly liquefied petroleum gas vehicles. Waiting time for NEATS service was shortened and service enhanced.
To better manage growing service demand, a series of hospital development projects are in the pipeline. Key milestones achieved included completion of construction works for the new ambulatory and rehabilitation block for phase 2 redevelopment of Caritas Medical Centre, and commencement of construction works for Tin Shui Wai Hospital and Hong Kong Children’s Hospital at the Kai Tak Development Area. Renovation works were carried out in six general outpatient clinics (GOPCs) to improve patient flow, barrier free access and environmental conditions. Review of designs for barrier free access in all GOPCs and 16 acute hospitals was completed.
Technology facilitates delivery of modern healthcare services. Digital imaging technology was extended to 38 hospitals in HA, greatly reducing the use of traditional films and improved service efficiency through electronic medical records.
The Enterprise Resource Planning system previously implemented in most hospitals to administer HA’s payroll, financial and procurement transactions was upgraded, ensuring effective performance and also enabled HA to benefit from the latest technology enhancement. The patient billing system was rolled out to all public hospitals, providing flexibility for patients to pay at any hospital and improve timeliness and accuracy.
Patient data privacy is of prime importance in HA. Ongoing education and training for staff on personal data protection upkeeps general awareness on privacy protection. In pursuant to the established policy, resources were allocated to drive various privacy protection initiatives, including regular audits and privacy compliance checks. To strengthen technological controls on network and system security, HA has joined the Cyber Security Centre initiative of Hong Kong Police Force in protection of HA systems against cyber attacks.
HA enhanced the level of quality assurance and risk management processes to improve the stability and accuracy of all IT systems, identify and understand the root cause associated with system failure, and take remedial actions to ensure that the likelihood of further failure occurrences are minimised.
HA continued to provide technical agency services to the Hong Kong Government in developing the eHealth Record Sharing System, Elderly Healthcare Voucher Scheme, Vaccination Subsidy Schemes, Primary Care Directory System and Communicable Disease Information System.
During the year, the HA Board implemented a good number of enhancements on corporate governance structure and processes, following the recommendations of a comprehensive review of governance practices completed in 2012-13 (the Corporate Governance Review). These enhanced corporate governance practices, together with various corporate policies approved and adopted by the HA Board over the years, were consolidated and documented into a Code of Corporate Governance Practices to provide detailed and transparent reference for Members of the HA Board and its committees, guiding them in performing their roles and responsibilities on the governance front.
At the cluster/hospital level, the enhanced corporate governance practices as recommended in the Corporate Governance Review were progressively implemented and documented in the updated Manual on the Operation of Hospital Governing Committees.
HA strives to foster a greener environment through implementing various environmental conservation measures and practices, thus continuously improving its environmental performance.
New hospital projects in HA are designed and constructed with prevailing best practicable environmental standards. Various energy conservation features, including high efficacy lighting, energy-efficient air-conditioning, hot water, lift and escalator systems were incorporated as standard provisions in new facilities. Other green features, such as application of renewable energy, water recycling, and soft landscaping also provide environmental benefits as well as healing environments for patients.
In 2013-14, the new North Lantau Hospital was awarded a Hong Kong Building Environmental Assessment Method (HK-BEAM) Platinum certificate in recognition of sustainable design and remarkable environmental achievements. Similar energy conservation technologies were also adopted in other HA facilities through renovation and retrofitting projects whenever appropriate. These initiatives can help HA reduce carbon emission and offset the rising trend of energy consumption incurred by new facilities and increasing hospital activities. The HA Head Office and 32 public hospitals and institutions have met the carbon emission reduction standard of the Hong Kong Awards for Environmental Excellence Scheme and awarded with Carbon’Less’ certificates.
Various waste reduction and recycling programmes continued in hospitals to protect the environment. A total of 3,100 tonnes of recyclables including waste paper, plastic, metals, glass bottles, used clothes and food waste were collected. HA also facilitated non-government organisations in various recycling programmes including used clothes, plastics, glass, electrical appliances and furniture. 18 hospitals achieved the Certificate of Appreciation for Used Clothes Recycling Programme 2013 from Friends of the Earth. A total of 27 hospitals and institutions were awarded the Class of Excellence Wastewi$e Label of the Hong Kong Awards for Environmental Excellence.
Continuous efforts were made to introduce environmental friendly LPG vehicles, with replacement of nine Non-emergency Ambulance Transfer Service vehicles and 15 more added in 2013-14.