How a Hong Kong doctor made international accreditation the norm for local hospitals
Renowned private doctor who returned from Australia realised quality sells
Private hospitals in Hong Kong have a lot to offer when it comes to medical skill, attentive care, quality service, cutting-edge technology, appealing food, and even five-star accommodation. But little more than two decades ago, Private Hospitals Association chairman Dr Anthony Lee Kai-yiu said the sector was a dying business.
At the time, Lee was a renowned private doctor in immunology and rheumatology practising in Australia. The restless Hong Kong native, however, decided to return home in search of a challenging new career in 1990, around the same time the Hospital Authority was formed. The then British colonial government granted the authority a considerable budget to improve public hospital conditions, phase out temporary cotton gauze beds and build new and better-designed blocks and facilities.
Private hospitals soon began feeling the heat of competition. By 1995, demand for private services dropped from 5 per cent to just 3 per cent. And still today, the overwhelming majority of Hongkongers seek care at public hospitals.
Amid this decline, in 1996, Lee took up the challenge of heading Union Hospital, which at the time was a two-year-old private facility in Shatin developed by Henderson Land Development. Confronting the business crisis head on, he steered the hospital towards offering good quality services at a price point that patients were willing to pay. He pushed hard to improve standards by setting benchmarks, with a view to attaining international accreditation, and by the late 1990s, Union Hospital had became one of the first accredited private facilities in the city. Many other private hospitals soon followed suit.
Today, Lee is a leading proponent in the field of hospital accreditation. He serves on a government working group focused on private hospital regulation. In December, the Australian Council on Health care Standards presented him a medal recognising his contributions to promoting quality in health care.
You have been a leading advocate for Hong Kong hospitals to attain accreditation. How did you come up with the idea?
My wife, daughter and I have always had a taste for expensive shopping and believed traditionally expensive brands offer better quality goods. We were willing to spend more to buy these products as they were more durable. So that idea inspired me – quality sells!
This is exactly the approach a private hospital should adopt. We need to think about improving the quality of service that private hospitals provide. By doing so, we will not only develop staff, but also develop a good system that ensures quality.
When I took the job at Union Hospital in 1996, the private hospital sector was facing major setbacks. Public hospitals provided good service at affordable prices, and it was difficult for the private market to compete. I would say Union Hospital was created at a difficult time and was destined to face several challenges. Its location, for example, posed difficulties, as it is situated in the eastern New Territories, north of the [Lion Rock] tunnel and away from urban areas. And in terms of software, the new hospital was not doing as well as others that had longer histories of providing training programmes for medical staff.
We recruited talent from everywhere, meaning each person was used to different protocols. We needed to set up a management system to make our practices uniform. And I believed it was most appropriate for us to join the International Standards Organisation (ISO) to achieve the best standards.
What challenges do Hong Kong hospitals face in their quest to gain international recognition?
At the time, there was no precedence in Hong Kong for gaining international accreditation and there was no consultancy that had ISO experience in hospitals to tell us what to do. I visited [private hospital] Thomson Medical Centre in Singapore to learn from their experience with ISO accreditation and I was most impressed by their internal audit team.
When I came back to Hong Kong, we hired a firm and started from scratch, learning from each other along the way. We examinated the merits and weaknesses of our hospital. We had to write our own departmental procedures, our working guidelines, among other things. The hospital spent about HK$1 million on gaining ISO accreditation. In 1999, Union became one of the first two hospitals in the city to reach that goal.
The Private Hospitals Association saw our success and encouraged its members to follow suit, but many were initially quite reluctant to spend so much money. It so happened that the medical superintendent of St Paul’s Hospital at the time, the late Sir Harry Fang Sin-yang, had connected with British experts who were willing to fly to Hong Kong every two years, and survey two or three hospitals on each trip. The surveyors were doing this on a complimentary basis, free of charge, while we covered all their travelling costs, accommodations and allowances. If they found any major shortcomings, measures had to be taken immediately to correct them in a matter of weeks to ensure accreditation could be secured.
There are different criteria to be followed, some of them mandatory. One by one, all private hospitals in Hong Kong have attained accreditations from the United Kingdom.
The union later moved towards complying with the Australian Council on Healthcare Standards, which emphasise clinical service, patient care and how these areas should be backed up by a corporate management culture and other support. In contrast, ISO tends to emphasise the system of documentation, corporate governance and management systems. I believe it’s important to maintain both accreditations, which complement each other.
Despite the accreditation, medical blunders still often take place. Why is that and what should be done?
There is a need for hospitals to be more transparent about information and medical blunders. It is their duty to report any incidents to the Health Department. The original intention for private hospitals in reporting these events was that they would share experiences so that other hospitals could learn how to avoid similar incidents. But the saddest thing is Hong Kong media focus on medical blunders and how to penalise someone for the incident. They see these events as a report card and accuse the hospital of not being good enough.
This has made some private hospitals shy away from the idea of disclosure. But I feel it’s good if disclosure can become part of hospital culture. But most importantly, there should be a government law on disclosure. For example, the information disclosed in the system should not be used for financial claims against the hospitals. But no such law exists in Hong Kong at the moment.
Also, no matter how good the system in place might be, there is always going be human error. For example, there has been a good system for medicine distribution. But say a staff member, while giving out drugs, just puts down the medicine next to a patient without giving it another thought. This [kind of lapse] is ridiculous. There were a lot of steps for him to verify the patient’s identity, including a machine to make a match. But he did nothing and didn’t realise it. Maybe his mind was suddenly playing tricks on him, or something had occupied his mind. Then of course a mistake was made. This kind of human error is sometimes hard to predict and difficult to prevent.
ISO has required us to conduct analysis of these incidents or adverse events, and at the same time, we need to plan remedial and preventive action. This is the correct way to go. This is why we believe accreditation does not end once you attain it. Rather, it creates an incentive for quality improvement, which should be an endless journey for us.
What should the government do to encourage a more balanced market between the private and public sectors?
The best way is to regulate the private health care sector. The government already published a consultation document on how to tighten regulations for private health care facilities.
Under the proposal, the code of practice required by hospitals would also be adjusted to ensure institutions can offer patients quality care. Hospitals are required to seek accreditation, too. For example, the new Gleneagles Hospital is required under the new licensing system to gain accreditation.
Why did you migrate to Australia in the first place and what prompted you to return to Hong Kong?
I was a private practitioner in Central before immigrating to Australia in 1986. At the time, we were worried about the 1997 handover. Our children were still young, and I felt moving away would offer the family security in the future. I soon got used to life there, with many friends and enjoying playing tennis.
But being a doctor in Australia was quite different. The patients were less grateful to their doctors due to their medical system. A large part of their consultation fee was subsidised by the government and they took for granted the fact that they would be taken care of. I also saw many patients who tried to cheat and get benefits for work injuries. This stood in sharp contrast with what I experienced in Hong Kong. Most patients here are very grateful. A patient once gave me a wristwatch, and a fisherman gave me heaps of fish. Whether they are rich or poor, Hong Kong patients have been more thankful when encountering a good doctor. It has given me a sense of satisfaction.
By 1993, when my two daughters completed their university studies and left home, my wife and I were alone. I felt a sense of emptiness. Or you could call it a mid-life crisis. At one point, I went back to Hong Kong on holiday to visit my parents, and a friend mentioned that a new private hospital [union] was hiring. I went for an interview. Henderson Development gave me an “irresistible offer”, so I’ve been working here until now.
The lesser-known Dr Lee...
What do you usually do for fun? There are a few things that help me relax and which I do enjoy: playing mahjong with good mates; getting a massage at a nice spa; listening to romantic music with a cup of Chinese tea and reading, maybe newspapers, journals or fiction. These are in descending order of my preference.
What is your favourite food and why? Cantonese. Simple dishes like steamed fish, roasted meats and poultry, delicacies like wonton noodles, congee with beef or pig’s liver and so on.
If you could change one thing in the world, what would it be and why?The world is too big a subject. The thing I’d most like to change is the political climate here. Let’s get on with making Hong Kong a better place to live rather than bickering over democracy issues. I believe there’s enough democracy in Hong Kong already. What I’ve been doing is trying my best to help our health care service.
Do you have any motto you live by?Work hard and play hard, although not really for the latter.
What is your favourite place to travel to in the world?I’d definitely choose Paris and the towns in France where wines are produced, like Bordeaux and Burgundy.
Do you have any phobias?I don’t have any phobias. Maybe becoming old and disabled.