Provisional Legislative Council
Panel on Health Services
12 January 1998
Report by the Hospital Authority on Remedial Measures for Medical Incidents and Review of Complaints Management
This information paper reports the latest progress of reviews conducted by the Hospital Authority (HA) on clinical supervision, clinical audit, risk management and complaint management.
Review on Clinical Supervision and Monitoring
2. The aim of the review is to minimize human factor as a contributing element of clinical incidents and to ensure that the quality of clinical services meets professional standard.
3. HA has conducted a series of briefings and discussion to solicit advice from all the Hospital Chief Executives, Chiefs of Service, Consultants, Department Operations Managers, Ward Managers, allied health professionals and staff groups, on the best approach to refocusing and redirecting staff efforts to improve clinical services. The following proposed initiatives are aimed at assuring quality of patient care :-
Review on Clinical Audit
- Enhancing clinical supervision and monitoring
To ensure competence of staff in undertaking clinical tasks, a two-tier professional accountability structure where experienced clinicians are responsible for close supervision and monitoring of junior doctors has been put in place. Expert Specialty Coordinating Committees have laid down the required capability and competence of clinicians in the performance of various clinical care activities.
- Refocusing on Clinical Work
In order to ensure that clinicians can focus more on patient care services/activities, Hospital Chief Executives and hospitals have been striving to :
- reduce or reprioritize administrative workload of clinical staff;
- send only appropriate circulars to relevant grades of staff;
- review and strengthen business support to departments and wards; and
- provide clinicians with support and assistance on financial and resource management matters.
4. Clinical audit is well recognized to be an important professional accountability mechanism to ensure professional performance and standard in the health care setting. It is a systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome.
5. Following a review of current clinical audit activities in public hospitals, HA will proactively safeguard professional standard and improve its service by the following initiatives :-
Review on Risk Management
- Establishment of an HA Clinical Audit Committee
In addition to existing Clinical Audit Committees at clinical department and hospital level, a Central HA Clinical Audit Committee will be established to :-
- define the scope of clinical audit activities to be conducted in HA hospitals;
- coordinate territory-wide clinical audit activities across various specialties, disciplines and hospitals;
- monitor the progress of clinical audit activities in HA hospitals;
- act as an external assessor of clinical audit activities of hospitals; and
- coordinate experience sharing workshops to enhance clinicians awareness of importance of clinical audit.
- HA will continue to organize experience sharing sessions on clinical audit to align understanding on the definition, aims and approach of clinical audit to be undertaken by all hospitals and staff.
- A manual on clinical audit is being produced to help clinicians conduct clinical audit in a systematic manner.
- The review findings and recommendations for enhancing clinical audit within HA has been sent to Professor Sir Cyril Chantler, a member of the Hospital Authority's expert panel member and Ms Wilma MacPherson, a nursing expert, (both from Guy's and St. Thomas Hospitals of University of London, U.K.) for advice. Meetings have been scheduled to discuss the review findings with both experts in the first and second quarters of 1998.
6. A key objective of managing risk in the health care setting is to ensure safer practices, safer systems of work, safer premises and greater awareness of danger and liability, thereby resulting in greater patient safety and improved staff morale. Risk can be briefly defined as the possibility of incurring misfortune or loss. Risk exists in all public hospitals as :
- the buildings which the hospitals own or occupy may give rise to risk;
- the equipment, chemicals or other hazardous substances used in hospitals may give rise to risk;
- the people employed by hospitals, their patients, clients, visitors or guests may give rise to risk; and
- the operational systems or management measures in the hospitals may give rise to risk.
Consultancy on Risk Management
7. To ensure appropriate risk management within HA, a consultant firm was appointed in April 1997 to advise HA on an appropriate and effective risk management model for HA hospitals. The consultancy work will be conducted in two main phases. Phase 1 Stage 1 involves the identification of best practice in hospital risk management on both clinical and non-clinical aspects. Phase 1 Stages 2 and 3 will focus on risk assessment of four representative HA hospitals by undertaking a strategic evaluation of incident and critical accident reporting system and risk management as well as recommending key clinical and non-clinical areas for risk management and quality improvements. Phase II will involve the provision of on-going risk management support on training and implementation by the consultant for specified hospitals. In each of these phases, the consultants have been asked to focus on the following key risk-prone clinical areas, including
- medical supervision;
- standard of health care services delivered;
- incident reporting system (e.g. adverse incidents, mistakes and near misses) and management of complaints from patients/staff concerned;
- clinical audit arrangements;
- relevant policies, procedures, protocols and guidelines.
The consultant has completed Phase 1 Stage 1 of the consultancy work and will proceed with other stages and phases as scheduled by HA.
Review on Complaints/Incidents Management
8. Following a critical review on complaint management, the following improvement measures are being/will be implemented
- Enhancing complaint management at the hospital level
- An internal mechanism will be established in all HA hospitals to regularly review complaint cases and complaint management. This will ensure all complaints be promptly and properly investigated, analyzed and fed back to staff, and when necessary, brought to the attention to the Hospital Chief Executive and/or senior management staff and the Hospital Governing Committee.
- Senior nurses have been assigned to take up patient advocate/patient relations functions in hospitals to help resolve complaints at the hospital level at the earliest opportunity.
- Enhancing complaint monitoring
To strengthen the Authority's complaint monitoring role and prevent recurrence of similar complaints, hospitals are required to compile regular reports on complaint cases and their improvement measures.
- Enhancing complaint management skills
To enhance complaint management skills of hospital staff, complaint management seminars have been and will continue to be organized. This will enable hospital staff to acquire expertise on the proper management of complaints and critical issues.
- Inculcating a complaint management culture
Effective complaint management requires a change in the staff's mindset as to they regard and approach complaints. To ensure that all levels of hospital staff would take a positive attitude and proactive role in managing complaints, training programmes have been further enhanced. Moreover, efforts to promote patient-centered culture and provision of good customer service among HA staff will be intensified.
- Reviewing the role of Public Complaint Committee (PCC)
The role of PCC will be expanded with a view to enhancing its effectiveness on complaint management. With its expanded power, PCC can investigate and consider complaints both of an administrative and clinical nature. It is envisaged that the PCC will have an expanded membership to enhance its representativeness. To improve efficiency, PCC will be supported by an expert panel comprising HA and non-HA medical and nursing experts.