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SCMP Reporter

Public denied access to performance reviews

There is growing pressure  on health authorities to  demonstrate the quality of their medical services.  In the first of a two-part series, Mary Ann Benitez looks at how public hospitals are responding.

This month, heart patients will be able to use the internet for the first time to check the quality, safety and risks of surgery at a local hospital.

Prince of Wales Hospital's cardiothoracic unit will upload a report onto its website showing the   mortality rate  of procedures  like open-heart surgery, bypass grafting, and valve replacement.

This has prompted debate about whether a more wide-ranging clinical audit should be introduced so patients can be better informed about the quality of medical services.

In a joint  programme by Chinese University and the Hospital Authority, data from 310 patients aged 18 to 85 treated at the unit from November 2005 to November 2006 were analysed  and compared with international standards.

The chief of the university division of cardiothoracic surgery, Malcolm Underwood,  said Britain's 200 cardiac surgeons  were assessed every three years.  'It's part of   doctors'  professional responsibility; it is accepted nowadays,' Professor Underwood said. 'We view things a lot more as a doctor and patient working in partnership in organising  treatment.  What that means is  a degree of transparency on behalf of the doctors and surgeons, and being able to give the patients information to allow them to come to an informed decision about the  treatment  they would like and the outcomes  they would expect.'

The Hospital Authority now requires all hospital clusters to  prepare regular performance reports. The authority has set up clinical management teams, a chief of services and service co-ordinators  to compile  clinical audits.

But before clinical audits  can be widely used, critics say, the Hospital Authority must drop its punitive outlook - and the  face-saving  culture that prevents doctors admitting mistakes  will have to change.

Of eight major surgical audits that the Hospital Authority has conducted in recent years, all but one was kept out of the public arena. A spokesman  listed the eight audits  to prove that  the authority does  assess  treatment  performance.

Areas reviewed included liver transplants, treatment for bladder cancer and removal of the oesophagus.  The only audit made public was  of liver transplant services, which led to the centralisation of all transplants at Queen Mary Hospital.

The last time the authority made public a bulletin  on medication incidents was  in 2004, during which there were 18,349 reports, a sharp increase from the 8,106 in 1994.

The Hospital Authority  posted that bulletin on its homepage, but  it is 'now reviewing the use of other means of communication' for the bulletin, and  has  discontinued it.

Liu Hing-wing,  the authority's chief manager, said a 'positive, non-punitive approach' was used to deal with clinical errors, except in cases involving dishonest or criminal conduct or negligence. An 'open disclosure of errors to patients and relatives' was balanced with 'fair blame to staff, especially if the contributing cause is identified as system issues'.

'This will reduce the fear of staff in reporting errors,' Dr Liu said.

Last year  the authority also completed  its Advanced Incident Reporting System,   designed to make it easier for staff to report incidents.

Lessons learned  are to be shared with other departments  and among other authority hospitals.

The president of the Public Doctors  Association, Paul Shea Tat-ming,  said he welcomed a more comprehensive and transparent clinical audit.  But he said doctors would hesitate to make audit reports public. 'I do not think it is proper to disclose it to patients or their relatives, because it could lead to undue fears,' he said.



Face-saving culture in hospitals under fire