Dated December 26 2015

 

Happy New Year.  Soon we are closing this year and opening 2016.

 

The year of 2015 was one of change and preparation to us.  We saw a definite plan for hospital expansion.  

 

Review to the Past

 

Towards the end of 2014, I was very pleased with our obstetric throughput being on healthy upward track.  We proved together that our system rivaled the time honored concept of ‘famous doctor’ in attracting clients.  Our brotherhood proved that we were at par with obstetric throughput against other private delivery suites, despite our regular obstetricians being relatively green in private practice experience.  Therefore our system and good service performance have become our productivity tool to promote client acceptance.  Unluckily, with obstetric indemnity being unilaterally changed by MPS, our childbirth performance also dropped by 10% in 2015, when many experienced colleagues reduced or stopped labor ward activity reluctantly. We added 3 new obstetricians and a new paediatrician to the 2 teams.  I am optimistic about output in a few years time.

 

With the glamorous light from obstetrics receding a bit, we saw other teams shining.  Accidents and Emergency is now an icon of the hospital.  Our young and diligent souls at the front-door have commanded patient acceptance and thereby admission statistics.  A few years back, many people in town did not view the establishment of emergency medicine in private sector as viable.  We have proved that our vision and dedication together marks history.

 

Surgeons have gained a lot of recognition.  In 2015, certain indicators of throughput from surgery rose above those of any other specialty here.  We have seen consistently good clinical outcome from our surgeons, and we are confident about the foundation they laid down.  We are on way to recruit new knives, and we shall place harmony as important as capacity in our consideration to recruits.  We are most happy that we are coming to the rapid growth phase of our ‘swordsmen’.

 

Internal medicine is actually the team which grew by the biggest order in the past decade when we counted number of doctors. We are seeing progressive maturation of the team in 2015.

 

Other teams all registered growth. In due course, every specialty healthily marches forward and will demand beds as resource. Our teams will expand with emphasis on efficiency, given that we do not have many new beds.

 

Assistance to Doctors

 

We are on way to improve feedback to doctors. Traditional methods to collect 360 degree peer feedback at annual bilateral feedback exercises did not yield enough information to our brotherhood.  This year, I asked service outlets to name doctors who are particularly worthy of praises as well as suggestions on which colleagues may benefit from special support. Nurses have responded effectively to this change in approach. They even provide me qualitative description on more abstract concepts such as good progress from personal baseline, a concept difficult to verify with statistics at this stage. I think they have accepted that I am here only to help doctors and others, and their information never harms any doctor.

 

About 1 out of 7 inpatients give feedback upon discharge from UH, and this is an extremely high proportion.  Over the past 1.5 years, we have successfully implemented electronic feedback to supplement the time honored paper system. Preliminary analyses with non-parametric methods gave good early glimpses to views of patients on specialties and service outlets. I shall use the information to congratulate top-guns and to help the needy.  In fact, there is little to worry even for  colleagues who appear to be slightly behind, because there is bound to be teammates who run slightly slower among our fast runners.  

 

We are developing a system to diagnose and assist doctors whose various reflection on performance may not have been as handsome as even they themselves may prefer.  You have seen how I explain interactions in consultations over the past decade.  It will be useful to every of us, if I may learn the method to diagnose specific problems in professional interactions of particular doctors. Initial impression so far about the most frequent causes might be over-simplified decision making (all or none), inexperience with using test messages in aligning clients, erroneous impression of having counselled clients when some ideas merely flowed through brain of the doctor, and secondary effects on risk management with clinical decisions from any of these factors. Sometimes, doctors might be seen as revealing their implicit wants too early, and other times their handling caused misunderstanding with staffs and clients. The improvement activity starts with problem identification, through replay of scenarios, to demonstration of alternative handling by meself in a workshop setting. I do not want to clone my own handling. Instead I only wish to explain that alternatives exist for the brother/sister to consider.  It is of course time consuming.  Given my priority to assist doctors, the effort is very worthwhile, probably even more meaningful than energy spent on governance or publicity. The scale of exercises will be expanded in 2016. Colleagues who may benefit from the work will be informed beforehand privately. Service position nurses are NOT involved, and the workshops are kept strictly confidential.

 

We shall continue to improve our governance framework. We have already started in radiology as a pioneer development to a new model. Prof Anil Ahuja, a cleverest and most diligent gentleman I have ever met, will represent me to help our radiologists and system there.  He is another Brother of ours, and I trust him as much as myself. In this way, radiology is given respect that it is led by an insider, instead of me someone who did practically all scans myself. 

 

Professional and Financial Consent

 

With the Montgomery case, the issue of consent gains international attention. The local society also demands transparency to medical expenses.  We are in the forefront, and those who know Ares long enough understand that I push anything forward usually for righteousness and many other reasons combined. Whether professionals like it or not, and whether some medical leaders try to block it or not, the changes are coming.  I have experience to ride tide of public expectation. It is good tactic to lead an inevitable change, rather than chasing after the wagon on which we should have boarded. I have asked for combination of work on clinical and financial consent. You will be kept informed.

 

Innovations on payment to help patients

 

Private medicine under our wings is of course very good. In eyes of the client family, affordability is determined with 2 factors, the amount usually required for a treatment being reasonable (not necessarily very low), and controllable fluctuations even when the unexpected strikes. A predictable expenditure pattern helps clients a lot.  It also helps professionals to command confidence and thereby client acceptance. Our Department of O&G has demonstrated that we can cap expenses. We gave this protection to more than 3000 consecutive local mothers, under simple inclusion and exclusion criteria. It is already certain that our system is sustainable.  What may be next? It is only up to our design and imagination. Any colleague may come to me to enlighten me of his innovation.

 

Quotable Professional Appointment 

 

Nearly fifteen years ago, UH began work on departmental organization of doctors and appointment of clinical leaders. Far back to that time, UH predicted that endorsement by reputable private hospitals would play important roles in progress of doctors. Private hospital appointments are now quotable according to the HK Medical Council.  It means consultant status and other even more illustrative titles conferred by a private hospital can be printed on practice name cards of a doctor. You will enjoy effect of our simple system to honor our colleagues.

 

Professional Indemnity

 

In 2016, an alternative medical professional indemnity scheme will be launched. There will be competition with the existing provider, subsequent to a sudden, unilateral & forced change on Asian obgyn doctors in 2015.   While O&G was caught in eye of the storm, indemnity matters affect every doctor.  We need to manage proactively.  

 

The problem of professional indemnity had a major blow onto American medical care, and Australia suffered a lot about 15 years ago.  It will destroy private medicine in Ireland. Academics recently explain that Canada might soon be in trouble.  I was also told that the NHS in the UK may be sparing very significant amounts of its budget onto compensation.

 

Asia is still not as legal as America and Europe.  But there is little doubt that the lay public is heading towards the same direction. A single approach to indemnity with rising subscription to fuel rising expenses will surely end with one unwelcome result. Please do not take me wrong that HK would fail this year or the next. Introduction of competitor(s) will cause MPS to reduce the percentage of non-compensation expenses in Asia (MPS does not take money away as there is no item of profit in its books), and MPS may even examine cost structures. Sustainability for the next 10 years is probably positive. On the other hand, our professional lives usually last much longer than a decade, and we have our family interests to protect.  The loud wake-up bang from MPS would alert us to develop a multiple thong strategy.  Just for illustration that we are safe, group indemnity is way easier to arrange and far more affordable. We have records about our own compensation.  As long as we stick together and perform well, many strategies are still under our deployment. In fact, I would reassure our brotherhood here that I have considered nearly all possible situations – and our teammates may continue to smile, even when our friends outside would have different feelings.

 

Our own problems

 

We shall have our fair share of usual problems.  Manpower shortage with clinic assistants in all clinics will continue.  Contract renewals will mark at least 30% increase in per foot rental, wherever the outlet, and whichever the team our doctor belongs.  We shall titrate income and expenses carefully.

 

Institutional Competition

 

In the time to come, within a few years we shall face stiff competition, and individual competitor could rise just at our backyard.  I am confident in our doctors and other teams.  Yet, we now enjoy the pride of working with very honest and governed supporters. Many private hospitals, especially those which admire our governance, like these staffs. One scenario could be serious brain drain to nursing and support colleagues, followed by inability to maintain our existing standards. Our preparedness might start with our own selves.  Nurses like to work in safe places where they are appreciated. Material money and apparent fame both talk but many things cannot be bought or imitated.