LCQ7: Governance of Hospital Authority

     Following is a question by the Dr Hon Leung Ka-lau and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (May 30):


     Will the Government inform this Council whether the Food and Health Bureau had appointed any consultant in the past two years to conduct an assessment of the governance (e.g. issues such as resource deployment, manpower planning, mode of service delivery or waiting time, etc.) of the Hospital Authority; if it had, of the assessment results; if not, whether such an assessment will be conducted in the future, and of the details?



     The Hospital Authority (HA) is an independent statutory body established under the Hospital Authority Ordinance (Cap 113).  The Ordinance includes provisions specifying that HA should use the resources efficiently to provide hospital services of high quality.

     To ensure accountability to the public for the management and control of the public medical services system, three Government officials (including the Permanent Secretary for Health, the Director of Health, and the Deputy Secretary for Financial Services and the Treasury) are ex-officio members of the HA Board and participate in the governance of HA.  The Secretary for Food and Health holds monthly meeting with the management of HA for the purpose of monitoring its work.  Moreover, the Government will set out the performance targets of HA in the Controlling Officer's Report under Head 140 in the Government's Estimates for each year.  These performance targets cover various aspects, including access to services (such as waiting time), delivery of services, quality of services, cost of services and manpower, etc.  Through regular reports submitted by HA, the HA Board and the Government assess and examine the performance of HA in accordance with these targets.

     In addition, being an independent statutory body and under the governance of its Board, HA has a comprehensive mechanism for conducting internal and external reviews from time to time to examine its operation and services in an effort to achieve efficient use of its resources and provide quality healthcare services to the public in a more effective manner.

     For the purpose of maintaining and improving quality of healthcare services, HA will closely monitor the performance of its hospitals based on the principles of independence and professionalism.  These include self assessment based on established international standards and peer evaluation by external institutions on the service performance of hospitals.  HA will also formulate and adopt measures to improve quality of hospital services continuously with reference to code of good practices, standards and principles commonly used internationally, in order to enhance the service quality of hospitals.

     In addition, HA launched the pilot scheme on hospital accreditation in 2009 in cooperation with the Australian Council on Healthcare Standards. Five HA hospitals participated the pilot scheme and all have been awarded four-year full accreditation status.  HA will further extend the hospital accreditation scheme to another 15 hospitals in the next five to seven years.

     In order to have an objective and comprehensive examination of its development in various aspects, HA has engaged independent consultants for conducting assessments in the past years.

     For example, HA commissioned a consultant last year to conduct a review on the structural reorganisation of the HA Head Office implemented since November 2006.  The review was completed at the end of last year and the consultant's recommendations were accepted by HA with measures being put in place step by step to strengthen the HA Head Office's functions in cluster co-ordination, corporate communications, staff communications and grade management.  In addition, after review, HA has proceeded to set up a consolidated corporate risk management framework to identify and handle the potential risks faced by HA in its various business areas.

     HA has also conducted other reviews related to its management structure to examine how the HA Management manages the operation of HA.  As affirmed by the findings of the review, the current governance framework of HA can afford reasonable assurance that it can facilitate the effective deployment of the resources of HA to achieve its corporate targets.  HA is now implementing in a gradual manner the various recommendations put forward by the consultant including rationalising the terms of reference of some administrative committees, modernising its corporate communications strategy as well as strengthening the training of management personnel.

     In order to further improve the standard of clinical services and the mechanism for patients safety to meet effectively the increasing demand for services and the rising expectation from the community, HA appointed a consultant in early 2012 to review the professional governance of clinical practice.  The review is expected to complete in June this year.

     Apart from engaging independent external consultants for assessment in different areas, HA also conducts internal reviews from time to time.  On resource allocation, HA has been adopting an approach that integrates its service planning and resource allocation through a structured framework and defined process to ensure the best use of resources for the delivery of quality service to the public.  As for service planning, the drawing up of the annual plans at hospital and cluster levels is guided by the overall direction and priority service planning at the corporate level.  Both the HA budget and the resource allocation among hospital clusters are put to the Finance Committee and the Administrative and Operational Meeting of the HA Board for consideration and endorsement.  The allocation of resources within each cluster is essentially based on the service programmes and targets as defined in the process of drawing up the annual plan.

     HA has also put in place a resource management framework, under which resource inputs are linked up with service outputs, targets and quality standard.  The use of resources at cluster level is then monitored and evaluated by the HA Head Office in an objective manner through a financial and performance reporting system.  The clusters are requested to submit regular reports to the HA Head Office to show its performance indicators in regard to its service activities, manpower and financial situation, clinical outcome and progress of its annual plan.  HA will examine closely any variations from the pre-determined targets and where appropriate, take remedial actions with corresponding adjustment in resource allocation.

     On manpower planning, HA will regularly assess and make projections on the growth of demand for its various healthcare services and staff turnover so as to determine the number of healthcare staff required to be recruited each year in the coming years for implementing various services included in its annual plan to meet the healthcare needs of the public.

     On service delivery models, when formulating its five-year strategic plans and annual work plans, HA conducts extensive consultation with its frontline healthcare staff, patients' groups and other stakeholders.  Regular reviews are also conducted on the service delivery model of public hospitals from time to time, including the introduction of public-private partnership (PPP) model for provision of quality healthcare services to the public.  Since 2008, the Government has, in collaboration with HA, implemented a number of PPP pilot projects to provide patients with subsidies to use outsourced services and promote PPP in healthcare.  These pilot projects include the Tin Shui Wai Primary Care Partnership Project, Haemodialysis Public-Private Partnership Programme, Cataract Surgeries Programme, and magnetic resonance imaging and computerised tomography scanning services project.

     Regarding waiting time, HA has always been concerned about the waiting time required for the public to use various public hospital services and has set up an ad hoc working group to review the waiting time problem.  In the case of specialist out-patient (SOP) services, for instance, HA has taken various measures to shorten the waiting time at SOP clinics, such as implementing a triage system to ensure that the public can be given timely and appropriate treatment.  HA will review the operation of its various services from time to time, closely monitor the waiting time for its services and conduct internal audits of its various major service areas with a view to formulating and implementing improvement measures.

     On organisational structure, in the past two years, HA followed up on the cluster structure review commenced in 2007.  After thorough consultation, HA made further improvements on the cluster management structure in January 2011 to define more clearly the powers and responsibilities of all hospitals and departments under each cluster and facilitate efficient delivery of appropriate and holistic services to the public.  Such improvements included streamlining and standardising the existing roles of the management positions in all clusters, service re-engineering, as well as appointment of Deputy Hospital Chief Executives and designated Specialist Clinical Co-ordinators and Cluster Service Directors.

     The Government will continue to closely monitor the services of HA and conduct assessment when necessary with a view to ensuring that HA's operation and the services it provide suit the needs of the community.

Ends/Wednesday, May 30, 2012
Issued at HKT 15:56