HOSPITAL AUTHORITY

ANNUAL PLAN 2005/06

Table of Contents

EXECUTIVE SUMMARY 1

PLANNING BACKGROUND

1. Introduction 10

2. Review of Progress 13

3. Planning Environment 14

4. Budget Allocation 17

MAJOR DIRECTIONS AND PROGRAMME INITIATIVES FOR 2005/06 HA ANNUAL PLAN

5. Major Directions for HA Annual Plan 2005/06 20

6. Improving Population Health 22

7. Enhancing Organisational Performance 25

8. Enhancing Healthcare System Sustainability 30

9. Improving Service Quality and Clinical Governance 34

10. Building Human Resources Capability 40

CLUSTER PLANS

11. Hong Kong East Cluster 45

12. Hong Kong West Cluster 50

13. Kowloon East Cluster 54

14. Kowloon Central Cluster 58

15. Kowloon West Cluster 62

16. New Territories East Cluster 66

17. New Territories West Cluster 70

Hospital Authority Annual Plan 2005/06 i

Table of Contents

APPENDICES

Appendix 1: List of Public Hospitals and Institutions 74

Appendix 2: List of Ambulatory Care Facilities 75

Appendix 3: Background Information on Hospital Authority 79

Appendix 4: Statistics of the Controlling Officer’s Report 81

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Executive Summary

OVERVIEW

1. The Hospital Authority (HA) is responsible for delivering a comprehensive range of hospital, outpatient and community-based services through its network of healthcare facilities. As part of its commitment to enhance accountability and transparency to the community, it has been publishing its Annual Plan since 1992/93, which provides a structured mechanism for the organisation to turn its corporate vision and directions into strategies, goals and operational targets.

2. There are a number of major changes in the external and internal environment of HA that shape the major directions adopted and presented in this Annual Plan for 2005/06:

(a) Key people changes after the SARS epidemic could have important bearings on the healthcare environment as well as the work of HA. These included succession for the positions of the Secretary for Health, Welfare and Food (SHWF), the HA Chairman and the former Director (Professional Services & Human Resources). There were also succession of the Director of Health, Deputy SHWF (Health), Dean of the Medical School of the Chinese University of Hong Kong, and new legislators representing the medical and health services constituencies respectively; all five had been appointed to the HA Board, together with other new members. At the senior executive level, there were new recruitments and reshuffling of portfolios involving Directors, Deputy Directors, Heads of divisions, and three of the seven Cluster Chief Executives. Meanwhile, the HA Board decided that for stability sake, the seven cluster management structure would remain unchanged for three years.

(b) It has been almost two years after the SARS epidemic, yet the organisation still needs to invest very significant resources into tackling the aftermath of SARS. These include continuous multi-disciplinary care for the SARS victims some of whom still suffer complications of this new disease the natural course of which is not completely known, continuous processing of injury-on-duty claims under the Employees Compensation Ordinance together with HA’s insurer on more than 300 cases, providing assistance to the Labour Department in ascertaining the degree of disabilities in some, and managing other legal claims. Other work includes continuous vigilance and response to hospital infectious disease outbreaks and those in neighbouring countries/areas, construction of an Infectious Disease Block in Princess Margaret Hospital, preparing for possible influenza pandemics, continuous effort to strengthen workforce capabilities in infectious diseases management, intensive care and microbiology, enhancing occupational safety and health, and changing practices in hospitals regarding infection control.

(c) Meanwhile, the organisation is facing increasing financial difficulties because of continuous budget cuts year on year. Despite very stringent savings measures, across-the-board salary reductions, lowering of staff packages for new recruits, voluntary retirement schemes to promote staff turnover, and because of the need to continuously absorb new healthcare graduates into the

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Executive Summary

workforce to provide training and fill service needs, reduction in overall cost of running the service could not catch up with the reduction in Government funding. Budgetary deficits since 2001/02 have gradually depleted the general reserve of the HA. Major measures are urgently called for both in terms of improving HA’s financial allocation/revenues and cutting cost.

(d) HA is also facing morale problems of staff, who had suffered multiple blows in terms of the SARS epidemic itself, further stress related to the SARS aftermath, yearly budget cuts, and pressure from rising service demands of a growing and ageing population. In addition, there is the sentiment over equal work-unequal pay among new recruits brought on by budgetary realities, lack of promotion prospect and even job security. Workplace violence from hospital users has also been a growing concern. Frontline staff have been stretched to their limits both in terms of numbers and in terms of psychological stress.

(e) As regards quality of services, there is also genuine concern on the impact of the budgetary and manpower problems. With limitation of resources in the face of growing demand, HA has embarked on triaging of cases based on clinical parameters to ensure that those with more urgent conditions are identified and given priority treatment. But this will inevitably be at the expense of those with less urgent conditions. The waiting time for the latter had therefore lengthened very considerably during the past year, to an extent that quality started to be compromised. While HA will double its effort to continuously maximise resource use, such worrying trend is expected to worsen until more effective measures are put in place to reverse the impossible situation imposed on the HA.

(f) Lastly it is recognised after SARS that there is a need to rebuild the organisation’s image. Internally, staff members have pent up frustrations while not seeing how the public healthcare system is going to be sustainable. Externally, the HA has been described as being not transparent enough in its policy making. The direction is set to involve staff more in working towards solutions and steps have been taken to improve external communication. The perception issue over the incentive award system of senior executives also needs to be addressed.

MAJOR DIRECTIONS FOR 2005/06 HA ANNUAL PLANNING

New Government Policy Directions

3. The new SHWF, Dr York Chow, had set forth clear policy directions in public healthcare. These include the following:

(a) There is a need to re-position the public healthcare services. For the HA, the four priority areas are:

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Executive Summary

(i) Acute and emergency care;

(ii) Services for the low income group and the underprivileged;

(iii) Illnesses that entail high cost, advanced technology and multi-disciplinary professional team work in their treatment; and

(iv) Training of healthcare professionals.

(b) For population health, the Government will forge ahead with anti-smoking legislation, promote Family Medicine practice, and enhance district-based collaboration across departments and agencies. There will be additional Chinese Medicine clinics established through the HA.

(c) It is anticipated that there will be a new round of fees revision for public healthcare services to inculcate cost-consciousness and narrow the gap between the public and private sectors. Financial measures will be taken to address the adverse health service seeking behaviour by Non-eligible Person users. In relation to the public private interface, contribution of the private sector in the specialist training of doctors is to be explored.

(d) The Health and Medical Development Advisory Committee is to be revived, and Government aims to formulate long-term healthcare financing strategies within the year.

Directions Endorsed by the HA Board

4. Together with the emphases expressed by the new HA Chairman and in accordance with discussions of the HA Board at its planning workshop and committee meetings, the key areas of consensus in HA are as follows:

(a) Stability is the overriding concern of the HA after the organisation had undergone so much trauma in the last few years especially after SARS.

(b) Staff is our greatest asset and to that extent the staff morale issue needs to be urgently addressed.

(c) Despite the fiscal constraints, HA cannot sacrifice the pursuit of quality of service, which is the raison d’etre of the organisation.

(d) HA will improve the transparency of policy decision-making and implementation, both in terms of staff involvement as well as communication to the public. We will share our achievements and our limitations.

(e) Macro measures are required to tackle the severe budgetary problems facing the organisation.

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Executive Summary

MAJOR DIRECTIONS FOR 2005/06

5. Taking the above-mentioned environmental factors and organisational positions into consideration, HA has formulated its 2005/06 Annual Plan along the following five strategic directions:

(a) Improving population health (b) Enhancing organisational performance (c) Enhancing healthcare system sustainability (d) Improving service quality and clinical governance (e) Building human resources capability

2005/06 ANNUAL PLAN PROGRAMMES

6. Major programme initiatives for the coming year in support of each of the five strategic directions are summarised in the ensuing paragraphs.

Improving Population Health

7. Investment in HA has traditionally been focused on the provision of services and facilities to those who require immediate medical care and support. There is, however, a growing emphasis in recent years on preventive care and improving the lifestyle choices of the population, which will have a profound impact on the health and wellbeing of individuals. Previous experiences showed that health promotion resources are less accessible by the low income and underprivileged groups. HA will therefore continue to join hands with other community partners to enhance prevention of disease and health promotion in the coming year. Strenuous efforts will be made to support the Government’s anti-smoking campaign. A series of preventive programmes will be launched to improve population health, including district-based hypertension management programmes, community-wide fall prevention programmes, and the production of patient education materials in six specialty areas.

8. It has been two years after the SARS epidemic, and yet Hong Kong has been kept under constant alert of infectious disease outbreak by sporadic SARS cases elsewhere and the Avian Flu epidemic in the neighbouring countries. HA has already put in tremendous effort to enhance its preparedness for infectious disease outbreak and will continue to move along this direction in 2005/06. Appropriate drugs and protective equipment items will be stocked. The contingency plans on infectious diseases will be reviewed in conjunction with the Centre for Health Protection (CHP) and in relation to the Government’s plan, in light of previous experiences gained. The Authority will also support the Government in conducting a feasibility study for the development of a Communicable Disease Information System to enhance disease surveillance in the long run.

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Executive Summary

9. Successful community-based healthcare delivery requires close collaboration among different parties. Over the past years, HA has gradually built up a solid infrastructure and community network with other healthcare providers. Through collaboration with the Department of Health and other health agencies, HA will help the Government to launch its Head Start Programme for those aged 0-5. The quality of Community Nursing Service will be further enhanced through implementation of home care protocols and evaluation of outcomes. Information flow between HA and community carers will be strengthened by rolling out the computerised Nursing Discharge Summary.

Enhancing Organisational Performance

10. The Authority has identified a few key areas for enhancing organisational performance in the coming year, including the relationship with Government and governance, management structure and functions, communication improvement, changing the care delivery models, as well as facilities and infrastructure enhancement.

11. The governance structure of HA will be enhanced by clearly delineating the roles and communication channels among the HA Chairman, the Board, HA executives, and the Health, Welfare and Food Bureau (HWFB). The HA Board will continue to discharge its governance functions through strategic planning and the work of the functional committees. At the hospital level, the governance structure in selected hospitals will be reviewed to improve efficiency and organisational effectiveness.

12. Effective management structure and functions are essential for optimal organisational performance. The revised senior executive structure and Cluster General Manager structure will be implemented in a stepwise manner. A consultancy study on senior executive remuneration will also be conducted.

13. In an effort to improve staff morale and corporate image, HA will improve its internal and external communication through a series of staff and public relations programmes. Internal communication will be enhanced through audit programmes, setting up additional channels, and involving staff in policy decisions. Externally, a more proactive approach will be adopted for media relations to ensure timely dissemination of relevant information to the public.

14. To manage upstream the growing demand for services, efforts will be made to educate the referral sources to reduce unnecessary specialist referrals. Effective triage methods will be rolled out to hospitals to ensure priority treatment of urgent cases, and to return patients with stable conditions to primary care providers. In addition, HA will continue with its cluster-based service consolidation and rationalisation to enhance efficiency of its care delivery models. Further opportunities of rationalising infirmary care will also be explored together with the social welfare sector under the coordination of the HWFB.

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Executive Summary

15. Although HA is facing the most critical financial crisis ever, it will continue to improve its facilities and infrastructure to provide quality public healthcare services to the people of Hong Kong. Major radiological and other equipment items in various hospitals will be replaced. Major capital projects including the redevelopment of Pok Oi Hospital and commissioning of the new Princess Margaret Hospital Oncology Block will proceed as scheduled to improve service accessibility of needy patients. The clinical information infrastructure will be further enhanced by rolling out the Clinical Management System (CMS) to the remaining general outpatient clinics including the new Chinese Medicine clinics, and by planning and upgrading the information systems in six new hospital extension blocks. Initiatives to enhance HA’s business support infrastructure in 2005/06 include the development of a corporate-wide revenue collection system for self-financed medical items, replacement of laundry equipment in five HA laundries, and revamp of the Payroll System under Phase 1 of the Enterprise Resource Planning Project.

Enhancing Healthcare System Sustainability

16. There is no easy solution to the severe budgetary problem facing HA. A multi-pronged approach is needed to address overall healthcare financing and the public-private imbalance in service utilisation, the budgetary cuts imposed on HA, and cost-saving measures. At all times, the principle that nobody should be deprived of adequate care because of lack of means must be upheld. On the other hand, those who can afford should contribute towards sustainability of the system.

17. In 2005/06, HA will support Government in the deliberation of long-term healthcare financing options in the Health and Medical Development Advisory Committee, and provide information and expertise for further studies as required. For short-term healthcare financing measures, HA will work with the Government in the review of public hospital fees and charges, and implement changes as appropriate.

18. The funding of HA services is provided by Government according to a population based formula since 2001/02. Instead of granting HA the projected 2.2% annual growth in budget to cater for the need of the increasing and ageing population, Government only afforded to HA 1% growth in the past few years. Moreover, no additional funding was allocated for the impact of new technology. The Authority will review this funding formula with Government in the coming year, including funding for the safety net for expensive new technology.

19. To enhance financial planning, HA will draw up realistic scenarios in the projection of manpower and other expenses, and assess their impact on its budget, scope and quality of service, staffing level and staff morale. In addition, an actuarial study on the Home Loan Interest Subsidy Scheme will be conducted.

20. To rationalise and maximise the use of resources, HA has successfully implemented many standardisation and prioritisation measures since its inception. HA will assess the introduction of new medical technologies through private financing and evaluate the safety, efficacy, and cost effectiveness of such financing method. To address the public-private imbalance in service utilisation, a common

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Executive Summary

registry of private practitioners will be developed in collaboration with the medical associations to facilitate sharing of patient information between the two sectors. Training activities offered to external parties will also be consolidated under the HA Institute of Health Care to promote exchange in knowledge and experience among the public and private medical practitioners.

21. A number of efficiency measures will be implemented in 2005/06 to achieve further productivity savings, including bulk purchase of major equipment, reorganisation of the catering service, total solution contract for supply of staff uniform, and business process reengineering in finance, procurement and human resources management. Options of further consolidation of facilities and institutions within the hospital clusters will also be actively explored.

22. To manage personal emolument expenses, HA will continue to adopt stringent control on headcount while balancing its training and service priorities. Staff will be involved in exploring available options to promote a healthy turnover of the workforce while minimising adverse effect on level and quality of service.

Improving Service Quality and Clinical Governance

23. Even under budgetary constraints, HA should not compromise on the quality of its clinical services. On the other hand, as in all modern societies, HA has to determine priorities among the myriads of healthcare needs and demands in order that use of available resources is maximised. Such prioritisation will take reference to the policy on positioning of public healthcare as clearly announced by the new SHWF, scientific assessment of new technologies on their efficacy and cost effectiveness, and value debates in established structures within HA as well as in society. New services will continue to be introduced in relation to identified needs and in accordance with Government priorities.

24. On the area of clinical risk management and quality improvement, a corporate risk registry comprising strategic and operational risks will be established to facilitate the planning and prioritisation of improvement work. Firstly, to ensure consistency and appropriateness of drug use, HA will complete the consultation exercise and introduce the HA Standard Drug Formulary to promote equitable and rational use of cost effective treatment across all hospitals. Secondly, to manage clinical risks, a number of programmes and studies will be launched, including a study on adopting bar coding technology to improve transfusion safety, formulation of new guidelines for obtaining patient consent to treatment procedures, promotion of patient transport safety, further enhancement of risk surveillance through Version 2 of the Advanced Incident Reporting System, training on root cause analysis, risk assessment and risk reduction, and enabling accessibility of patient-based drug allergy information to all pharmacies. Moreover, HA-wide clinical audits will be conducted in high priority areas including patient identification/documentation and selected major surgical operations.

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Executive Summary

25. To strengthen information management in clinical care, HA will start to develop the application architecture platform for the next generation clinical systems. Other related initiatives during the year include developing and implementing the Operating Theatre Management System, extending the Laboratory Information System and Radiological Information System to non-acute hospitals, and extending the image distribution infrastructure to another four hospitals.

26. In accordance with the Government’s direction, HA will set up three additional Chinese Medicine clinics in 2005/06 with the installation of appropriate information technology systems in the clinics to enhance interface between Western and Chinese Medicine from the experience gained in research and service. The e-Knowledge Gateway on Chinese Medicine will be developed to facilitate sharing of information among frontline clinicians.

Building Human Resources Capability

27. Human resources (HR) management has been identified, especially after the SARS epidemic, as one of the key areas that need much strengthening. The HR functions in both Head Office and clusters will be enhanced in line with a previous consultancy review, with addition of HR professionals and a revised reporting structure. Major emphases will be put on partnering with staff in mapping out future corporate strategies, boosting staff morale, further work on occupational safety and health, and improving training and career development opportunities for staff.

28. To enhance the HR functions, a new HR structure will be established at the cluster/hospital level with dual reporting both to the cluster/hospital line management and the Head Office HR. Work processes would be reengineered and additional HR professionals recruited as appropriate. The management of the medical grade and postgraduate training of doctors would be consolidated and the continuing professional development programmes for nurses and allied health professionals formalised in line with the requirements of accreditation authorities.

29. Improvement to staff morale will be achieved by devising a performance-based mechanism to grant salary increments for new recruits with fixed pay point contracts, exploring the opportunity of converting contract staff with distinctive performance to permanent terms, and dealing more effectively with poor performing staff. Over 1,500 temporary staff will be converted to contract employment terms based on the service needs identified. With additional one-off funding, HA will continue to employ staff under the Government’s Initiative for Wider Economic Participation Scheme to enhance its patient care services.

30. To strengthen communication with staff, an audit will be conducted to identify weaknesses in the existing processes for improvement. Training for HR managers will be stepped up and more effective communication channels established to enhance communication with key staff group leaders on strategic issues facing HA and in the various stages of policy formulation. The issues identified in a staff survey conducted in 2004 will be followed up to address concerns of staff members.

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Executive Summary

31. To improve career development of healthcare professionals, HA will recruit 300 doctors, 400 nurses and 100 allied health personnel for professional training and services provision in 2005/06. Career prospect statistics of the various clinical specialties will be provided to the new medical graduates and Residents undergoing training to facilitate their career planning. A total of 149 Enrolled Nurses in HA will be converted to Registered Nurses, while 35 and 40 Registered Nurses (General) will be assisted to acquire midwifery and psychiatric qualifications respectively. Other initiatives in this area include rolling out a competency-based 360 degrees tool to help development of targeted staff groups, revamping the Executive Partnership Scheme to develop leaders in management and clinical fields, evaluating the Advanced Practice Nurse pilot project, and enhancing the Staff Development Review mechanism for measurement of staff performance.

32. To promote occupational safety and health, a comprehensive campaign against workplace violence will be launched to ensure staff safety. The capturing of data on sharps injury and other injury-on-duty cases will be improved to facilitate managerial monitoring. An injury prevention programme for manual handling operations will be rolled out to all public hospitals to reduce the injury-on-duty rate. In addition, development of occupational medicine within the HA will be explored.

CONCLUSION

33. Facing the changes in its internal and external environment, HA has repositioned itself and set reachable standards and targets in the coming year to deliver its services with the available resources to meet the numerous challenges in the post-SARS era. Nevertheless, it is anticipated that signs of system strain will increasingly manifest as overcrowding, quality issues and staff morale problems that need to be tackled. The gap between population needs and resources available to address those needs calls for more fundamental solutions. Meanwhile, it is hoped that through the implementation of the specific targets formulated at both the Head Office and cluster/hospital levels, the Authority can continue to maintain quality healthcare services to the people of Hong Kong in a cost-effective and sustainable manner.

Hospital Authority Annual Plan 2005/06 9

1 - Introduction

SIMPLE FACTS AND STATISTICS ABOUT HA

1.1 HA is responsible for delivering a comprehensive range of preventive, curative and rehabilitative medical services to the people of Hong Kong through its network of healthcare facilities. As at 31 December 2004, HA managed 43 public hospitals/ institutions, two of which were in the process of being de-gazetted (Appendix 1), and a host of ambulatory care facilities (Appendix 2) including 45 specialist outpatient clinics and 74 general outpatient clinics. It managed 28,476 hospital beds, representing approximately 4.0 public hospital beds per 1,000 population. For 2004/05, its revised recurrent subvention from the Government, net of income, is HK$27,908M including the one-off funding for the extension of the Initiatives for Wider Economic Participation (IWEP).

1.2 The SARS epidemic resulted in a significant reduction in a whole range of HA activities in 2003/04 except for general outpatient service. Although there had been gradual increase of activities after the SARS period, the volume remained below that of the pre-SARS level. In 2004/05, increases were recorded in total inpatient and day patient discharges and deaths, patient days and total specialist outpatient attendances. The total number of accident and emergency attendances also increased.

1.3 As for general outpatient attendances, the substantial increase was mainly attributed to the transfer of 59 general outpatient clinics from the Department of Health in July 2003.

Statistics from 95/96 to 04/05

** Projected figures

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1- Introduction

1.4 In 2004/05, there were approximately 1,112,500 inpatient and day patient discharges and deaths, 7,649,100 patient days (including day patient discharges and deaths), 2,070,000 accident and emergency attendances, 8,181,000 specialist outpatient attendances (including clinical and allied health attendances) and 5,278,000 general outpatient attendances. A comparison of HA’s activities between 2003/04 and 2004/05 is shown below:

Comparison between 03/04 and 04/05

** Projected figures

1.5 As at 31 December 2004, HA had a staff strength of 52,299 full-time equivalents. The majority, at 68.68%, were involved in direct patient care with breakdown as follows:

Staff Strength (Full-time equivalents) Direct Patient Care (68.68%) as at 31.12.2004 % of total staff

Medical 4,963 9.49

Nursing 19,274 36.85

Allied Health 4,830 9.23

Care-related Support Staff 6,854 13.11

Subtotal 35,921 68.68

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1 - Introduction

Indirect Patient Care (31.32%)

Other Professionals/Management 994 1.90

Non Care-related Support Staff 15,384 29.42

Subtotal 16,378 31.32

Total 52,299 100

EVOLUTION OF THE ANNUAL PLANNING PROCESS OF HA

1.6 HA has been publishing its Annual Plan since 1992/93 as part of its commitment to enhance its accountability and transparency to the community. The plan sets out on a prospective basis the work and improvement targets of the organisation using the budget allocated from the Government. In each Annual Plan, the status of achievement of the previous year’s targets is accounted for, including reasons for deviations. There is also a description of the strategic directions that the organisation intends to pursue, accompanied by detailed programme initiatives.

1.7 The Annual Planning process provides the organisation with a structured mechanism to turn corporate vision and mission (Appendix 3) into strategies, goals and targets, in line with governmental policy directions and within budget constraints. It serves to align the work plans and priorities between the hospital clusters and the corporate HA.

1.8 The HA planning process has evolved over the years. Mechanisms have now been put in place to receive input from the HA Board, the staff and the general public as well as to take account of the healthcare needs of the community.

1.9 The HA Annual Plan in 2005/06 has taken into consideration the funding position, societal expectations, the Government’s policy directions, and the challenges in the internal and external environment. It is hoped that through the clearly delineated strategies, HA will rise to the challenges ahead to serve the Hong Kong people better.

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2 - Review of Progress

2.1 The 2004/05 Annual Plan described a total of 275 targets. Of these 262 (95.27%) were achieved according to schedule and 273 (99.27%) were achieved within the year. Details of the remaining 2 targets not achieved by year end are shown below:

REVISED TARGET

• Regroup Tai O & Mui Wo General Outpatient Clinics from Kowloon West Cluster to Hong Kong Clusters

It was initially proposed that Lantao Island, apart from North Lantao, should be linked to the Hong Kong clusters with effective from July 04 to facilitate patient referrals. It was finally decided that status quo should be maintained in view of the proposed construction of the Tung Chung Hospital. Tai O and Mui Wo General Outpatient Departments were therefore not regrouped away from Kowloon West Cluster to Hong Kong East Cluster. The whole of Lantao Island remains within the Kowloon West Cluster.

SUPSPENDED TARGET

• Complete the actuarial and market studies on the development of a subsidized medical insurance scheme and assess the financial feasibility of the overall model

This target was suspended as the project had been superseded by event, with the new Secretary for Health, Welfare & Food establishing the Health & Medical Development Advisory Committee (HMDAC). Healthcare financing including insurance is one of the key deliverables of the HMDAC and the Government will be releasing its financing options by end 2005.

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3 - Planning Environment

3.1 There are a number of major changes in the internal and external environment of HA that shape the major directions adopted in this Annual Plan for 2005/06.

Key People Changes

3.2 There were a number of key people changes after the SARS epidemic which could have important bearings on the healthcare environment and the work of HA. These included the succession for the positions of the Secretary for Health, Welfare and Food (SHWF), the HA Chairman and the former Director (Professional Services & Human Resources). There were also succession of the Director of Health, Deputy SHWF (Health), Dean of the Medical School of the Chinese University of Hong Kong, and new legislators representing the medical and health services constituencies respectively; all five had been appointed to the HA Board, together with other new members. At the senior executive level, there were new recruitments and reshuffling of portfolios involving Directors, Deputy Directors, Heads of divisions, and three of the seven Cluster Chief Executives. Meanwhile, the HA Board decided that for stability sake, the seven cluster management structure would remain unchanged for three years. To date, new directions had been set by the SHWF regarding future development of the healthcare system, while the HA Chairman and the Board, together with the senior executives, also formulated major strategies for the development of the HA through a process of strategic planning. The re-shuffled senior executive team is well set to meet the multiple challenges ahead.

The aftermath of SARS

3.3 It has been almost two years after the SARS epidemic, yet the organisation still needs to invest very significant resources into tackling the aftermath of SARS. These include continuous multi-disciplinary care for the SARS victims some of whom still suffer complications of this new disease the natural course of which is not completely known, continuous processing of injury-on-duty claims under the Employees Compensation Ordinance together with HA’s insurer on more than 300 cases, providing assistance to the Labour Department in ascertaining the degree of disabilities in some, and managing other legal claims. Other work includes continuous vigilance and response to hospital infectious disease outbreaks and those in neighbouring countries/areas, construction of an Infectious Disease Block in Princess Margaret Hospital, preparing for possible influenza pandemics, continuous effort to strengthen workforce capabilities in infectious diseases management, intensive care and microbiology, enhancing occupational safety and health, and changing practices in hospitals regarding infection control. New opportunities arose from the establishment of the Centre for Health Protection (CHP) in which the HA contributed its input through the Infection Control Branch, and from the completion of isolation facilities in all acute hospitals. However, the dedication of space and resources to strengthen infection control also means further challenge to the overcrowding situation for general wards especially during flu seasons.

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3 - Planning Environment

Severe Budgetary Constraints

3.4 The organisation is facing increasing financial difficulties because of continuous budget cuts year on year. Despite very stringent savings measures, across-the-board salary reductions, lowering of staff packages for new recruits, voluntary retirement schemes to promote staff turnover, and because of the need to continuously absorb new healthcare graduates into the workforce to provide training and fill service needs, reduction in overall cost of running the service could not catch up with the reduction in Government funding. Budgetary deficits since 2001/02 have gradually depleted the general reserve of HA. Major measures are urgently called for both in terms of improving HA’s financial allocation/revenues and cutting cost. The HA has been continually negotiating with the Government on more viable solutions including incentives for the HA to keep the additional income generated through its services, as well as deliberations on the population based funding formula that had not been fully met in the subventions.

Staff Morale

3.5 HA is also facing morale problems of staff, who had suffered multiple blows in terms of the SARS epidemic itself, further stress related to the SARS aftermath, yearly budget cuts, and pressure from rising service demands of a growing and ageing population. In addition, there is the sentiment over equal work-unequal pay among new recruits brought on by budgetary realities, lack of promotion prospect and even job security. Workplace violence from hospital users has also been a growing concern. Frontline staff have been stretched to their limits both in terms of numbers and in terms of psychological stress. There is also a rising trend of experienced clinicians leaving the HA recently. The HA Board therefore considered staff morale to be the top priority issue that needed be tackled irrespective of the budget challenges, because it would directly affect the core business of the HA in providing quality patient services.

Quality of Clinical Services

3.6 There is genuine concern that the budgetary and manpower problems will impact adversely on the service quality of HA. With limitation of resources in the face of growing demand, HA has embarked on triaging of cases based on clinical parameters to ensure that those with more urgent conditions are identified and given priority treatment. But this will inevitably be at the expense of those with less urgent conditions. The waiting time for the latter had therefore lengthened very considerably during the past year, to an extent that quality started to be compromised. While HA will double its effort to continuously maximise resource use, such worrying trend is expected to worsen until more effective measures are put in place to reverse the impossible situation imposed on the HA. Faced with such difficulty, the HA Board also considered it important to share our circumstances as well as our strategies of prioritisation with the public in order to promote community ownership of the problems and to listen to their views.

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3 - Planning Environment

Image of HA

3.7 It is recognised after SARS that there is a need to rebuild the organisation’s image. Internally, staff members have pent up frustrations while not seeing how the public healthcare system is going to be sustainable. Externally, the HA has been described as being not transparent enough in its policy making. The direction is set to involve staff more in working towards solutions and steps have been taken to improve external communication. The perception issue over the incentive award system of senior executives also needs to be addressed. The latter had unfortunately been misinterpreted in public arena. The HA Board had reiterated the importance of structuring the executive packages to attract high quality executives to tackle the multiple and complex challenges that the organisation is facing, while improving the transparency of the process could help gain public support.

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4 - Budget Allocation

GOVERNMENT FUNDING

4.1 The gross subvention, including one-off funding for the extension of the Initiatives for Wider Economic Participation (IWEP), for 2005/06 indicated by the Government is HK$28,588M. The funding includes the following:

(a) 1% increase in funding to partly meet the population growth;

(b) Funding for the set up of additional Chinese Medicine clinics, which is inclusive of the three clinics opened in 2004/05;

(c) Funding for strengthening infectious disease control and meeting the additional demand for hospital services arising from an ageing population and population growth;

(d) Salary reduction of HK$524M for pay adjustment in January 2005 in line with the Government pay adjustment exercise; and

(e) A deduction of HK$624M for efficiency savings.

4.2 The Government will provide additional funds of HK$278M for the purchase and replacement of equipment and vehicles, and development of information technology, and a further HK$210M for capital improvement works.

4.3 The income budget of HA for 2005/06 is HK$1,389M, including HK$58M and HK$42M from accident and emergency (A&E), and drugs charges respectively. Based on the agreement with the Government on the fees and charges revision in 2003/04, whilst HA can keep 50% of the additional income arising from the new fees, i.e., the A&E and drugs charges, on a perpetual basis, it can keep 100% of the additional income arising from the revision of existing fees for 2003/04 and 2004/05 only. The arrangement for the latter has now expired and thus an additional HK$150M has been added to the income budget of HA in 2005/06 to effect the return of additional income arising from revision of existing fees to the Government.

OVERALL FINANCIAL POSITION OF HA

4.4 This year’s Government subvention reflects the Government’s continued efforts to balance the fiscal budget within the next five years. As advised by Health, Welfare and Food Bureau (HWFB), in addition to the $917M efficiency savings deducted in 2004/05, HA is required to deliver further savings of $624M in 2005/06.

4.5 The HA has been recording operating deficits since 2001/2002 despite having taken actions to curb costs through stringent saving programmes, cost containment initiatives, reorganisation, and voluntary early retirement scheme. The deficit situation is expected to continue in 2005/06, aggravated by the need to implement the new hospital operation mode for handling infectious diseases in the aftermath of SARS. The operating deficit for 2005/06 is estimated to be about $670M. Although

Hospital Authority Annual Plan 2005/06 17

4 - Budget Allocation

HA will continue to adopt stringent control to manage the spending level, in the event that the projected expenditure exceeds the Government funding, the reserve will be substantially depleted by the end of 2005/06 and thus HA will need to identify alternative funding sources or to mobilise other funds/reserves to finance the deficit.

4.6 The main contributing factors for the projected deficit in 2005/06 are:

(a) The reduction of subvention from Government. The Government has reduced the population-based funding addition to 1% instead of the population growth and ageing effect of 2.2%.

(b) Government has imposed a further 2.11% deduction amounting to $624M from the HA budget as part of the Government’s Efficiency Savings Initiative.

(c) Salary increments for the existing staff moving to higher points of their pay scales, where there is no separate funding from Government.

(d) Despite the projected deficit, HA plans to recruit new clinical and supporting staff in order to meet the manpower requirements arising from strengthened infection control measures, partial replacement of vacancies, as well as training of new graduates.

(e) Based on the latest income projection, there will be a projected fee income surplus of HK$34M. This has already been offset by a shortfall in the non-income budget, as a result of the annual budget being set at 0.7% of prior year’s gross subvention by the Government and the prevailing low interest rate environment. The projected income surplus will contribute to reducing the deficit in 2005/06.

4.7 The unfavourable budgetary situation is expected to continue for a few more years given the Government’s indication to reduce further the subvention to HA between 2005/06 and 2008/09. To address the long-term projected deficits, HA will explore further means to widen its revenue streams, reduce operating costs, and work with the Government in devising a viable financial plan.

RESOURCE ALLOCATION

4.8 A population-based internal resource allocation system was implemented for 2003/04 budget allocation exercise to replace the historical allocation method. This model of allocating resources to the hospital clusters promotes equity as funding is based on the needs of cluster population.

4.9 Under the population-based funding, resources are allocated to clusters according to the population size and age profile of their residents. Each cluster is responsible for assuring that service needs of its resident population are met with the allocated funding. Centralised services, education, teaching and research are funded separately, based on agreed budgets.

18 Hospital Authority Annual Plan 2005/06

4 - Budget Allocation

4.10 Population-based funding provides hospital clusters incentives for improving the allocative efficiency of limited resources amongst competing services, favouring the development of ambulatory and community care, service rationalisation, continuous improvement in technical efficiency, and the discharge of patients back to the private sector.

4.11 A post-implementation review of the population-based funding approach concluded that it was, in general, a fair and effective way of allocating resources to clusters and should continue to be refined and applied.

Hospital Authority Annual Plan 2005/06 19

5 - Major Directions for Annual Plan 2005/06

NEW GOVERNMENT POLICY DIRECTIONS

5.1 The new SHWF, Dr York Chow, had set forth clear policy directions in public healthcare. These include the following:

(a) There is a need to re-position the public healthcare services. For the HA, the four priority areas are:

(i) Acute and emergency care;

(ii) Services for the low income group and the underprivileged;

(iii) Illnesses that entail high cost, advanced technology and multi-disciplinary professional team work in their treatment; and

(iv) Training of healthcare professionals.

(b) For population health, the Government will forge ahead with anti-smoking legislation, promote Family Medicine practice, and enhance district-based collaboration across departments and agencies. There will be additional Chinese Medicine clinics established through the HA.

(c) It is anticipated that there will be a new round of fees revision for public healthcare services to inculcate cost-consciousness and narrow the gap between the public and private sectors. Financial measures will be taken to address the adverse health service seeking behaviour by Non-eligible Person users. In relation to the public private interface, contribution of the private sector in the specialist training of doctors is to be explored.

(d) The Health and Medical Development Advisory Committee is to be revived, and Government aims to formulate long-term healthcare financing strategies within the year.

DIRECTIONS ENDORSED BY THE HA BOARD

5.2 Together with the emphases expressed by the new HA Chairman and in accordance with discussions of the HA Board at its planning workshop and committee meetings, the key areas of consensus in HA are as follows:

(a) Stability is the overriding concern of the HA after the organisation had undergone so much trauma in the last few years especially after SARS.

(b) Staff is our greatest asset and to that extent the staff morale issue needs to be urgently addressed.

(c) Despite the fiscal constraints, HA cannot sacrifice the pursuit of quality of service, which is the raison d’etre of the organisation.

20 Hospital Authority Annual Plan 2005/06

5 - Major Directions for Annual Plan 2005/06

(d) HA will improve the transparency of policy decision-making and implementation, both in terms of staff involvement as well as communication to the public. We will share our achievements and our limitations.

(e) Macro measures are required to tackle the severe budgetary problems facing the organisation.

MAJOR DIRECTIONS FOR 2005/06

5.3 Taking the above-mentioned environmental factors and organisational positions into consideration, HA has formulated its 2005/06 Annual Plan along the following five strategic directions:

(a) Improving population health (b) Enhancing organisational performance (c) Enhancing healthcare system sustainability (d) Improving service quality and clinical governance (e) Building human resources capability

Hospital Authority Annual Plan 2005/06 21

6 - Improving Population Health

HEALTH PROMOTION

6.1 In supporting the Government’s goal of maximising population health, HA will enhance its programmes in disease prevention, health promotion and health protection. These include the smoking cessation campaigns, with HA participating actively in the World No Tobacco Day, collaborating with partners in health to deliver antismoking health messages to the public, and ensuring tobacco-free environment in hospitals.

6.2 District-based fall prevention and hypertension management programmes will be launched in the early part of 2005/06. The main objective of these community projects is to heighten the public’s awareness of the risks of fall and hypertension among the elderly and the general population, and the need to take regular exercise and for the risk factors to be properly controlled. Community partners including District Councils, welfare organisations, volunteer agencies, private practitioners and related government departments will participate in the health promotion campaigns, fall risk screening programmes, Tai Chi classes and blood pressure measurement and hypertension management projects.

6.3 To empower patients in disease management, patient education packages will be developed and promulgated during the care process. These packages will increase patients’ knowledge on their illnesses, remove misconceptions and improve self-management after clinical interventions.

Targets:

• Support the Government’s anti-smoking campaign through continuous 3Q05 effort in health education to the public and to patients attending HA clinics and smoking cessation services

• Launch district-based hypertension management programmes in 3Q05 association with primary care providers and home carers

• Launch community-wide fall prevention programmes in association with 3Q05 other agencies, including promotion of Tai Chi exercise

• Enhance patients' knowledge of diseases and complications of procedures 1Q06 through the rollout of patient education packages in all related specialties

22 Hospital Authority Annual Plan 2005/06

6 - Improving Population Health

HEALTH PROTECTION

6.4 HA is collaborating closely with the Centre for Health Protection (CHP) of the Department of Health (DH) to enhance the disease surveillance and control network in Hong Kong. A surveillance system has been established in hospitals for the reporting and monitoring of specified nosocomial infections from time to time. Besides, a mechanism has also been devised, in collaboration with the CHP, in developing the antibiotics stewardship and resistance surveillance programme for all hospitals.

6.5 To facilitate timely reporting and follow-up investigation, HA will provide full support to the Government in embarking on a feasibility study of a Communicable Disease Information System (CDIS). When the System is in place, on-line reporting can be made to both the HA and CHP for the range of notifiable diseases and other communicable diseases of infection under surveillance.

6.6 Contingency measures have been taken to enhance the organisational preparedness in case infectious diseases are to strike again. Contingency plans have been devised and reviewed regularly. Appropriate levels of drugs and personal protective equipment have been stockpiled.

Targets:

• Develop and implement the case notification and outbreak reporting system 4Q05 for notifiable and other communicable diseases

• Support Government in the feasibility study of a Communicable Disease 1Q06 Information System

• Collaborate with the Centre for Health Protection in launching: (a) the 1Q06 antibiotics stewardship and (b) resistance surveillance programme for all hospitals

• Review HA contingency plans on infectious diseases in conjunction with the 3Q05 Centre for Health Protection and in relation to Government's plan, in the light of experience gained

• Commence stockpiling appropriate drugs and protective equipment to 2Q05 prepare for possible influenza pandemic

• Develop and implement the surveillance system on specific laboratory data 1Q06 for the early detection and monitoring of disease outbreak

Hospital Authority Annual Plan 2005/06 23

6 - Improving Population Health

COMMUNITY-BASED HEALTHCARE DELIVERY

6.7 In line with international trend, HA has commenced shifting the delivery of healthcare away from hospitals to settings that are nearer to the patient’s home. This represents a paradigm shift in health service provision: from a disease model to a health model; from medical dominance to multidisciplinary and cross-sectoral collaboration; and from episodic acute hospital care to a life course approach in the provision of preventive, curative and rehabilitative healthcare.

6.8 Over the years, HA has gradually built up a solid infrastructure and community network with other healthcare providers. HA will help Government launch its Head Start Programme through inter-sectoral collaboration with the Department of Health, Social Welfare Department, and Education and Manpower Bureau. The objective is to provide comprehensive and timely support to children aged 0-5 with developmental problems and their families, so as to promote their healthy development.

6.9 The quality of community-based nursing care will be strengthened further through improvement of information flow with the rolling out of the computerised Nursing Discharge Summary, and the implementation of outcome focused home care protocols.

6.10 In the care of medically stable psychiatric patients, HA will facilitate their transfer from institutional rehabilitation to community based rehabilitation in collaboration with non-governmental organisations and the welfare sector.

Targets:

• Support the Government’s Head Start programme for those aged 0-5, 4Q05 through collaboration with the Department of Health and other health agencies, using the Maternal and Child Health Centres as platform

• Prepare to transfer stable psychiatric long stay patients to a new Long Stay 2Q05 Care Home in Tuen Mun

• Implement home care protocols for Community Nursing Service and 1Q06 develop outcome measures

• Roll out computerised Nursing Discharge Summary to facilitate 1Q06 information flow to community carers

24 Hospital Authority Annual Plan 2005/06

7 - Enhancing Organisational Performance

GOVERNMENT AND GOVERNANCE

7.1 HA is a publicly funded organisation. It is vitally important that public resources are utilised appropriately and efficiently for the benefits of the Hong Kong people. This is facilitated by a clear framework of effective corporate governance. In this context, the governance structure of HA will be enhanced by clearly delineating the roles and communication channels among the HA Chairman, the HA Board, HA executives, and the Health, Welfare and Food Bureau (HWFB). The HA Board will continue to discharge its governance functions through strategic planning and the work of the functional committees. At the hospital level, the governance structure in selected hospitals will be reviewed to improve efficiency and organisational effectiveness.

Targets:

• Clarify roles and communication channels among HA Chairman and 2Q05 Board, HA executives, and the Health, Welfare and Food Bureau

• Discharge of governance functions of the HA Board through strategic 2Q05 planning and the work of the functional committees

• Review hospital governance in selected hospitals to enhance efficiency and 4Q05 organisational effectiveness

MANAGEMENT STRUCTURE AND FUNCTIONS

7.2 Effective management structure and functions are essential for optimal organisational performance. The revised senior executive structure and Cluster General Manager structure will be implemented in a stepwise manner. A consultancy study on senior executive remuneration will be conducted to determine the appropriate package for the Authority. The issue concerning the incentive award system of senior executives will also be addressed.

7.3 In addition, a leadership training and development programme will be launched. The programme should be able to assess individual's strengths and weaknesses in a structured manner possibly including the use of psychometric tools and introducing a system of 360-degree feedback. The ultimate objective is to foster each individual’s personal growth and to ensure that the HA has complementary skills, abilities and behaviours among its top management team.

Targets:

• Implement the revised senior executive structure and develop training and 2Q05 performance measurement strategies

Hospital Authority Annual Plan 2005/06 25

7 - Enhancing Organisational Performance

• Conduct consultancy study on senior executive remuneration and 3Q05 implement recommendations as appropriate

• Implement the revised Cluster General Manager structure and functions 3Q05

COMMUNICATIONS IMPROVEMENT

7.4 To enable staff and the general public to better understand HA's policies and positioning, existing internal and external communication channels used by HA will be thoroughly reviewed.

7.5 New channels and techniques will also be explored and tested, so that all available means will be deployed effectively by HA in the dissemination of information.

7.6 Externally, a more proactive approach will be adopted to further enhance HA's relationship with various stakeholders, especially the media, to ensure timely and adequate explanation of HA's position in the policy formulation and implementation process.

Targets:

• Improve internal communication systems through audit programmes and 2Q05 additional channels

• Improve external communication through more proactive media relations 2Q05 and increased exposure of senior executives to explain policies where appropriate

CHANGING THE CARE DELIVERY MODELS

7.7 To maintain the quality of service despite the shrinking budget, HA will continue its quest to maximise the value of resources by providing the right service to the right patient in the right place at the right time. This entails a continuous modification of the care delivery model through prioritisation and rationalisation of services.

7.8 For specialist outpatient services, HA will manage upstream the growing demand for services. Efforts will be made to educate the referral sources to reduce unnecessary referrals. Effective triage methods will be rolled out to hospitals to ensure priority treatment of urgent cases.

7.9 To ensure appropriate use of inpatient facilities, HA will continue to develop and consolidate initiatives which provide safe alternatives to emergency admissions through development of care plans for target disease groups and enhancing the roles of observation wards in Accident and Emergency Departments. Pre-hospital

26 Hospital Authority Annual Plan 2005/06

7 - Enhancing Organisational Performance

diversion of trauma patients to hospitals that are able to provide the necessary definitive treatment will improve patients’ outcome. This arrangement will be extended to the Hong Kong Island and other clusters where feasible in collaboration with the Fire Services Department.

7.10 To improve the care of patients with chronic psychiatric illness, further rationalisation of psychiatric beds will be made between clusters. Support for the physically frail in Old Aged Homes will be strengthened through the Visiting Medical Officer (VMO) Scheme and the extension of Clinical Management System accessibility. HA will also explore further opportunities of rationalising infirmary care together with the Social Welfare Department under the coordination of the Health, Welfare and Food Bureau.

Targets:

• Enhance effort to manage upstream through education of referral sources 4Q05 to decrease unnecessary specialist referrals

• Roll out effective triage methods to all hospitals to ensure priority 1Q06 treatment of urgent cases

• Extend pre-hospital primary trauma diversion to the ambulance catchment 4Q05 area of Ruttonjee & Tang Shiu Kin Hospitals with Queen Mary Hospital serving as the Trauma Centre for the area, and explore the feasibility of extending pre-hospital primary trauma diversion to other clusters

• Rationalise psychiatric beds by transferring 164 beds from Hong Kong 1Q06 East cluster and 66 beds from Kowloon West cluster to Kowloon East and Kowloon Central clusters

• Explore further opportunities of rationalising infirmary care together with 1Q06 the social welfare sector under the coordination of the Health, Welfare and Food Bureau

• Promote disease management approach through introduction of Clinical 1Q06 Practice Guidelines & integrated patient care plan (IPCP)

• Improve effectiveness of support to elderly residents in 100 Old Aged 3Q05 Homes through the Visiting Medical Officer Scheme

• Extend Clinical Management System access in selected Old Aged Homes 4Q05 for continuity of care

Hospital Authority Annual Plan 2005/06 27

7 - Enhancing Organisational Performance

• Develop and consolidate initiatives to provide safe alternatives to 1Q06 emergency admissions through development of six care plans for target disease groups and enhancing the roles of Observation Wards

FACILITIES AND INFRASTRUCTURE ENHANCEMENT

7.11 The renovation and development of buildings continues in a scheduled sequence with the completion of Phase II of Castle Peak Hospital Redevelopment and Princess Margaret Hospital Radiotherapy Centre in 2005/06. The maintenance of existing buildings will follow a rolling plan based on need assessment and risk analysis. The maintenance of engineering and medical equipment will follow a three-year plan, aiming to maintain an updated technology for the respective services. Other facilities and infrastructure improvements will go parallel with other clinical targets in the corporate and cluster annual plans.

Targets:

• Replace radiotherapy equipment and upgrade the treatment in three major 2Q05 hospitals

• Replace Magnetic Resonance Imaging (MRI) and Computed Tomographic 1Q06 (CT) scanners at Queen Elizabeth Hospital & Princess Margaret Hospital and other radiological equipment in various hospitals

• Replace and improve laundry equipment in five HA laundries to maintain 1Q06 service continuity and to improve energy efficiency

• Complete 50% of building services installations and internal finishes for 1Q06 the Pok Oi Hospital Redevelopment Project

• Complete construction of the Radiotherapy Centre & redevelopment of 3Q05 Accident & Emergency Department in Princess Margaret Hospital

• Commence superstructure construction of an Infectious Disease Block at 2Q05 Princess Margaret Hospital

• Complete Phase II of Castle Peak Hospital Redevelopment Project 4Q05

7.12 The value of HA’s information infrastructure in supporting clinical care is well recognised. System utilisation will expand in the coming year through the enabling of current applications in the remaining General Outpatient Clinics and the new Chinese Medicine clinics. However, further development and expansion is limited because of the current legacy architecture of both the clinical and non-clinical systems.

28 Hospital Authority Annual Plan 2005/06

7 - Enhancing Organisational Performance

To improve organisational performance, management and control, a programme has been initiated to implement an Enterprise Resource Planning (ERP) software to provide timely, relevant and integrated management information to senior executives. The ERP programme will provide for the financial modules initially and be expanded later to comprise a comprehensive range of functionalities. In addition, information systems and infrastructure will also be developed for the new hospital blocks to support clinical care.

Targets:

• Prepare for the replacement of the Payroll System under the Enterprise 1Q06 Resource Planning (ERP) project Phase 1, and commence planning for Phase 2 to replace the existing Finance systems

• Extend the Clinical Management System (CMS) to remaining General 1Q06 Outpatient Clinics

• Establish information technology infrastructure and systems in the new 1Q06 Chinese Medicine clinics

• Plan and upgrade information systems and infrastructure in six new 1Q06 hospital extension blocks

• Develop a corporate-wide revenue collection system for privately financed 1Q06 medical items (drugs and itemized charges for private patients)

• Develop and enhance Clinical Data Analysis and Reporting System 1Q06 (CDARS) to allow the analysis of more clinical data to support risk assessment, measurement of disease burden, clinical outcome indicators and better interface with other HA partners

Hospital Authority Annual Plan 2005/06 29

8 - Enhancing Healthcare System Sustainability

8.1 HA is facing increasing financial difficulties because of continuous budget cuts year-on-year. Despite very stringent savings measures, across-the-board salary reductions, lowering of staff packages for new recruits, voluntary retirement schemes to promote staff turnover, and because of the need to continuously absorb new healthcare graduates into the workforce to provide training and fill service needs, reduction in overall cost of running the service could not catch up with the reduction in Government funding. Budgetary deficits since 2001/02 have gradually depleted the general reserve of the HA and major measures are urgently called for both in terms of improving HA’s financial allocation and revenues as well as cutting cost. The Government will continue to curb public spending in order to balance the fiscal budget in 2008/09 and there is no easy solution to the severe budgetary problem facing the HA.

8.2 A multi-pronged approach is needed to address the issues of overall healthcare financing, the public-private imbalance in service utilisation, the budgetary cuts imposed on HA, and cost-saving measures. At all times, the principle that nobody should be deprived of adequate medical care because of lack of means must be upheld. On the other hand, those who can afford should contribute more towards the sustainability of the system.

LONG AND SHORT TERM HEALTH FINANCING OPTIONS

8.3 The challenges of long term sustainability of the public healthcare system are not unique to Hong Kong and cannot be resolved without a revamped system in healthcare financing.

8.4 The Government has revived the Health and Medical Development Advisory Committee which aims to formulate long term healthcare financing strategies within the year. HA will provide full support with information and expertise as appropriate, as it has in the studies on Domestic Health Accounts and options for medical insurance. HA has also been looking at ways in which subsidies can be targeted most effectively and this can be taken forward following the announcement by SHWF on the positioning of HA with emphasis on the four priority services areas, namely: (a) acute and emergency care, (b) services for the low income group and the underprivileged, (c) illnesses that entail high cost, advanced technology and multi-disciplinary professional team work in their treatment, and (d) training of healthcare professionals.

8.5 In the short term, it is anticipated that there will be a new round of fees revision for public healthcare services to inculcate cost-consciousness and narrow the gap between the public and private sectors. Charges for private patients in HA hospitals will also be reviewed. Financial measures will be taken to curb the adverse health service seeking behaviour of Non-eligible Person users.

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8 - Enhancing Healthcare System Sustainability

Targets:

• Support the Government in the deliberation of long term healthcare 4Q05 financing options in the Health & Medical Development Advisory Committee, and provide information and expertise for further studies as required

• Work with the Government in the review of fees and charges, and 1Q06 implement changes as appropriate

FUNDING AND FINANCIAL PLANNING

8.6 In order to address the imminent financial situation, apart from seeking financial support from the Government and cutting costs, HA will also identify alternative funding sources through various means.

Targets:

• Review with Government the funding formula to the HA, including funding 4Q05 for the safety net for expensive new technology

• Conduct actuarial study on the Home Loan Interest Subsidy Scheme 2Q05

• Formulate financial planning based on various scenarios in the projection 3Q05 of manpower and other expenses

RATIONALISING AND MAXIMISING RESOURCE USE

8.7 Given that our resources are finite and yet the health care needs of the ageing population are increasing, there will be a constant need to prioritise services to ensure that the resources are used in a rational manner to bring maximum benefits to the community.

8.8 New medical technologies will continue to be evaluated based on their safety, efficacy, cost effectiveness, and whether the technologies should be targets of public subsidies. To enable public hospitals to introduce expensive treatment options which are proven to be of significant benefits, the HA will introduce these technologies with private financing by patients, whilst those who cannot afford will be protected by a financial safety net established through charity donations.

Hospital Authority Annual Plan 2005/06 31

8 - Enhancing Healthcare System Sustainability

8.9 Enhancing the interface between the public and private health sectors is another important strategic direction of the HA, which also aims to assist in the rationalising and maximising of health resources. To this end, the facilitation of communication and sharing of patient information across public and private healthcare sectors has an important role. In the 05/06 HA Annual Plan, HA plans to develop a common registry of private practitioners in collaboration with medical associations. The registry aims to provide easy identification of individual private doctors, thereby facilitating the timely release of a patient's clinical information to the referring private doctor upon discharge from public hospitals. Establishment of the registry can also help promote the Family Doctor concept through facilitating continuation of care. In addition, to take advantage of HA’s expertise in providing health related training, the Institute of Health Care (IHC) will make available its training activities to external parties and learners on a cost recovery basis.

Targets:

• Evaluate the safety, efficacy and cost effectiveness of new medical 4Q05 technologies for introduction through private financing, while providing a safety net for those who cannot afford

• Develop a common registry of private practitioners in collaboration with 4Q05 the medical associations, to facilitate communication and sharing of patient information across public and private sectors

• Consolidate training activities offered to external parties and learners into 4Q05 the HA Institute of Health Care (IHC) and implement charges through cost-recovery principle

• Enhance existing IT infrastructure and databases so as to allow the piloting 1Q06 of the sharing of patient information between public and private sectors, with the aim to enhance public-private interfacing and continuity of care

EFFICIENCY MEASURES

8.10 To achieve further efficiency, cost-effectiveness and increase in productivity, various initiatives will be implemented to optimise the internal capabilities with enhanced focus or re-alignment of services. Initiatives covering exploration of options to leverage on relevant expertise and the capabilities of potential external partners for delivery of non-core services will also be pursued to achieve sustainable cost reduction with assurance of quality and proper risk management.

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8 - Enhancing Healthcare System Sustainability

Targets:

• Capitalise opportunities identified in the Enterprise Resource Planning 1Q06 (ERP) system project towards business process re-engineering in finance, procurement and human resources management

• Generate savings from taking over the biomedical engineering services for 2Q05 general outpatient clinics from the Electrical and Mechanical Services Department

• Finalise a plan to achieve efficiency and quality improvements in catering 2Q05 service either through public private partnership or in-house initiatives

• Arrange a total solution contract for supply of staff uniforms in two 1Q06 hospital clusters to generate savings

• Explore options for the rationalisation of resources in caring for stable 1Q06 infirmary patients through inter-hospital exchange of patients and adjustment of staff mix

• Explore options of further consolidation of facilities and institutions within 4Q05 hospital clusters

CONTROLLING PERSONAL EMOLUMENT EXPENSES

8.11 To manage personal emolument expenses, HA will continue to adopt stringent control on headcount while balancing its training and service priorities. Staff will be involved in exploring available options to promote a healthy turnover of the workforce while minimising adverse effect on the level and quality of service, thereby creating opportunities for rationalisation measures.

Targets:

• Continue to adopt stringent control on headcount while balancing the 2Q05 training and service priorities of HA

• Explore options to promote turnover of existing staff while minimising 3Q05 adverse effect on the level and quality of service

Hospital Authority Annual Plan 2005/06 33

9 - Improving Service Quality and Clinical Governance

CLINICAL RISK MANAGEMENT AND QUALITY IMPROVEMENT

9.1 Delivery of safe and effective patient care hinges on the integration of a continuous process designed to detect, assess, eliminate and/or control actual and potential risk to patients and staff, while enhancing performance.

9.2 Since 1998, HA has established a Risk Management Committee Structure in its Head Office, respective clusters and hospitals to monitor the work in risk management, and to co-ordinate system-wide review and implementation of risk management initiatives. The leading roles of the Head Office Risk Management Committee include analysis of risks, priorities and direction setting, and assisting hospitals in risk management activities.

9.3 The Risk Management Policy and Strategy established in 2001 stipulated HA’s commitment to “improving patient safety and reducing error”. Emphases were placed on the need to adopt a systematic approach to managing risk, top-level leadership commitment and a culture of safety embracing the whole organisation. To ensure quality of care and patient safety, HA has set quality standards for compliance. Hospitals will conduct regular monitoring and review for continuous quality improvement.

9.4 HA has developed an electronic incident reporting system, Advanced Incident Reporting System (AIRS), to encourage efficient reporting of incidents from frontline staff to hospital management. The AIRS has been enhanced and successfully implemented in some cluster hospitals. The system’s rollout programme to most of the HA hospitals is underway and is expected to complete in 2006. The AIRS will be further developed in 2005/06 to enable efficient transfer of information from hospitals to Head Office to facilitate corporate-wide analysis of data.

9.5 All HA hospitals are assessing and prioritising risks through review of incidents, root cause analysis, complaints, and medico-legal issues, etc. The Head Office Risk Management Committee is formalising this process to establish a corporate risk register comprising strategic risks and operational risks for prioritisation of risk reduction activities and review.

9.6 HA has identified the high-risk areas and working groups are set up to recommend action plans to mitigate the effects of such risks. The top ten priority areas include prevention of medication errors, correct identification of patients, safe transport of patients, effective patient communication, infection control, triage of patients, prevention of patient falls, medical record, occupational health and safety, and enhanced medical equipment safety.

9.7 To enhance the organisation-wide risk management capability, HA is organising and facilitating cluster based training programmes in key areas of risk assessment, risk reduction strategies, root cause analysis and promotion of new guidelines on obtaining informed consent of patients.

34 Hospital Authority Annual Plan 2005/06

9 - Improving Service Quality and Clinical Governance

9.8 HA will work to ensure that the patient care systems and processes are continually enhanced, and that lessons learned from patient safety incidents and innovations in patient safety, both local and overseas, are shared among the frontline staff to minimise risks and enhance patient safety.

Targets:

• Establish a corporate risk register comprising corporate strategic risks and 2Q05 operational risks, for planning and prioritisation of improvement work

• Complete consultation and introduce the HA Drug Formulary to promote 3Q05 equitable and rational use of cost effective treatment across all HA hospitals

• Review drug use in three drug groups (antibiotics, proton pump inhibitors, 1Q06 and alpha-adrenergic blockers in benign prostatic hyperplasia)

• Establish pharmacists-run Refill and Drug Counselling Clinics to enhance 1Q06 drug therapy effectiveness

• Conduct study on adopting bar coding technology to improve transfusion 4Q05 safety, and map out implementation plan across hospitals

• Conduct corporate-wide communication and promotion in adopting new 2Q05 guidelines and forms of patient consent to treatments and procedures

• Develop guidelines and toolkits for staff regarding the safety of patients 3Q05 transport

• Enable accessibility of patient-based drug allergy information in the 4Q05 Clinical Management System to all pharmacies for inpatient dispensing

• Upgrade the contingency downtime system for pharmacies 1Q06

• Further roll out the Advanced Incident Reporting System (AIRS) version 2 1Q06 to another seven hospitals, and develop AIRS Tier II system for information capture from hospitals to Head Office to facilitate corporate-wide analysis

• Roll out cluster-based training programmes on root cause analysis, risk 2Q05 assessment and risk reduction

• Implement primary nursing model in 15 hospitals to minimise cross 1Q06 infection

Hospital Authority Annual Plan 2005/06 35

9 - Improving Service Quality and Clinical Governance

• Prepare for the remaining laboratories in six major hospitals for 3Q05 laboratory accreditation

• Develop infection control guidelines for seven Allied Health services 3Q05

• Consolidate services for patients with chronic low back pain in 1Q06 Orthopaedic & Traumatology outpatient clinics to ease the current workload while enhancing care for those requiring specialist care

EVIDENCE-BASED PRACTICE AND CLINICAL AUDIT

9.9 Due to the rapid proliferation of knowledge and technology in healthcare, evidence-based medicine (EBM) is increasingly being used to aid healthcare decision. The process of heath technology assessment (HTA) and clinical practice guideline (CPG) development, being methodologically rigorous, open and objective, provides effective platforms to engage different stakeholders to critically consider current best evidence and local healthcare system factors. HA has been promoting EBM for a number of years through large scale training of staff, building the Electronic Knowledge Gateway (e-KG) to facilitate rapid access to evidence, and establishing expertise in technology assessment. Given its success, HA will continue to make use of EBM to manage new technologies (e.g. the HAMSINP) and support service development in various specialties, especially those involving multiple disciplines (e.g. cancer care) or unsettled issues (e.g. acute stroke care), and to monitor its own performance through developing clinical data registry, auditing care activities and to learn through benchmarking best practices, i.e., comparative audit among healthcare institutes.

Targets:

• Perform technology assessment to support service development in various 1Q06 specialties including endovascular coiling versus open surgical treatment for intra-cerebral aneurysm, and updating Health Technology Assessment (HTA) on early surgery versus initial conservative treatment for spontaneous supratentorial intra-cerebral haematomas

• Conduct comparative audit on three major surgical operations 1Q06

• Conduct audit on clinical practice guidelines for schizophrenia 4Q05

• Conduct nursing audits in oxygen therapy, patient documentation and 1Q06 patient identification

• Conduct clinical audit on major procedure for five Allied Health services 4Q05

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9 - Improving Service Quality and Clinical Governance

• Conduct a clinical audit on HA's colposcopy service 1Q06

• Promulgate the use of comparative audit in all relevant clinical specialties 1Q06

• Establish Central Cancer Committee to coordinate and rationalise 4Q05 HA-wide cancer services based on clinical practice guidelines (CPGs)

STRENGTHENING INFORMATION MANAGEMENT IN CLINICAL CARE

9.10 To strengthen the information support to clinical care, HA will extend the Laboratory and Radiological Information systems to non-acute hospitals. The development of the next phase of the Operating Theatre Management System - the final phase of the current proposal - will enhance this system in the coming year and provide clinical users with additional management functionalities. In line with the overall Clinical Systems Strategic Plan 2005/09, HA will initiate the development of an enterprise application architecture platform for the next generation systems. This development will provide a comprehensive platform to ensure that the next generation systems can be procured, developed and implemented within an overall strategy in a cost-effective and timely manner. These developments will enhance capture of clinical data which facilitate analysis and monitoring for the purpose of clinical governance.

Targets:

• Commence development of the application architecture platform for the 1Q06 next generation clinical systems

• Develop and implement the Operating Theatre Management Systems 1Q06

• Extend the Laboratory Information System and Radiological Information 1Q06 System to non-acute hospitals to support cluster-based clinical service delivery

• Extend image distribution infrastructure to four hospitals with mini-PACS 1Q06 (Picture Archiving and Communication System)

• Establish key performance indicators for acute stroke care and develop a 1Q06 HA-wide Stroke Registry

• Develop the Generic Results Reporting (GRR) system for Percutaneous 1Q06 Coronary Intervention (PCI) audit data and selected cardiac procedures

Hospital Authority Annual Plan 2005/06 37

9 - Improving Service Quality and Clinical Governance

DEVELOPING CHINESE MEDICINE SERVICES

9.11 HA began the first phase of Chinese Medicine service by setting up three Chinese Medicine outpatient clinics and a toxicology reference laboratory. As the development of Chinese Medicine service in HA evolves over time and as HA accumulates experience in this new area of service, opportunities will be taken in the coming year to consolidate the past experience and to strengthen the existing infrastructure support to the Chinese Medicine clinics. In addition, HA will further develop its e-knowledge gateway (e-KG) as a platform for sharing of information on Chinese Medicine to frontline clinicians.

9.12 In line with the Government's direction, HA will commission non-governmental organisations (NGOs) in partnership with the three universities to run self-financed Chinese Medicine clinics and to provide training for graduates of the universities. At the same time, efforts will be directed to enhance the interface between Western medicine and Chinese Medicine by piloting research-based Chinese Medicine inpatient service in selected patient groups.

Targets:

• Establish three additional Chinese Medicine clinics in accordance with the 1Q06 Government’s direction, including installation of information technology infrastructure and other support systems

• Enhance interface between Western and Chinese Medicine from experience 3Q05 gained in research and service

• Develop e-Knowledge Gateway (eKG) to broaden the knowledge base and 1Q06 facilitate sharing of information on Chinese Medicine for frontline clinicians

• Pilot a collaboration model with Chinese Medicine practitioners for 4Q05 inpatient consultation service based on research

ENHANCING INFECTIOUS DISEASE CONTROL

9.13 To enhance infectious disease management, a structured training programme will be organised to strengthen the capability of the microbiology laboratory team in providing molecular diagnostic services. A pilot programme will be organised for staff involved in infection control in collaboration with renowned overseas professional associations to enhance their professional development and promote professional excellence. The Infectious Disease Control Training Centre (IDCTC) will also partner with overseas institutions to commission epidemiology training course for staff involved in infection control.

38 Hospital Authority Annual Plan 2005/06

9 - Improving Service Quality and Clinical Governance

Targets:

• Strengthen the capability of the laboratory team in the provision of 4Q05 molecular pathology service through structured training programmes

• Set up a programme to facilitate certification for infection control 3Q05 practitioners in collaboration with renowned overseas professional association

• Implement epidemiology training for infection control officers in 4Q05 partnership with overseas institutions

Hospital Authority Annual Plan 2005/06 39

10 - Building Human Resources Capability

ENHANCING HUMAN RESOURCES FUNCTIONS

10.1 HA is facing morale problems of staff who had suffered multiple blows in the past few years, e.g., SARS epidemics and its aftermath, yearly budget cuts, and pressure from rising demands of a growing and ageing population. There is also the sentiment over equal work-unequal pay, poor promotion prospect and even job security. The organisation needs to further strengthen its human resources (HR) function to help the organisation tackle its people challenges. The plan is to implement a matrix management structure in which Cluster HR structure will mirror that of the Head Office HR to help ensure alignment and communication for both strategic and operational purposes. The implementation plan will also include recruiting the right people with the right skills to support the organisation.

10.2 To enhance the HR functions, a new HR structure will be established at the cluster/hospital level with dual reporting both to the cluster/hospital line management and the Head Office HR. Work processes would be reengineered and additional HR professionals recruited as appropriate.

Targets:

• Establish a new Human Resources structure at cluster/hospital level with 4Q05 dual reporting both to cluster/hospital line management and to Head Office Human Resources

• Enhance HR performance through work reengineering of critical processes 1Q06 identified in the Enterprise Resource Planning (ERP) business case

• Consolidate HR management function and postgraduate training of 2Q05 medical grade

• Formalise all HA Continuous Nursing Education (CNE) programmes to 3Q05 achieve accreditation status of the Hong Kong Nursing Council

• Support the Continuing Professional Development (CPD) Scheme of the 4Q05 Supplementary Medical Professions Council through accreditation as programme provider

• Roll out the Staff Rostering System to ten hospitals 1Q06

40 Hospital Authority Annual Plan 2005/06

10 - Building Human Resources Capability

IMPROVING STAFF MORALE

10.3 Improvement to staff morale will be achieved by devising a performance-based mechanism to grant salary increments for new recruits with fixed pay point contracts, and by exploring the opportunity of converting contract staff with distinctive performance to permanent terms. Over 1,500 temporary staff will be converted to contract employment terms based on the service needs identified. With additional one-off funding, HA will continue to employ staff under the Government’s Initiative for Wider Economic Participation Scheme (IWEP) to enhance its patient care services.

10.4 To help address the staff morale problems, the work in staff relations will focus on enhancing the wellbeing of staff. The HA’s initiatives include programmes to support the psychological wellness of staff and measures to strengthen performance management to enable us to deal with poor performance more effectively.

Targets:

• Continue employment of staff supported under the Government’s Initiative 2Q05 for Wider Economic Participation (IWEP) Scheme with additional one-off funding obtained

• Convert 1,500 temporary staff to contract employment based on service 2Q05 needs identified in various cluster hospitals

• Devise a mechanism to grant salary increments for new recruits (employed 2Q05 after 15 June 2002 with fixed pay point contracts) who demonstrate consistently good performance

• Deliberate on granting the opportunity of staff with distinctive 3Q05 performance, who are employed on contracts, to convert to permanent terms

• Explore options to deal more effectively with poor performance 4Q05

• Support the psychological wellness of staff through organising 40 sessions 1Q06 of "Resilience to crisis" and 6 "Mindfulness based stress reduction" training programmes and further roll out of Critical Incident Support Teams

Hospital Authority Annual Plan 2005/06 41

10 - Building Human Resources Capability

IMPROVING STAFF COMMUNICATION

10.5 To strengthen staff communication which was identified as one of the shortcomings by the two SARS review reports, HA has formulated its internal communication strategies and put in place additional staff communication channels in 2004.

10.6 As part of the ongoing effort to enhance staff communication, HA will constantly review its strategies and plans to identify areas for further enhancement. HA will further strengthen its communication with staff group leaders and engage them in addressing key issues together.

Targets:

• Enhance communication with staff group leaders on key issues faced by HA 2Q05 and in stages of policy formulation

• Follow up issues identified in the staff survey conducted in 2004 to address 2Q05 staff concerns

• Conduct communication audit to identify weaknesses and implement 4Q05 improvement measures including training to managers and more effective communication channels

IMPROVING CAREER DEVELOPMENT OF STAFF

10.7 Training and development has always been a priority for HA. For developing future senior executives, HA has implemented the Executive Partnership (EP) Scheme since 1994. This serves as a good channel to widen staff exposure to management duties and experience. The plan for 05/06 is to identify EPs through a central recruitment exercise and maximise exposure to key areas of management. Besides taking on specific projects, the EPs will receive a structured development programme. The revised EP scheme will be carefully monitored and supported by a designated member of the Head Office Human Resources Division.

10.8 To improve career development of healthcare professionals, HA will recruit 300 doctors, 400 nurses and 100 allied health personnel for professional training and services provision in 2005/06. Career prospect statistics of the various clinical specialties will be provided to the new medical graduates and Residents undergoing training to facilitate career planning. The Staff Development Review mechanism will also be reviewed and enhanced for measurement of staff performance.

42 Hospital Authority Annual Plan 2005/06

10 - Building Human Resources Capability

Targets:

• Recruit 300 doctors, 400 nurses and 100 allied health personnel for 1Q06 professional training and service needs

• Provide updated information on the manpower projection, intake number 2Q05 and career prospect statistics of various clinical specialties to new medical graduates and Residents undergoing training to enable their career planning

• Convert 149 Enrolled Nurses to Registered Nurses, and 35 and 40 4Q05 Registered Nurses (General) to commence training in midwifery and psychiatric qualifications respectively

• Revamp the Executive Partner Scheme to develop leaders in management 3Q05 and clinical fields

• Improve the Administrative Medicine Training Programme 1Q06

• Evaluate the Advanced Practice Nurse Pilot Project 1Q06

• Review and update mechanisms for the measurement of staff performance 1Q06 through the Staff Development Review (SDR)

• Roll out competency-based Staff Development Review set for allied health 4Q05 professionals

Hospital Authority Annual Plan 2005/06 43

10 - Building Human Resources Capability

ENHANCING OCCUPATIONAL SAFETY AND HEALTH

10.9 The Head Office multidisciplinary team has been re-established to spearhead programmes on occupational safety and health in partnership with cluster hospitals, focusing on workplace violence and manual handling operations. Training in Occupational Medicine will be initiated. For all occupational safety and health programmes, HA will continue to emphasise the importance of value change, followed by behavioural and cultural changes amongst the workforce.

Targets:

• Launch a comprehensive campaign against workplace violence to enhance 3Q05 staff safety

• Roll out an injury prevention programme for manual handling operations 4Q05 to reduce injury-on-duty rate

• Standardise data capture and reporting on sharps injury and strengthen 4Q05 safety measures

44 Hospital Authority Annual Plan 2005/06

11- Hong Kong East Cluster

GENERAL BACKGROUND

11.1 The Hong Kong East Cluster serves the population of the Eastern, Wanchai and Islands (excluding North Lantau) districts. The estimated population of these districts is 0.81 million. There are six hospitals in the cluster providing a comprehensive inpatient, ambulatory and community-based healthcare services:

• Pamela Youde Nethersole Eastern Hospital - An acute regional hospital providing a full range of specialist services. • Ruttonjee & Tang Shiu Kin Hospitals - A community hospital providing accident and emergency and a selected range of secondary and tertiary services, especially Internal Medicine, Respiratory Medicine, Geriatrics, and Surgery. • Tung Wah Eastern Hospital - A community hospital providing secondary and tertiary services including Internal Medicine, Ophthalmology, Rehabilitation and Convalescent Care. • Wong Chuk Hang Hospital and Cheshire Home (Chung Hom Kok) - Both provide infirmary services for patients requiring long term care. • St. John Hospital - It provides services to meet the general healthcare needs of the population of Cheung Chau.

11.2 In addition, the Hong Kong Tuberculosis, Chest & Heart Diseases Association supports the health education activities of the cluster hospitals.

11.3 As at 31 December 2004, there were in the cluster a total of 3,199 beds, with 1,639 for acute care, 950 for convalescent, rehabilitation, infirmary and hospice care, and 610 for the mentally ill.

FUTURE CHALLENGES AND MAJOR INITIATIVES

11.4 Financial constraints and the threat of pandemic diseases have posed severe challenges to the healthcare system of Hong Kong. Like many others in the territory, Hong Kong East Cluster hospitals are faced with long waiting time for specialist outpatient consultations and surgical operations. Healthcare staff are stressed by the increasing workload, public pressure, unclear career prospect, and increasing turnover.

11.5 While some of the challenges have to be addressed at a macro and policy level, the Hong Kong East Cluster is positive in managing the situation, and making further improvement in enhancing the quality of patient care for the benefits of the community.

Hospital Authority Annual Plan 2005/06 45

11 - Hong Kong East Cluster

Clinical Service

11.6 Family Medicine Specialist Clinics will be set up to ensure timely and appropriate care for new patients. Designated doctors will be entrusted with the responsibility of screening referrals and providing immediate appropriate treatment to those with urgent conditions. The drug formulary of the various outpatient outlets will be reviewed to facilitate continuity of care in the community.

11.7 To better support emergency care, Hong Kong East Cluster will implement pre-hospital diversion of trauma patients from the ambulance catchment area of Ruttonjee & Tang Shiu Kin Hospitals to Queen Mary Hospital which serves as the Trauma Centre of the area.

11.8 For inpatient care, the intensive care service will be strengthened through integration with the medical High Dependency Unit of Pamela Youde Nethersole Eastern Hospital. With the donation from the Board of Management of Chinese Permanent Cemeteries, additional beds will be provided at Ruttonjee & Tang Shiu Kin Hospitals to enhance the cluster palliative care service. In line with HA’s overall rationalisation of psychiatric services, 164 psychiatric beds which accommodate patients from Kowloon East and Kowloon Central will be transferred back to the relevant clusters. The microbiology service for Pamela Youde Nethersole Eastern Hospital and Ruttonjee & Tang Shiu Kin Hospitals will be rationalised to enhance our clinical support services. The turnaround time of pathological reports will be shortened.

11.9 As an ongoing effort to improve healthcare quality, the Cluster Quality & Risk Management Committee will review patient identification strategy and explore new technologies as well as clinical processes to reduce medical errors. New patient consent guidelines and forms for patient treatment and care procedure will be implemented. In line with the HA Standard Drug Formulary, cluster drug utilisation and payment practices will be aligned. Clinical audit will continue to be an important quality assurance tool. Surveillance of hospital infections and surgical site infection will be carried out. Multi-disciplinary care for acute stroke service will be enhanced to reduce the long term disability of patients.

Community and Ambulatory Care

11.10 The Cluster attaches much importance to enhance community-based care through partnership with other care providers. Multi-disciplinary fall prevention and hypertension screening programmes will be implemented in collaboration with NGOs and the Hong Kong West Cluster. A network of volunteers will be developed to strengthen support to the needy including elders living alone. To reduce the need for inpatient services and yet improve quality of care, the new Tang Shiu Kin Hospital will be commissioned in the year as an ambulatory and community healthcare centre.

46 Hospital Authority Annual Plan 2005/06

11- Hong Kong East Cluster

Administration Support

11.11 Despite the tight budget situation, support to clinical services has been improved. In addition, management of stores will be strengthened at the cluster level to reduce wastage. Facilities management services will further be consolidated to streamline administration and improve efficiency.

Human Resources

11.12 The provision of a healthy, safe and rewarding workplace is of paramount importance to support our staff in the delivery of patient care. Injury prevention programmes such as manual handling, workplace violence, and surveillance of hospital acquired infections will be strengthened. A “Care for Carers” programme to enhance staff well-being and increase community support for healthcare workers will be launched. Internal communication and staff wellness facilities will be enhanced. A cluster staff recognition scheme for outstanding staff and team will also be implemented.

Targets:

Improving Population Health

• Implement multi-disciplinary fall prevention & hypertension screening 2Q05 programmes in collaboration with 12 non-governmental organisations (NGOs) & Hong Kong West Cluster to enhance community-based healthcare

Enhancing Organisational Performance

• Extend pre-hospital primary trauma diversion to the ambulance catchment 2Q05 area of the Ruttonjee & Tang Shiu Kin Hospitals with Queen Mary Hospital serving as the Trauma Centre serving the area

• Reduce Specialist Outpatient Department new bookings through triage of 2Q05 appropriate cases at Family Medicine Specialist Clinic

• Strengthen intensive care service by integrating Intensive Care Unit and 4Q05 Medical High Dependency Unit (HDU) of Pamela Youde Nethersole Eastern Hospital

• Enhance Store Management in the cluster to reduce wastage associated 4Q05 with slow moving inventory items

Hospital Authority Annual Plan 2005/06 47

11 - Hong Kong East Cluster

• Consolidate Facilities Management Service Providers in the cluster to 4Q05 reduce risks and improve cost-efficiency in the delivery of facilities management service

• Transfer 164 psychiatric beds to Kowloon East and Kowloon Central 1Q06 Clusters in line with HA's overall rationalisation of psychiatric services

Enhancing Healthcare System Sustainability

• Review drug formulary for General Outpatient Clinics/Integrated Clinics/ 2Q05 Specialist Outpatient Departments to facilitate continuity of care in the community

• Enhance palliative care in Hong Kong East Cluster through the 2Q05 development of an inter-hospital referral guideline and provision of designated infirmary beds in the cluster hospitals

• Enhance rationalisation of microbiology service to strengthen year-round 3Q05 support to Pamela Youde Nethersole Eastern Hospital & Ruttonjee & Tang Shiu Kin Hospitals and improve turnaround time

Improving Service Quality and Clinical Governance

• Promote and implement new patient consent guidelines and forms for 3Q05 patient treatment and care procedure

• Pilot the implementation of thrombolytic therapy and enhance early 4Q05 evaluation of acute stroke cases to reduce long term disability of patients

• Standardise cluster/hospitals drug utilisation and payment practices in 4Q05 accordance with HA Standard Drug Formulary

• Review patient identification strategy and explore new technologies to 1Q06 redesign wrist band & clinical processes to reduce medical errors

Building Human Resources Capability

• Implement a Cluster Recognition Scheme for outstanding staff and teams 2Q05

• Strengthen staff communication through enhancement programmes 2Q05 including the setting up of cyber stations in cluster hospitals

48 Hospital Authority Annual Plan 2005/06

11- Hong Kong East Cluster

• Promote staff health & fitness through enhancing staff club facilities and 2Q05 setting up sports associations

• Enhance management, provide system support and training for staff in 4Q05 managing workplace violence

• Develop and launch a "Care for Carers" programme to enhance employee 4Q05 wellbeing and increase community awareness and support for healthcare workers

Hospital Authority Annual Plan 2005/06 49

12 - Hong Kong West Cluster

GENERAL BACKGROUND

12.1 The Hong Kong West Cluster serves the population of the Central, Western and Southern districts. The estimated population of these districts is 0.53 million. The Cluster comprises seven hospitals and five satellite institutions. Apart from providing a comprehensive range of health care services to cater for the needs of the residents in its catchment area, the Cluster is well known for its tertiary and quaternary services which serve the whole population of Hong Kong. The seven hospitals are:

• Queen Mary Hospital – A regional acute hospital and the teaching hospital for the Faculty of Medicine of The University of Hong Kong. It is also a tertiary and quaternary referral centre for advanced technology services such as bone marrow transplant and liver transplant. • Tsan Yuk Hospital – With its obstetric and newborn inpatient services relocated to Queen Mary Hospital in late 2001, the hospital is currently operating as a community family health centre. • Duchess of Kent Children’s Hospital – The hospital provides specialist services in paediatric orthopaedics, neurology and dental surgery, developmental paediatrics and spinal surgery. It is serving child patients throughout the territory. • Grantham Hospital – A tertiary referral centre for treatment of heart and lung diseases. It is also the only hospital in the territory providing medical care for babies and children with heart problems. With the reorganisation of Nam Long Hospital in December 2003, Grantham Hospital has commenced provision of palliative medical service to cancer patients. • Fung Yiu King Hospital – An extended care hospital specialising in geriatric service. It provides rehabilitation and convalescence for medical and orthopaedic patients. It also provides community outreach service through its Community Geriatric Assessment Team. • MacLehose Medical Rehabilitation Centre – Opened in 1984 by the Hong Kong Society for Rehabilitation, the centre now provides comprehensive rehabilitation services. • Tung Wah Hospital – The oldest hospital under the medical division of the Tung Wah Group of Hospitals. The hospital provides extended care as well as ambulatory and day surgery services for patients from Queen Mary Hospital and the other cluster hospitals.

12.2 The satellite institutions in the Cluster are David Trench Rehabilitation Centre and the General Outpatient Clinics in Sai Ying Pun, Aberdeen, Ap Lei Chau and Kennedy Town, and the Central District Health Centre.

12.3 As at 31 December 2004, there were in the Cluster a total of 3,396 beds, with 2,631 for acute care, 673 for convalescent, rehabilitation, infirmary and hospice care, and 92 for the mentally ill.

50 Hospital Authority Annual Plan 2005/06

12 - Hong Kong West Cluster

FUTURE CHALLENGES AND MAJOR INITIATIVES

12.4 The Hong Kong West Cluster is faced with the following major challenges:

Financial Constraints

With the implementation of population-based funding and the prevailing fiscal policy of the Government, the cluster budget for 2005/06 will be further reduced substantially and the year ahead will continue to be a very challenging one. With rising community expectations and reduced resources, the present level of public service will be unsustainable in the long run. To enhance sustainability of the current system, one of the key strategies of the cluster is to review and reprioritise services with the primary aim of serving the needy while offering alternative choices of private services to those who can afford.

Human Resources Management

Following the successful combat against SARS in 2003, the Cluster is faced with significant increase in workload despite substantial reduction in headcount. Based on the findings of the 2004 Staff Opinion Survey, efforts would have to be directed to enhance staff communication, supervision, training and development, leadership and succession planning as a means to improving staff morale.

Physical Limitations

The old hospital building of Queen Mary Hospital with severe space limitation and scattered services as well as the rundown or suboptimal utilisation of facilities in Duchess of Kent Hospital, McLehose Medical Rehabilitation Centre and Tsan Yuk Hospital have rendered it difficulty to operate services with maximal efficiency or effectiveness. There is therefore continuing need for further consolidation and streamlining of clinical and non-clinical services in the cluster.

12.5 In meeting these challenges, the Cluster will reorganise its services targeted at four priority areas:

y Acute and emergency care; y Services for the low-income group and the under-privileged; y Illnesses that entail high cost, advanced technology and multi-disciplinary professional team work in their treatment; and y Training of all health care and other professional staff.

12.6 Accordingly, the main focus of the Cluster in the coming year will be as follows:

(a) To reduce patients’ dependency on hospital services by

y Enhancing gate keeping/community-oriented services; and y Service rationalisation, streamlining, integration and prioritisation.

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12 - Hong Kong West Cluster

(b) To address staff sentiment and promote “care for the carers” by further enhancing

y Risk management/safety/occupational safety & health; y Staff health and wellness; y Internal communication; and y Training and development.

(c) To provide a comprehensive range of services without compromising quality and standards by implementing initiatives to further generate savings or additional revenue.

Targets:

Improving Population Health

• Strengthen the Quality Old Aged Home Recognition Scheme through 2Q05 encouraging good drug administration in Old Aged Homes (OAH) (to reduce drug errors) while continuing all general care and infection control standards

• Collaborate with non-governmental organisations (NGOs) and District 2Q05 Councils to promote fall prevention and hypertension management in the community

• Strengthen Visiting Medical Officers (VMOs) / Community Geriatric 3Q05 Assessment Team (CGAT) collaboration in Old Aged Homes to reduce medication incidents and improve infection control

• Collaborate with Community Nursing to provide counselling service for 1Q06 patients re-admitted due to drug compliance problem

Enhancing Organisational Performance

• Roll out "Inventory Control System" to operating theatres of 3 cluster 4Q05 hospitals (Duchess of Kent Children's Hospital, Grantham Hospital & Tung Wah Hospital)

• Improve Infection Control Provisions in Autopsy Facilities 1Q06

• Enhance Magnetic Resonance Imaging (MRI) / Computed Tomographic 1Q06 (CT) service by replacing old scanners through donation and start installing new ones at newly constructed sites

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12 - Hong Kong West Cluster

Enhancing Healthcare System Sustainability

• Plan to further roll out energy conservation initiatives 2Q05

• Plan to install a new Brachytherapy equipment to enhance cancer service 1Q06

• Explore options to further consolidate facilities/institutions within the 1Q06 cluster

Improving Service Quality and Clinical Governance

• Set up a multi-disciplinary Central Cancer Committee to coordinate cancer 2Q05 services and treatment standards

• Standardise cluster/hospitals drug utilisation and payment practices in 2Q05 accordance with HA Standard Drug Formulary

• Introduce new anti-psychotic drugs in a algorithmic approach to promote 3Q05 rational use of anti-psychotic drugs

• Promote and implement new patient consent guidelines and forms for 4Q05 patient treatment and care procedure

• Implement Advanced Incident Reporting System Version II 4Q05

• Pilot a collaboration model with Chinese Medicine Practitioners for 1Q06 inpatient consultation service for selected group of patient in Tung Wah Hospital/Hong Kong West Cluster under research/protocol basis

Building Human Resources Capability

• Set up a Cluster Occupational Safety and Health Resource Centre to 3Q05 support Occupational Safety and Health initiatives

• Develop and launch a "Care for Carers" programme to enhance employee 3Q05 well being and increase community awareness and support for healthcare workers

• Enhance management and provide comprehensive support and training for 3Q05 staff in managing workplace violence

Hospital Authority Annual Plan 2005/06 53

13 - Kowloon East Cluster

GENERAL BACKGROUND

13.1 The Kowloon East Cluster serves the population of the Kwun Tong and Tseung Kwan O districts. The estimated population of these districts is 0.95 million. There are three hospitals in the Cluster:

z United Christian Hospital - The major acute hospital providing secondary service for the Kwun Tong region and tertiary service for the whole Kowloon East Cluster. z Tseung Kwan O Hospital - An acute hospital providing secondary service for Tseung Kwan O region. z Haven of Hope Hospital - A sub-acute hospital providing extended care and rehabilitation services in the Cluster.

13.2 Apart from the above, the Cluster also looked after eight general outpatient clinics, as well as the outpatient and day patient facilities in the Yung Fung Shee Memorial Centre and Pamela Youde Polyclinic.

13.3 As at 31 December 2004, there were in the Cluster a total of 2,165 beds, with 1,657 for acute care, 478 for convalescent, rehabilitation, infirmary and hospice care, and 30 for the mentally ill.

FUTURE CHALLENGES AND MAJOR INITIATIVES

13.4 The greatest challenge to the Cluster is to make the best use of the resources available to provide cost-effective service, with the ultimate aim of improving the health of the local community.

13.5 The bed to population ratio in the Cluster is very low, but the workload has been increasing, due to the increasing population in Tseung Kwan O region and the ageing population in Kwun Tong region. In order to cope with this situation, the Cluster has placed a lot of emphasis on improving ambulatory care, through outreach teams, and through empowerment of other healthcare providers and informal carers in the community. The cluster management structure, which started in October 2001 and emphasised collaboration and flexibility, provides an opportunity for the Cluster to meet the challenge. A lot of rationalisation and efficiency gains have been achieved in the past years. Further effort will be made to improve population health and to enhance organisational performance in the coming year. For better public/private interface, efforts will be made to enhance patient choice by providing information on private practitioners to the patients, and by knowledge and skill transfer to private surgeons.

13.6 All along, United Christian Hospital has been providing comprehensive outpatient, day patient and outreach psychiatric services for the whole Kowloon East region, whereas the inpatient facilities were limited to 30 beds. The psychiatric patients who need compulsory admission are admitted to Pamela Youde Nethersole Eastern Hospital. To rationalise psychiatry service by geographical region, 50 new

54 Hospital Authority Annual Plan 2005/06

13 - Kowloon East Cluster

psychiatry beds for informal patients will be added in United Christian Hospital in early 2006. Together with the opening of more gazetted beds in Kowloon Hospital, the Kowloon East and Kowloon Central Clusters would be able to manage the needs of psychiatric patients within the geographic regions together.

13.7 The Main Block of the United Christian Hospital Redevelopment Project was completed in 1995. Major equipment items over ten years will be replaced in phases in order to maintain the quality of service. To improve access in the hospital, construction works for additional lifts will commence in the year.

13.8 To maintain a high quality of service has all along been the Cluster’s priority. In the coming year, the Cluster would focus on risk management initiatives in its drive towards continuous quality improvement.

13.9 A good team of staff is essential. Open communication with staff will be maintained and performance management capability of line managers will be enhanced. “Care for Carers” programmes will be enhanced to improve the wellbeing of the cluster staff and to boost morale.

Targets:

Improving Population Health

• Commission community fall prevention and hypertension management 2Q05 programmes for the elderly in Kowloon East Cluster

• Build a volunteer network to support at risk post-discharged patients 3Q05

• Enhance home care quality in Community Nursing Service by implementing 4Q05 11 home care protocols and developing monitoring mechanism to monitor and evaluate outcomes

• Support the implementation of the Government's Head Start programme for 1Q06 those aged 0-5 in Tseung Kwan O region

Enhancing Organisational Performance

• Commence construction works for the Block S Additional Lift Project of 2Q05 United Christian Hospital

• Integrate the laboratory service of Tseung Kwan O Hospital and Haven of 2Q05 Hope Hospital under a single Chief of Service

• Establish cluster security service contract 3Q05

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13 - Kowloon East Cluster

• Replace ultrasound scanner for Radiology Department of United Christian 4Q05 Hospital

• Reduce Specialist Outpatient Department new case bookings through triage 4Q05 of low priority ones at Family Medicine Specialist Clinic

• Replace laundry equipment at United Christian Hospital 1Q06

• Award contract for the replacement of physiological monitoring system of 1Q06 Coronary Care Unit, Intensive Care Unit and Operating Rooms of United Christian Hospital

• Award contract for the replacement of the Computed Tomographic (CT) 1Q06 Scanner for Radiology Department of United Christian Hospital

• Commence construction works for the disabled lifts at United Christian 1Q06 Hospital Hip Wo Street Entrance

• Rationalise psychiatry service for Kowloon region with opening of 50 1Q06 informal beds in United Christian Hospital

Enhancing Healthcare System Sustainability

• Enhance patient choice through provision of information on private 2Q05 practitioners to the public in Kwun Tong region

• Implement mentorship programme for private surgeons in minimal invasive 3Q05 surgery

Improving Service and Clinical Governance

• Promote the culture of reporting near misses in Kowloon East Cluster 3Q05

• Promote and implement new patient consent guidelines and forms for 3Q05 patient treatment and care procedure

• Standardise cluster/hospitals drug utilisation and payment practices in 3Q05 accordance with the HA Standard Drug Formulary

Building Human Resources Capability

• Enhance the performance management capability of line managers by 4Q05 providing training programmes on staff performance management/ discipline

56 Hospital Authority Annual Plan 2005/06

13 - Kowloon East Cluster

• Enhance management and provide comprehensive support and training for 4Q05 staff in managing workplace violence

• Develop and launch a "Care for Carers" programme to enhance employee 4Q05 wellbeing and increase community awareness and support for healthcare workers

• Review the effectiveness of the existing return-to-work programme and 1Q06 explore the possibility of extending to other types of injury-on-duty cases with prolonged sick leave

Hospital Authority Annual Plan 2005/06 57

14 - Kowloon Central Cluster

GENERAL BACKGROUND

14.1 The Kowloon Central Cluster serves the population of the Yau Ma Tei & Tsim Sha Tsui and Kowloon City districts. The estimated population of these districts is 0.49 million. However, a significant proportion of the patients residing outside these two districts are also served by Kowloon Central Cluster. There are six hospitals/ institutions in the Cluster:

• Queen Elizabeth Hospital - A major acute hospital providing 24-hour comprehensive services. • Kowloon Hospital - An extended care hospital providing rehabilitation and psychiatric services. • Buddhist Hospital - A community hospital with some general and extended care services. • Hong Kong Eye Hospital - A specialised Ophthalmic Centre. • Hong Kong Red Cross Blood Transfusion Service - It provides blood and blood products to all hospitals in Hong Kong. • Rehabaid Centre - It provides specialised community-based rehabilitation services.

14.2 As at 31 December 2004, there were in the Cluster a total of 3,707 beds, with 2,128 for acute care, 1,266 for convalescent, rehabilitation, infirmary and hospice care, and 313 for the mentally ill.

FUTURE CHALLENGES AND MAJOR INITIATIVES

14.3 In the past year, the Cluster has implemented many initiatives to tackle the possible return of SARS and to rationalise services to reduce dependency on inpatient services. Although SARS did not return, there were sporadic infectious disease outbreaks elsewhere in the South East Asia region. Vigilance has to be maintained at all times and the isolation facilities together with the logistics and expertise may be called upon at any instance.

14.4 The future challenge is still that of managing the demand from our population with limited resources. Some experienced staff had left through the Hospital Authority’s Voluntary Early Retirement and the Civil Service Voluntary Retirement schemes. Some gazetted psychiatric beds will be moved to Kowloon Hospital in the coming year. That gives the Cluster further impetus to rationalise, integrate and reengineer its services. In line with the HA’s corporate directions, and the directions of the new SHWF, the Cluster will continue to focus on means to reduce the dependency on inpatient services and promote outpatient/community-based care. Community health promotion and disease prevention programmes will allow the Cluster to manage the health care demand upstream. Coupling with the enhancement of the gate-keeping function of Accident & Emergency Department, inpatient services will be further rationalised. With all these measures, the Cluster would be able to manage the health care of our population with the reduced funding in relation to the Enhanced Productivity Programme.

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14 - Kowloon Central Cluster

Targets:

Improving Population Health

• Reduce falls in elderly patients by implementing the Fall Prevention 2Q05 Community Programme in collaboration with non-governmental organisations (NGOs)

• Take over from the HK Marrow Match Foundation the management and 3Q05 operation of the Bone Marrow Registry services in collaboration with Hong Kong Red Cross

• Enhance diabetic complication screening programme in General 4Q05 Outpatient Department of Kowloon Central Cluster

• Promote healthy eating lifestyle and disease prevention by organising 1Q06 community programmes on medical nutrition therapy and disease prevention

• Promote population health through health education and promotion 1Q06 programmes on specific areas, including cancer and other diseases, by collaborative efforts amongst clinical departments, community partners/organisations and Patient Resource Centre in Kowloon Central Cluster

Enhancing Organisational Performance

• Reduce Specialist Outpatient Department new case bookings from Yau Ma 3Q05 Tei General Outpatient Clinic by 10% through triage at Family Medicine Specialist Clinic/Ambulatory Care Physician clinic

• Enhance the Accident & Emergency Department's gate-keeping function 4Q05 and reduce hospital admission by maximizing the use of additional observation beds in Ward G1

• Develop the Augmented-ambulatory Rehabilitative Training (ART) and the 4Q05 Community Oriented Rehabilitation & Empowerment programme (CORE) for spinal cord injury patients in Kowloon Hospital

• Enhance Computed Tomographic (CT) Scan services by replacing old CT 4Q05 scanner through donation

Hospital Authority Annual Plan 2005/06 59

14 - Kowloon Central Cluster

• Relocate 180 gazetted psychiatric beds from Kwai Chung Hospital and 1Q06 Pamela Youde Nethersole Eastern Hospital to Kowloon Hospital to enable the management of psychiatric patients in Kowloon Central Cluster within the cluster's resources

Enhancing Healthcare System Sustainability

• Explore the measures to tackle the long waiting time for cataract surgery 2Q05

• Rationalise Non-Emergency Ambulance Transfer Service (NEATS) quota 3Q05 allocation and enhance NEATS monitoring mechanism after implementation of NEATS Transport Supporting System (Automatic Dispatching System)

Improving Service Quality and Clinical Governance

• Rationalise the use of targeted second-line antibiotics by extending 2Q05 antibiotic stewardship programme to medical services in Kowloon Central Cluster to control antibiotic resistance and reduce unnecessary expenditure

• Reinforce proper infection control practice by conducting post-campaign 2Q05 audits to evaluate the effectiveness of Hand Hygiene Campaign launched in 2004/05 and re-strategise in 2005/06

• Enable better care of refractory epilepsy patients by developing referral 3Q05 protocol in Kowloon Central and Kowloon East Clusters

• Facilitate the management of patients requiring non-invasive ventilation at 3Q05 home by streamlining logistics and developing protocols for managing non-invasive ventilation in the ward and at home

• Promote and implement new patient consent guidelines and forms for 4Q05 patient treatment and care procedure

• Standardise cluster/hospitals drug utilisation and payment practices in 1Q06 accordance with HA Standard Drug Formulary

Building Human Resources Capability

• Build up the expertise and facilitate skills transfers to ambulatory care 2Q05 physician in General Outpatient Clinic by customising a training module

• Enhance management and provide comprehensive support and training for 4Q05 staff in managing workplace violence

60 Hospital Authority Annual Plan 2005/06

14 - Kowloon Central Cluster

• Conduct training and injury prevention programmes on Manual Handling 1Q06 Operation

• Develop and launch a "Care for Carers" programme to enhance employee 1Q06 wellbeing and increase community awareness and support for healthcare workers

Hospital Authority Annual Plan 2005/06 61

15 - Kowloon West Cluster

GENERAL BACKGROUND

15.1 The Kowloon West Cluster serves the population of the Mong Kok, Wong Tai Sin, Sham Shui Po, Kwai Tsing, Tsuen Wan and North Lantau districts. The estimated population is 1.88 million. There are seven hospitals in the cluster providing a full spectrum of health services ranging from primary, secondary, tertiary, to extended care, including mental health. The seven hospitals in the Cluster are:

z Princess Margaret Hospital - A major regional hospital providing a comprehensive range of acute services. z Kwong Wah Hospital - A major regional hospital providing a comprehensive range of acute services. z Caritas Medical Centre - A general hospital providing acute, extended and community care services. z Yan Chai Hospital - A community hospital providing general and rehabilitation services. z Kwai Chung Hospital - A psychiatric hospital. z Our Lady of Maryknoll Hospital - A community hospital providing general services. z Tung Wah Group of Hospitals Wong Tai Sin Hospital - An extended care hospital providing rehabilitation and tuberculosis and chest services.

15.2 As at 31 December 2004, there were in the Cluster a total of 7,306 beds, with 4,265 for acute care, 1,369 for convalescent, rehabilitation, infirmary and hospice care, 1,372 for the mentally ill, and 300 for the mentally handicapped.

FUTURE CHALLENGES AND MAJOR INITIATIVES

15.3 In 2005/2006, coping with enormous service volume with a diminishing healthcare budget will be a key challenge to the Cluster. To alleviate the specialist outpatient service volume, a designated Family Medicine Centre will be set up in each of the five districts in the Cluster to see and triage the non-urgent cases referred from General Outpatient Clinics, Accident and Emergency Departments, and private general practitioners. Besides, the Cluster will set up Community Care Networks in the five districts to link up the multi-sectoral healthcare service providers from HA and the community to promote seamless care. An Oncology Centre will be established to provide a comprehensive range of Oncology services for patients in the Cluster. A collaboration model with Chinese Medicine practitioners for inpatient consultation service will be piloted. Construction works for the Infectious Disease Centre located in Princess Margaret Hospital will continue as part of the endeavours to enhance the overall capability within HA in managing infectious diseases.

62 Hospital Authority Annual Plan 2005/06

15 - Kowloon West Cluster

Targets:

Improving Population Health

• Establish five Community Care Networks in five districts of the Cluster 2Q05 involving Family Medicine, Community Nurses, Community Geriatric Assessment Team, Psychiatrists, District Councils, Department of Health, Social Welfare Department, non-governmental organisations and Private Practitioners

• Support the implementation of the Government's Head Start programme for 4Q05 those aged 0-5 in Shum Shui Po district

• Formulate a plan for partnership with non-governmental or charitable 1Q06 organisations for management of the infirmary beds for the Kowloon West Cluster

Enhancing Organisational Performance

• Implement full-scale operation of the Kowloon West Cluster Central Sterile 2Q05 Supplies Department

• Integrate laboratory service for Our Lady of Maryknoll Hospital and Wong 3Q05 Tai Sin Hospital

• Improve Developmental Disability Unit facilities in Caritas Medical Centre 4Q05 and decrease overcrowding by downsizing the beds to 200

• Commission opening of the new Oncology & Trauma Block at Princess 4Q05 Margaret Hospital with installation of radiotherapy equipment

• Relocate the Princess Margaret Hospital Accident & Emergency 4Q05 Department to the new Oncology & Trauma Block

• Relocate the Princess Margaret Hospital Radiology Department to the new 4Q05 Oncology & Trauma Block

• Replace the Magnetic Resonance Imaging Scan for Princess Margaret 4Q05 Hospital

• Explore feasibility of trauma diversion from Yan Chai Hospital ambulance 4Q05 catchment area to Princess Margaret Hospital

Hospital Authority Annual Plan 2005/06 63

15 - Kowloon West Cluster

• Start operation of the Oncology Centre at Princess Margaret Hospital to 1Q06 provide Oncology services for Kowloon West Cluster

• Rationalise the clustering of Psychiatric services by relocating Yau Ma Tei 1Q06 Psychiatric Clinic back to Princess Margaret Hospital, and transferring 66 gazetted beds to Kowloon Hospital

• Explore integration of the Psychiatric clinical management teams at Kwai 1Q06 Chung Hospital to enhance efficiency

• Establish five designated Family Medicine centres to triage referrals from 1Q06 General Outpatient Clinics, General Practitioners and Accident & Emergency Departments, aiming to reduce Specialist Outpatient new case waiting time and reduce referrals by 5%

Enhancing Healthcare System Sustainability

• Collaborate with HK Association of Private Eye Surgeons (HKAPES) and 3Q05 Yan Chai Board as a Public Private Initiative to set up private ophthalmology service at Yan Chai Hospital

• Rationalise Orthopaedics & Traumatology service in Kowloon West Cluster 1Q06

Improving Service Quality and Clinical Governance

• Pilot a collaboration model with Chinese Medicine Practitioners for 3Q05 inpatient consultation service for selected group of patient in Kwong Wah Hospital under research/protocol basis

• Standardise the guideline on patient transfer within Kowloon West Cluster 3Q05

• Implement protocols for total care management of acute stroke 4Q05

• Promote and implement new patient consent guidelines and forms for 4Q05 patient treatment and care procedure

• Standardise cluster/hospitals drug utilisation and payment practices in 4Q05 accordance with HA Standard Drug Formulary

• Implement Advanced Incident Reporting System Version II in all hospitals 1Q06

64 Hospital Authority Annual Plan 2005/06

15 - Kowloon West Cluster

Building Human Resources Capability

• Enhance management and provide comprehensive support and training for 2Q05 staff in managing workplace violence

• Develop and launch a "Care for Carers" programme to enhance employee 2Q05 wellbeing and increase community awareness and support for healthcare workers

• Provide training for staff on awareness and prevention of patient suicide 3Q05

• Roll out Critical Incident Support Team in two more hospitals in 3Q05 conjunction with the Oasis

• Organise five training programmes for 10% of staff to enhance manual 1Q06 handling operations

Hospital Authority Annual Plan 2005/06 65

16 - New Territories East Cluster

GENERAL BACKGROUND

16.1 The New Territories East Cluster serves the population of the Sai Kung (excluding Tseung Kwan O), Shatin, Tai Po and North districts. The estimated population of these districts is 1.31 million. In addition, there has been a significant increase in the cross-border utilisation of hospital services in the Cluster in the past year as the Cluster is in close proximity to the boundary with the Mainland. There are seven hospitals providing a comprehensive acute, convalescent, rehabilitation, extended and community care services to the Cluster:

z Prince of Wales Hospital (PWH) - A major acute hospital that is also the teaching hospital for the Chinese University of Hong Kong’s medical school; it provides secondary care services for the residents in Shatin as well as a range of tertiary and quaternary services for the whole of Hong Kong. z Shatin Hospital - An extended care hospital providing convalescent and rehabilitation support to patients from PWH as well as psychiatric inpatient care. z Cheshire Home Shatin - An extended care hospital providing infirmary care for patients from the central infirmary waiting list and the severely disabled. z Bradbury Hospice - It provides inpatient and community outreach hospice services. z Alice Ho Miu Ling Nethersole Hospital (AHNH) - An acute general hospital in Tai Po. z North District Hospital - An acute general hospital in North District. z Tai Po Hospital (TPH) - An extended care hospital providing convalescent and rehabilitation support to patients from Alice Ho Miu Ling Nethsole Hospital and North District Hospital as well as psychiatric inpatient care.

16.2 As at 31 December 2004, there were in the Cluster a total of 4,574 beds, with 2,611 for acute care, 1,335 for convalescent, rehabilitation, infirmary and hospice care and 628 for the mentally ill.

FUTURE CHALLENGES AND MAJOR INITIATIVES

16.3 In 2005/06, the Cluster will face major challenges arising from the continuous budget cuts, morale problems of staff and concerns on quality of services. The Cluster annual plan initiatives are formulated along the corporate directions to address these challenges. There will be specific emphasis on the following areas:

z Enhancing ambulatory and community care to reduce the burden on inpatient care; z Strategic role development of Alice Ho Miu Ling Nethersole Hospital and establishment of a training centre for community specialist; z Strengthening partnership with the Chinese University of Hong Kong (CUHK) and the local private healthcare providers to enhance quality and system sustainability; z Promoting patient safety and risk management in patient care delivery; z Re-positioning and rationalising services to optimise access and ensure patient care quality; and z Creating a harmonious organisation and fulfilling working environment for staff.

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16 - New Territories East Cluster

16.4 In 2004/05, the Cluster has developed a set of core values as the linchpin of all the work in support of corporate strategies. These cluster values form the basis of cohesiveness and decision making in the Cluster. Continuous communication enhancement programmes will be organised to instil the cluster core values in all staff and in day-to-day activities. The Cluster has developed strategies to establish or strengthen partnership with CUHK, Union Hospital and the community care provider networks in the districts. It has also formulated plans to develop the strategic role of AHNH. The first stage of establishing the cluster ambulatory and short stay surgery centre has already been started in 2004/05. In the second stage, it is planned to establish a training centre for community specialist in AHNH to enhance the quality of training for the would-be specialists who are going to practise independently in the community. The Cluster will also explore the feasibility of merging the governance and management of AHNH and TPH to improve efficiency.

16.5 On the provision of services, the Cluster will introduce programmes to manage general outpatient referrals to specialist outpatient clinics. It will enhance services of the community outreach service teams and community nurses to inpatients for early discharge and reducing admission. The Cluster will continue to promote ambulatory and community services with the engagement of local partners. Through collaboration with these community and private partners, patients will be offered more choices. On the quality of services, the Cluster will accord priority to address two key quality issues: optimising access for patients waiting for specialist outpatient consultations and ensuring patient safety during their stay in hospitals.

16.6 On the human resources side, the Cluster sees the urgency of improving the morale of staff working in hospitals. Programmes are developed to enhance staff support, to create a harmonious organisation, and to promote a fulfilling environment for staff and their career development.

Targets:

Improving Population Health

• Establish a Family Medicine clinics and Community Outreach Service 2Q05 Team collaboration model to improve community care

• Enhance the community outreach service to promote early discharge and to 3Q05 reduce re-admission of the acute inpatients

• Organise community health promotion programmes in collaboration with 4Q05 the community care provider networks in the Shatin, Tai Po and North Districts

Hospital Authority Annual Plan 2005/06 67

16 - New Territories East Cluster

Enhancing Organisational Performance

• Reorganise the distribution of psychiatric beds in Tai Po Hospital to meet 3Q05 the changing needs for acute psychiatric inpatient care

• Reorganise the General Surgery and Orthopaedics & Traumatology 3Q05 services respectively into cluster subspecialty teams

• Complete a functional brief for the redevelopment of Prince of Wales 4Q05 Hospital

• Centralise the provision of private outpatient clinic services with the 4Q05 completion of a combined private clinic in Prince of Wales Hospital

• Complete the setting up of an integrated ambulatory Otorhinolaryngology 4Q05 (ENT) centre in Alice Ho Miu Ling Nethersole Hospital

• Develop the strategic role of Alice Ho Miu Ling Nethersole Hospital with 1Q06 establishment of the Training Centre for Community Specialists

• Explore the feasibility of merging the governance and management of Alice 1Q06 Ho Miu Ling Nethersole Hospital and Tai Po Hospital

• Commission the enhanced physical segregation arrangements for patients 1Q06 in the Accident & Emergency Departments of North District Hospital and Alice Ho Miu Ling Nethersole Hospital

• Optimise patient access in Specialist Outpatient Clinics and chemotherapy 1Q06 day centre

Enhancing Healthcare System Sustainability

• Introduce a collaborative programme with Society for Promotion of 3Q05 Hospice Care to enhance the hospice home care services

• Expand the capacity for haemodialysis service in Alice Ho Miu Ling 4Q05 Nethersole Hospital and provide designated beds for the rehabilitation of patients on Continuous Ambulatory Peritorneal Dialysis (CAPD) in Tai Po Hospital

• Explore the feasibility of setting up a transitional care unit for tetraplegic 1Q06 patients in Cheshire Home Shatin in collaboration with the Hong Kong Cheshire Home Foundation and the Social Welfare Department

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16 - New Territories East Cluster

Improving Service Quality and Clinical Governance

• Promote and implement new patient consent guidelines and forms for 2Q05 patient treatment and care procedures

• Launch the antibiotics stewardship and surveillance programme to reduce 1Q06 antibiotics resistance

• Implement the three yearly cross-sectional infection prevalence survey in 1Q06 New Territories East Cluster and standardisation of surveillance of infections caused by Methicillin-resistant Staphylococcus Aureus (MRSA) and Multi-drug resistant Gram-negative organisms

• Standardise cluster drug utilisation and payment practices in accordance 1Q06 with the HA Standard Drug Formulary

Building Human Resources Capability

• Develop and launch a series of "Care for Carers" programmes to enhance 1Q06 employee wellbeing and increase community awareness and support for healthcare workers

• Enhance staff relation by enhancing the cluster staff suggestion scheme, 1Q06 promoting the usage of hospital Oasis, expanding the Critical Incident Support teams, conducting cluster recreational activities, enhancing the Instant Staff Recognition Scheme, and conducting seminars to instil core value

• Enhance management and provide comprehensive support and training for 1Q06 staff in improving occupational safety and managing workplace violence

Hospital Authority Annual Plan 2005/06 69

17 - New Territories West Cluster

GENERAL BACKGROUND

17.1 The New Territories West Cluster serves the population of the Tuen Mun and Yuen Long districts. The estimated population of these districts is 1.08 million. There are four hospitals in the Cluster:

• Tuen Mun Hospital - The only acute general hospital in the cluster which provides a comprehensive range of acute, ambulatory and community services. • Pok Oi Hospital - It was once an acute hospital. In 2001, a redevelopment project commenced and it has since then been converted temporarily into an extended care hospital, providing rehabilitation and infirmary service support to Tuen Mun Hospital. • Castle Peak Hospital - It is a psychiatric hospital which provides a full range of psychiatric services for patients living in all areas in Hong Kong. • Siu Lam Hospital - A specialised facility to accommodate severely mentally disabled adult patients.

17.2 As at 31 December 2004, there were in the Cluster a total of 4,063 beds, with 1,453 for acute care, 423 for convalescent, rehabilitation, infirmary and hospice care, 1,687 for the mentally ill, and 500 for the mentally handicapped.

SIGNIFICANT LOCAL ISSUES AND FUTURE CHALLENGES

New Service Model of Pok Oi Hospital

17.3 The hospital operation model and manpower plan will be developed to optimise the service provision with the available resources for the new Pok Oi Hospital which will start to operate in 2007. The new service model will take into consideration the community’s needs and the Cluster’s service development direction in ambulatory and community care.

Impact of Growing Number of Long Term Care Institutions

17.4 More long-term care institutions will be built within the catchment areas of the Cluster. Since the inhabitants of these institutions include the elders, and physically or mentally disabled, their dependence on public health care is high. In the year 2005/2006, it is anticipated that 800 clients will move into the Cluster from other parts of Hong Kong due to the opening of a newly built long term care institution. This will impose great demand on the service provision at the Cluster, particularly the already stretched psychiatric service.

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17 - New Territories West Cluster

MAJOR INITIATIVES OF THE CLUSTER

Improving Population Health

17.5 The Cluster will enhance the provision of rehabilitation service in the community for patients with heart failure and stroke by developing joint programmes with NGOs and expanding the service coverage of the community rehabilitation practitioners. The Cluster will also commission the operation of Yung Fung Shee and Yan Oi Community Care Centres and establish nurse-led clinics there for managing patients with chronic heart failure and chronic obstructive airway disease (COAD). Adequate liaison and planning will also be made to facilitate and prepare for the transfer of stable psychiatric long stay patients from Castle Peak Hospital to a new long stay care home in Tuen Mun. A local network with NGOs will be developed to further enhance community psychiatric care.

Enhancing Organisational Performance

17.6 The Cluster will continue to manage the Specialist Outpatient Clinic (SOPC) volume through the control of referrals from the Accident and Emergency (A&E) Department and the General Outpatient Clinics (GOPC), and the expansion of triage clinics. Disease management programmes in cardiovascular diseases, stroke, diabetes mellitus, COAD, chronic low back pain and depression and anxiety will be further developed to enhance the management of patients suffering from these medical conditions.

17.7 The Cluster will work out the service models of the new Pok Oi Hospital and Tuen Mun Hospital Rehabilitation Block along the cluster development direction.

Enhancing Healthcare System Sustainability

17.8 The Cluster will launch a series of patient empowerment programmes through structured information provision to patients and collaboration with patient support groups to enhance the patients’ self-care capability at home and in the community. To meet the ever-growing need for pharmacy service, the Cluster will integrate the outpatient dispensing service of Tuen Mun Hospital Main Block Pharmacy with that provided by the Pharmacy of the Ambulatory Care Centre in order to enhance service efficiency by pooled manpower and streamlined workflow.

Improving Service Quality and Clinical Governance

17.9 The Cluster will increase service throughput of cataract operation in the new Tuen Mun Eye Centre, enhance outpatient haemodialysis service through the opening of haemodialysis stations in the same new facility, and improve access of cancer patients to key radiological and pathological diagnostic tests. With the implementation of the HA Standard Drug Formulary, the Cluster will standardise drug utilisation and payment practice of hospitals in accordance with the new HA policy.

Hospital Authority Annual Plan 2005/06 71

17 - New Territories West Cluster

Building Human Resources Capability

17.10 The Cluster will provide comprehensive support and training to staff in managing workplace violence. A series of e-learning orientation and induction programmes will be established to enable better integration of newly employed staff into the working environment and organisational culture.

Targets:

Improving Population Health

• Establish a local network with non-governmental organisations to enhance 2Q05 community psychiatric care

• Prepare to transfer stable psychiatric long stay patients from Castle Peak 2Q05 Hospital to a new Long Stay Care Home in Tuen Mun

• Enhance provision of rehabilitation service in the community for patients 4Q05 with heart failure and stroke by developing joint programmes with non-governmental organisations and expanding the service coverage of the community rehabilitation practitioners

• Support the implementation of the Government's Head Start programme for 4Q05 those aged 0-5 in Tuen Mun and Tin Shui Wai regions

• Commission the operation of Yung Fung Shee and Yan Oi Community Care 1Q06 Centres and establish nurse-led clinics for managing patients with chronic heart failure and Chronic Obstructive Airway Disease (COAD)

Enhancing Organisational Performance

• Determine the service models of the new Pok Oi Hospital and Tuen Mun 4Q05 Hospital Rehabilitation Block

• Manage Specialist Outpatient Clinic volume through control of referrals 4Q05 from Accident & Emergency department and General Outpatient Clinics and expansion of triage clinics

• Develop disease management programmes in cardiovascular diseases, 1Q06 stroke, diabetes mellitus, chronic obstructive airway disease, chronic low back pain and depression and anxiety

• Enhance nuclear medicine service by replacing one gamma camera 1Q06

72 Hospital Authority Annual Plan 2005/06

17 - New Territories West Cluster

Enhancing Healthcare System Sustainability

• Consolidate pharmacy service into one site at Tuen Mun Hospital 2Q05

• Implement patient empowerment programmes through information 4Q05 provision and collaboration with patient support groups

Improving Service Quality and Clinical Governance

• Develop a risk register and implement risk management programmes to 4Q05 reduce medication errors and minimize risk of transferring critically-ill patients

• Increase service throughput of cataract operation in the new Tuen Mun Eye 4Q05 Centre by 200 per year

• Promote and implement new patient consent guidelines and forms for 4Q05 patient treatment and care procedure

• Enhance outpatient haemodialysis service in the new Tuen Mun Eye Centre 1Q06 by opening 7 haemodialysis stations with 1500 haemodialysis sessions

• Improve access of cancer patients to key radiological and pathological 1Q06 diagnostic tests

• Standardise cluster/hospitals drug utilisation and payment practice in 1Q06 accordance with the HA Standard Drug Formulary

Building Human Resources Capability

• Enhance management and provide comprehensive support and training for 3Q05 staff in managing workplace violence

• Develop e-learning orientation and induction programmes to enable better 3Q05 integration of newly employed medical, nursing, allied health and support staff into the working environment and organisational culture

• Develop and launch a series of "Care for Carers" programmes to enhance 1Q06 employee wellbeing and increase community awareness and support for healthcare workers

Hospital Authority Annual Plan 2005/06 73

Appendix 1 - List of Public Hospitals and Institutions

Hong Kong East Cluster Kowloon East Cluster

Cheshire Home, Chung Hom Kok (CCH) Haven of Hope Hospital (HHH) Pamela Youde Nethersole Eastern Hospital Tseung Kwan O Hospital (TKOH) (PYNEH) United Christian Hospital (UCH) Ruttonjee & Tang Shiu Kin Hospitals (RHTSK) Kowloon West Cluster St. John Hospital (SJH) Tung Wah Eastern Hospital (TWEH) Caritas Medical Centre (CMC) Wong Chuk Hang Hospital (WCHH) Kwai Chung Hospital (KCH) Kwong Wah Hospital (KWH) Hong Kong West Cluster Our Lady of Maryknoll Hospital (OLMH) Princess Margaret Hospital (PMH) Duchess of Kent Children’s Hospital Wong Tai Sin Hospital (WTSH) (DKCH) Yan Chai Hospital (YCH) Fung Yiu King Hospital (FYKH) Grantham Hospital (GH) New Territories East Cluster MacLehose Medical Rehabilitation Centre (MMRC) Alice Ho Miu Ling Nethersole Hospital (AHNH) Queen Mary Hospital (QMH) Bradbury Hospice (BBH) Tsan Yuk Hospital (TYH) North District Hospital (NDH) Tung Wah Hospital (TWH) Prince of Wales Hospital (PWH) Shatin Hospital (SH) Kowloon Central Cluster Cheshire Home, Shatin (SCH) Tai Po Hospital (TPH) Hong Kong Buddhist Hospital (BH) Hong Kong Red Cross Blood Transfusion New Territories West Cluster Service (BTS) Hong Kong Eye Hospital (HKE) Castle Peak Hospital (CPH) Kowloon Hospital (KH) Pok Oi Hospital (POH) Queen Elizabeth Hospital (QEH) Siu Lam Hospital (SLH) Rehabaid Centre (RC) Tuen Mun Hospital (TMH)

Note: (1) Apart from the above, Lai Chi Kok Hospital was converted into a long stay care home for patients with chronic mental illness under the subvention of Social Welfare Department. (2) Nam Long Hospital was closed on 13 December 2003. (3) Management of Ruttonjee and Tang Shiu Kin Hospitals is combined.

74 Hospital Authority Annual Plan 2005/06

Appendix 2 - List of Ambulatory Care Facilities

Specialist Outpatient Day Accident & General * Cluster Institution / Satellite Clinic (including Allied Patient Emergency Health, excluding Outpatient Integrated Clinics) Hong Kong Anne Black Health Centre √ East Cluster Chai Wan Health Centre √ Cheshire Home (Chung Home Kok) √ North Lamma Clinic √ Pamela Youde Nethersole Eastern Hospital √ √ √ Peng Chau Clinic √ Ruttonjee & Tang Shiu King Hospitals √ √ √ Sai Wan Ho Health Centre √ Shau Kei Wan Jockey Club Clinic √ Sok Kwu Wan Clinic √ Southern Centre √ St. John Hospital √ √ √ √ Stanley Public Dispensary √ Tung Wah Eastern Hospital √ √ √ Violet Peel Health Centre √ Wan Tsui Government Clinic √ Subtotal 4 3 6 12 Hong Kong Aberdeen Jockey Club Clinic √ West Cluster Ap Lei Chau Clinic √ Central District Health Centre √ David Trench Rehabilitation Centre √ Duchess of Kent Children’s Hospital √ √ Fung Yiu King Hospital √ Grantham Hospital √ √ Kennedy Town Jockey Club Clinic √ MacLehose Medical Rehabilitation Centre √ Queen Mary Hospital √ √ √ Sai Ying Pun Jockey Club General Outpatient Clinic √ Tsan Yuk Hospital √ √ Tung Wah Hospital √ √ √ Subtotal 5 1 8 6

Hospital Authority Annual Plan 2005/06 75

Appendix 2 - List of Ambulatory Care Facilities

Specialist Outpatient Day Accident & General * Cluster Institution / Satellite Clinic (including Allied Patient Emergency Health, excluding Outpatient Integrated Clinics) Kowloon Haven of Hope Hospital √ √ East Cluster Kowloon Bay Health Centre √ Kwun Tong Jockey Club Health Centre √ Lam Tin Polyclinic √ Mona Fong Clinic √ Ngau Tau Kok Jockey Club Clinic √ Shun Lee Government Clinic √ Tseung Kwan O Hospital √ √ √ Tseung Kwan O Jockey Club General Outpatient Clinic √ Tseung Kwan O (Po Ning Road) Health Centre √ United Christian Hospital √ √ √ Yung Fung Shee Memorial Centre √ Subtotal 3 2 4 8 Kowloon Central Kowloon Health Centre √ Central Hong Kong Buddhist Hospital √ √ √ Cluster Hong Kong Eye Hospital √ √ Hung Hom Clinic √ Kowloon Hospital √ √ Lee Kee Memorial Dispensary √ Queen Elizabeth Hospital √ √ √ Rehabaid Centre √ Shun Tak Fraternal Association Leung Kau Kui Clinic √ Yaumatei Jockey Club Clinic √ Yaumatei Specialist Clinic Extension √ Subtotal 4 1 6 6

76 Hospital Authority Annual Plan 2005/06

Appendix 2 - List of Ambulatory Care Facilities

Specialist Outpatient Day Accident & General * Cluster Institution / Satellite Clinic (including Allied Patient Emergency Health, excluding Outpatient Integrated Clinics) Kowloon Caritas Medical Centre √ √ √ √ West Cluster Caritas Medical Centre Cheung ShaWan General Outpatient Clinic √ East Kowloon Polyclinic √ Ha Kwai Chung Polyclinic and Special Education Services Centre √ Kwai Chung Hospital √ √ Kwong Wah Hospital √ √ √ √ Lady Trench Polyclinic √ Li Po Chun Health Centre √ Mrs Wu York Yu Health Centre √ Mui Wo Clinic √ Nam Shan Health Centre √ North Kwai Chung Clinic √ Our Lady of Maryknoll Hospital √ √ √ Our Lady of Maryknoll Hospital East Kowloon General Outpatient Polyclinic Clinic √ Pamela Youde Polyclinic √ Princess Margaret Hospital √ √ √ Robert Black Health Centre √ Shek Kip Mei Health Centre √ South Kwai Chung Jockey Club Polyclinic √ Tai O Jockey Club Clinic √ Tsing Yi Cheung Hong Clinic √ Tsing Yi Town Clinic √ Tung Chung Health Centre √ Wang Tau Hom Jockey Club Clinic √ West Kowloon Health Centre √ Wong Tai Sin Hospital √ √ Wu York Yu Health Centre √ Yan Chai Hospital √ √ √ √ Yaumatei Jockey Club Clinic √ Subtotal 7 4 10 23

Hospital Authority Annual Plan 2005/06 77

Appendix 2 - List of Ambulatory Care Facilities

Specialist Outpatient Day Accident & General * Cluster Institution / Satellite Clinic (including Allied Patient Emergency Health, excluding Outpatient Integrated Clinics) New Alice Ho Miu Ling Nethersole Hospital √ √ √ Territories Bradbury Hospice √ √ East Cluster Cheshire Home (Shatin) √ Fanling Family Medicine Centre √ Ho Tung Dispensary √ Lek Yuen Health Centre √ Ma On Shan Health Centre √ North District Hospital √ √ √ Prince of Wales Hospital √ √ √ Sha Tin Clinic √ Shatin Hospital √ √ Sha Tau Kok Clinic √ Shek Wu Hui Jockey Club Clinic √ Ta Kwu Ling Clinic √ Tai Po Hospital √ √ Tai Po Jockey Club Clinic √ Wong Siu Ching Clinic √ Yuen Chau Kok Clinic √ Subtotal 6 3 7 11 New Castle Peak Hospital √ Territories Kam Tin Clinic √ West Cluster Pok Oi Hospital √ √ √ Tin Shui Wai Health Centre √ Tuen Mun Clinic √ Tuen Mun Hospital √ √ √ Tuen Mun Wu Hong Clinic √ Yan Oi General Outpatient Clinic √ Yuen Long Jockey Club Health Centre √ Yuen Long Madam Yung Fung Shee Health

Centre √ √ Subtotal 2 1 4 8 Overall total 31 15 45 74

* General outpatient clinics in this list exclude mobile services.

78 Hospital Authority Annual Plan 2005/06

Appendix 3 - Background Information on Hospital Authority

ESTABLISHMENT OF HOSPITAL AUTHORITY

1. The Hospital Authority was established in December 1990 under the Hospital Authority Ordinance to manage all the public hospitals in Hong Kong. It took over the management of 38 public hospitals and the related institutions and their 37,000 staff on 1 December 1991.

2. It is a statutory body that is independent of, but accountable to, the HKSAR Government through the Secretary for Health, Welfare and Food. It is charged with the responsibility of delivering a comprehensive range of preventive, curative and rehabilitative medical services through its network of healthcare facilities at an affordable price which ensures access to every citizen.

MISSION OF HOSPITAL AUTHORITY

3. The Government’s policy is to safeguard and promote the general health of the community as a whole and to ensure the provision of medical and health services for the people of Hong Kong so that no one should be prevented, through lack of means, from obtaining adequate medical attention. This includes particularly that section of the community which relies on subsidised medical attention. In keeping with this policy, the mission of the Authority is:

• To meet the different needs of the patients for public hospital services, and to improve the hospital environment for the benefit of the patients; • To serve the public with care, dedication and efficiency, and to encourage community participation in the system, resulting in better care and more direct accountability to the public; • To provide rewarding, fair and challenging employment to all its staff, in an environment conducive to attracting, motivating and retaining well qualified staff; • To advise the Government of the needs of the community for public hospital services and of the resources required to meet these needs, in order to provide adequate, efficient, effective and value for money public hospital services of the highest standards recognised internationally within the resources obtainable; and • To collaborate with other agencies and bodies in the healthcare and related fields both locally and overseas to provide the greatest benefit to the local community.

Hospital Authority Annual Plan 2005/06 79

Appendix 3 - Background Information on Hospital Authority

CORPORATE VISION

4. To fulfil its mission, the Authority has established the following corporate vision:

‘The Hospital Authority will collaborate with other healthcare providers and carers in the community to create a seamless healthcare environment which will maximise healthcare benefits and meet community expectations.’

STRATEGIC DIRECTIONS

5. With the rapid changes in Hong Kong’s social, economic and political environment, strategic directions are formulated every year through an extensive annual planning process taking into account the funding position, societal expectations, the Government’s healthcare policy, and the challenges in the internal and external environment so that the corporate vision and mission can be turned into operational targets to meet community needs.

80 Hospital Authority Annual Plan 2005/06

Appendix 4 - Statistics of the Controlling Officer’s Report

Estimate for Target for 2004/05 2005/06 Targets Access to services Inpatient services no. of hospital beds general (acute and convalescent) 20,550 20,250 Infirmary 2,151 2,151 mentally ill 4,730 4,730 mentally handicapped 800 700 Total 28,231 27,831 Ambulatory & outreach services accident and emergency (A&E) services % of A&E patients with target waiting time Triage I (critical cases – 0 minutes) 100% 100% Triage II (emergency cases < 15 minutes) 95% 95% Triage III (urgent cases < 30 minutes) 90% 90% specialist outpatient services median waiting time for first appointment at specialist clinics first priority patients 2 weeks 2 weeks second priority patients 8weeks 8 weeks rehabilitation & geriatric services no. of community nurses 385 390 no. of geriatric day places 567 567 psychiatric services no. of community psychiatric nurses 105 105 no. of psychiatric day places 719 719 Indicators I) Delivery of services Inpatient services no. of discharges & deaths general (acute and convalescent) 826,300 826,300 Infirmary 3,300 3,300 mentally ill 14,000 14,200 mentally handicapped 400 400 Overall 844,000 844,200 no. of patient days general (acute and convalescent) 5,243,000 5,243,000 Infirmary 575,000 575,000 mentally ill 1,309,000 1,309,000 mentally handicapped 253,600 253,600 Overall 7,380,600 7,380,600 bed occupancy rate general (acute and convalescent) 83% 83% Infirmary 84% 86% mentally ill 80% 80% mentally handicapped 88% 88% Overall 82% 82% average length of stay (days) (Note 1) general (acute and convalescent) 6.4 6.4 Infirmary 133.0 133.0 mentally ill 101.0 174.0 mentally handicapped 546.0 546.0 Overall 8.9 8.9

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Appendix 4 - Statistics of the Controlling Officer’s Report

Estimate for Target for 2004/05 2005/06 Ambulatory & outreach services day inpatient no. of discharges & deaths 268,500 270,600 accident & emergency services no. of attendances 2,070,000 2,103,000 no. of attendances per 1000 popn 291 299 outpatient services no. of specialist outpatient (clinical) new attendances 587,000 587,000 no. of specialist outpatient (clinical) follow-up 5,461,000 5,464,000 total no. ofd specialist outpatient (clinical) attendances 6,048,000 6,051,000 no. of general outpatient attendances 5,278,000 5,278,000 rehabilitation & palliative care services no. of rehabilitation day and palliative care day 60,400 60,400 attendance (Note2) no. of home visits by community nurses 780,600 785,000 no. of allied health (community) attendances (Note2) 20,900 20,900 no. of allied health (outpatient) attendances 2,133,000 2,133,000 geriatric services no. of outreach attendances 453,000 453,000 no. of geriatric elderly persons assessed for infirmary care service 1,600 1,600 no. of geriatric day attendances 126,000 126,000 no. of Visiting Medical Officer attendances 81,400 81,400 psychiatric services no. of psychiatric outreach attendances 82,900 83,000 no. of psychiatric day attendances 179,200 179,200 no. of psychogeriatric outreach attendances 45,500 45,500 II) Quality of services no. of hospital deaths per 1000 popn (Note 3) 3.8 3.8 unplanned readmission rate within 28 days for general 9.4% 9.4% inpatients III) Cost of services cost distribution cost distribution by services types cost distribution by services (%) Inpatient 63.2% 63.1% ambulatory & outreach 36.8% 36.9% cost by services per 1000 popn ($m) Inpatient 2.7 2.6 ambulatory & outreach 1.6 1.5 cost of services for persons aged 65 or above share of cost of services (%) 45.2% 45.2% cost of services per 1000 popn ($m) 16.3 16.0 unit cost inpatient services cost per inpatient discharged ($) general (acute and convalescent) 19,960 19,450 infirmary 193,540 188,980 mentally ill 125,150 120,290 mentally handicapped 620,310 604,770 ambulatory & outreach services cost per accident & emergency attendance ($) 680 650 cost per specialist outpatient attendance ($) 710 700 cost per outreach visit by community nurse ($) 300 290 cost per psychiatric outreach attendance ($) 1,070 1,040 cost per geriatric day attendance ($) 1,430 1,390

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Appendix 4 - Statistics of the Controlling Officer’s Report

Estimate for Target for 2004/05 2005/06 IV) Manpower (no. of full-time equivalent staff as at 31st March) Medical Doctor 4,546 4,561 Intern 324 324 Dentist 5 5 Medical total 4,875 4,890 Nursing qualified staff 18,917 19,073 Trainee 180 180 nursing total 19,097 19,253 allied health 4,817 4,784 Others 23,040 22,885 Total 51,829 51,812

Note 1 Derived by dividing the sum of length of stay of inpatients by the corresponding number of inpatients discharged/ treated.

Note 2 Ambulatory and community-oriented services first presented in the Controlling Officer’s Report (COR).

Note 3 Refers to the standardised mortality rate covering all deaths in the Hospital Authority hospitals. This is derived by applying the age-specific mortality rate in the Hospital Authority in a particular year to a ‘standard’ population (which is the 2001 Hong Kong mid-year population).

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