In response to the Report of the Steering Committee on Review of Hospital Authority released by the Hong Kong Government in July, the Hospital Authority has formulated an Action Plan (Plan) for implementing in three years 124 action items across five areas with 10 recommendations. This issue’s Cover Story will highlight some of the Plan’s key initiatives, and reviewed the staff forum held in early November.
Establishing a better balance between demand for and supply of medical services is a major concern in Kowloon Central Cluster (KCC) and Kowloon West Cluster (KWC). One key initiative under the Plan is regrouping Wong Tai Sin district and Mongkok area, which are currently part of KWC, under KCC. This will result in Kwong Wah Hospital, Tung Wah Group of Hospitals Wong Tai Sin Hospital and Our Lady of Maryknoll Hospital becoming part of KCC. Administrative arrangements for this regrouping exercise will be in effect by late 2016.
This redrawing of cluster boundaries will narrow the gap between the medical needs of the serviced population and the clusters’ capacity for providing such care. To give one example, there will be a better balance in terms of the number of available hospital beds per 1,000 people. The change will require the reorganisation of the provision of care in both KCC and KWC, giving appropriate consideration to acute care, extended care, primary care and community care services.
The Plan also proposes reorganising the number of hospitals managed by HA’s various Hospital Chief Executives (HCEs) to bring the scope of duties of all HCEs to a comparable level and to facilitate job rotation among HCEs. The proposed changes will be phased in over three years, taking into account the existing service tenures of HCE incumbents and the need to dovetail with cluster boundaries. The proposed changes will be put before the HA Board for endorsement in December this year. Below are the hospitals which have been suggested and grouped to be managed by seven HCEs. These HCEs can depend on the necessity of the individual hospitals follow up on consequential appointment of Deputy HCEs to support them.
Hong Kong West Cluster
HA will mobilise in 2015/16 and 2017/18 an additional HK$300 million to finance ‘catch-up’ plans for Kowloon East Cluster (KEC), New Territories East Cluster (NTEC) and New Territories West Cluster (NTWC). The main thrust of the plans is to address deficiencies in service capacity, particularly with respect to manpower shortfalls in nursing, allied healthcare workers and supporting staff.
.jpg)
The optimal allocation of resources plays a crucial role in supporting the provision of quality healthcare services. HA will develop a refined population-based resource allocation model that uses data on local population demographics, provision of designated services and cross-cluster movement of patients to better understand current and future service needs. This model will support the development of robust short, medium and long-term service plans and ensure HA’s resources are allocated to maximum service effect.
HA will solicit the clusters and frontline staff for their opinions. Starting from third quarter of this year, biannual meetings with each cluster to share ideas on model development and potential application of analysis findings will be held. In the third quarter of 2016 a consultation paper to solicit views on model from frontline will be published. An external consultant will be engaged to validate the model’s approach and framework. The model will be finalised by the first quarter of 2017.
Meanwhile, HA will simplify the procedures of resources bidding and allocation process in order to minimise the administrative workload of frontline clinical staff. Training workshops will be organised for frontline users to consolidate the workflow of Annual Planning System (APS) during the first quarter of 2016. At the same time, over 10 systems enhancements will be implemented to the APS to improve system functionality, facilitate automation and reduce administrative work.
Enhancing transparency of the resource bidding and allocation process is also one of the initiatives in the Action Plan. It is suggested that briefing forums will be held in the first quarter of every year for Coordination Committee and Central Committee members, clusters and HAHO subject officers in a bid to explain the rationale and considerations behind the final decisions and allocation result of submitted proposals. Feedback concerning the submitted proposals will be given to stakeholders involved as well.
The high demand for Specialist Outpatient Clinic (SOPC) and Accident & Emergency (A&E) services are resulting in extended waiting times for some patients, particularly for the high pressure areas in Orthopaedics & Traumatology (O & T) and Psychiatric SOPCs. For example, strengthen the role of Family Medicine Specialist Clinics (FMSC) as it will follow up on stable O & T cases where appropriate, as well as enhance and make use of the referral guidelines and electronic referral system template for neck / back pain.
To reduce the pressure on Psychiatric SOPCs, HA will strengthen the multidisciplinary teams that provide mental health services for children and adolescents and for adult patients, such as those dealing with emotional or anxiety disorders. A centrally-coordinated cross-cluster booking system will be piloted in the fourth quarter of this year, under which suitable patients with common mental disorders (CMD) from other clusters will be referred to the CMD clinic in KWC.
HA also plans to re-engineer the A&E work process in 2016/17 and deploy additional medical and nursing manpower to A&E Departments, with the aims of providing earlier assessment and intervention for Category III i.e urgent case patients and ensuring patients receive timely medical treatment. Action will be taken to enhance transparency with respect to making estimated waiting times available to the public and to cut waiting times for Category IV and Category V i.e semi-urgent and non-urgent case patients. The scale and coverage of the A&E Support Session Programme will also be extended.
The service access block is currently most acute at Queen Elizabeth Hospital and Prince of Wales Hospital. HA will continue with efforts to increase service capacity by allocating additional manpower and beds, undertaking refurbishment and minor works projects, and through longer-term planning with regard to the development of major medical facilities. A Key Performance Indicator (KPI) to monitor access block is being formulated and will be presented to the HA Board for endorsement during the first quarter of 2016. A dashboard will be developed to provide real-time information to facilitate bed coordination.
.jpg)
HA will promote the concept of ‘One HA’ to enhance the sense among staff that they are part of one united HA family, rather than just a member of an individual cluster or hospital. Enhancements to job rotation mechanisms will include formulating comprehensive role descriptions, clear objectives, selection and endorsement criteria, and funding arrangements for job rotations at the rank of Chief Executive Officer and above by the third quarter of 2016. During 2016/17, the job rotation programme will expand to include the intra-specialty and cross-specialty rotation of clinical staff. In parallel, the format and boilerplate content of HA appointment letters will be standardised to emphasise the ‘One HA’ family culture and the authority for deployment by HA in case of need.
One-off funding of HK$570 million will be allocated to implement re-employment schemes for suitable retirees to help address manpower shortages and encourage knowledge transfer. Actions under the schemes will include the re-employment of suitable clinical doctors, nurses, allied healthcare workers, pharmaceutical and supporting staff who will retire in 2015/16 and 2016/17. As at 30 September 2015, arrangements have been made to re-employ 60 retiring doctors. Over 110 retiring nurses and allied healthcare professionals are expected to have been recruited by the end of the fourth quarter of 2015, and around 460 retiring supporting staff have been recommended for re-employment.
HA will invest a funding of HK$300 million in enhancing staff training by launching or scaling up a total of 11 related programmes, including scholarships, commissioned training, overseas training, simulation training, staff rotation development programmes, and additional manpower support for training relief to maintain daily service operations. Particular emphasis will be placed on increasing overseas training opportunities for staff in order to facilitate awareness and transfer of best practices from other countries. A structured Healthcare Services Management Training Curriculum will be developed to enhance the core business knowledge of senior executives.
In the fourth quarter of 2015, HA will set up a Central Training and Development (T&D) Committee under the Board’s Human Resources Committee. The T&D Committee will advise on policies and monitor resource allocation to facilitate greater consistency, parity and transparency in the provision of training programmes.
The Human Resources Department at HA Head Office organised a staff forum on 5 November, at which colleagues were able to raise their questions and concerns regarding the Action Plan.
Whether at the staff forums or during visits by HA Chairman and Chief Executive to hospitals, staff members frequently raised questions in relation to the Action Plan and its implementation. The following are some of those questions and answers.
A full-length video of the staff forum on the Action Plan is available at (intranet) http://havideo.home/HAVOD/Video.aspx?vid=1202. To read the details of the Action Plan, please visit (internet) www.ha.org.hk/goto/HAReviewActionPlan/en or (intranet) http://ha.home/visitor/?parent_id=32041&content_id=36669&language=ENG.
