1

Upholding Catholic Moral Principles

Managing a Private Hospital

D Fang

2

Beyond caring for and curing physical and mental affliction

Touched the people at deepest level of their existence

Provided for their physical, mental, and spiritual healing

“He came so that they may have life and have it more abundantly.” John 10:10

Jesus’ Healing Mission

3

To provide loving care to the sick and needy Depends on not only the dedication of the

clinical team and advanced technology, but personal loving care

“I made myself all things to all men”

(1 Cor. 9:22)

Mission Statement of SPH

4

Apply the Paulinian spirit of caring to all people, regardless of age, colour, race or creed and social status in the provision of our healthcare service.

Provide a peaceful and comfortable healing environment as promulgated by the Sisters of St. Paul de Chartres for our clients.

Maintain a high standard of service in the promotion and restoration of health for all people.

Mission Statement of SPH

5

State of complete physical, mental and social wellbeing and not merely the absence

of disease or infirmity

WHO Definition of Health

6

Moral duty to save life, heal the sick, promote Health

Traditional code of ethics puts moral duty above self interest

Duty invokes charity, humanity, compassion, sacrifice, professional integrity

Duty to update knowledge, and skills, necessitates lifelong learning

Healthcare Professionals

7

The present

The Future

St. Paul’s Hospital

8

Systematic approach to maintaining & improving quality of care within the Hospital

Framework thru which an organization is accountable for continuously safeguarding and improving high standards of clinical care

Patient safety is first & foremost

Clinical Governance

9

SPH organizational structure

(organizational chart as attached)

10

Hospital Governing Committee ◦Oversees management and set directions for

the Hospital Hospital Management Committee

◦Develop, monitor and implement operational policies

Clinical and Advisory Committees ◦Advise on clinical and other practice in the

Hospital◦Approve and advise new procedures and

audits◦Visiting experts/ consultants as members

Management framework of SPH

11

Independent non-interested members of HGC

Specialist & academic advisors on medical and professional committees

Clinical audit Education & training Research & development (good clinical

practice) Risk management External accreditation

Clinical Governance

12

Clinical governanceFinancial : accounts, fees & charges

Tender procedureHR management

Transparency and Accountability

13

Openness Collective decision Tendering Recruitment Staff appraisal Project management Avoidance of scandal

Is Conservatism within the Church hindering Clinical Governance?

14

Catholic healthcare should not only provide charity care for the poor; it should also work for universal coverage, care based on need rather than on ability to pay for it.

Jennings, Bradford H. Gray, Virginia A. Sharpe, Linda Weiss, Alan R. Fleischman; The Hastings Center Report, Vol. 32, 2002

Fee for Service vs Charity

15

Fees waiver system Outreach projects Voluntary service Control of professional fees Reinvesting any profit in hospital

development

Fee for Service and Charity

16

Provision for the sacramentsAppointed priests approved by Cardinal

Sisters of St Paul de ChartreLay Catholic staffVery frequent visits

Pastoral Care

17

Membership Terms of reference: all ethical issues

relating to patient & health service, audits, clinical research, new technology, information, resuscitation, consent, etc.

Guidelines: Religious Directives for Catholic Healthcare Services.

Conduct of meetings Case consultation

Ethics Committee

18

Consider and advise hospital on ethical issues of healthcare policy, provision, and outcomes.

Consider, approve, and monitor new technology and clinical research.

Provide urgent individual case consultation.

Ethics Committee Terms of Reference

19

Contraceptive devices & interventions other than medically necessary

Scientifically assisted reproduction (IVF) Abortion Certain research e.g. Embryonic stem cells Euthanasia (illegal) Unethical organ transplant (illegal)

What Doctors May Not Do

20

Thou shalt not kill. 5th Commandment

Abortion is murder in the womb. A child is a gift of God. If you do not want him, give him to me. Mother Teresa

On Abortion

21

Intervention or medication for the direct treatment of a proportionately serious pathological condition of a pregnant woman when such cannot be safely postponed, even if such results in the death of the unborn foetus.

Medically Necessary Abortion

22

No contraceptive interventions that either in anticipation of the marital act, or in its accomplishment, or in the development of its natural consequences, have the purpose, whether as an end or a means, to render procreation impossible

Such violate the inseparable connection between the unitive and procreative purposes of the conjugal act

On Contraception

23

Interventions that result in contraception or sterilization with the specific purpose of cure or alleviation of a present and serious pathologies where simpler options are not available.

e.g. Hysterectomy to remove a malignant tumour

Medically indicated contraception or sterilization

24

Reproductive technologies that substitute for the marriage act are not consistent with human dignity. E.g. extracorporeal fertilization, heterologous fertilization, conception

Assistance which does not separate the unitive and procreative ends of the act allowed to help married couples conceive

On Assisted Reproduction

25

Trust essential to the healing process

Respect for human dignity and rights, privacy and confidentiality

Respect for advance directives Doctor and patient making decisions together

Doctor Patient Relationship

26

Who should sign Interpreter General and specific risks Treatment options Separate anaethetic considerations Under no stress, premedication or

misrepresentation Properly witnessed

Surgical Consent

27

Death is a beginning for the Catholic health ministry

Relief of pain & suffering Care for human dignity, support for family Avoidance of meaningless insistence on life

sustaining technology Avoidance of withdrawal of life support with

intention of causing death

Care for the Dying

28

Great majority are visiting doctors Organization differs vastly from HA Adequacy of medical documentation Absence of credentialing process Maternity services for Mainland patients Emergency specialist backup lacking

Problems Peculiar to HK Private Hospitals

29

Complex surgical interventionsObstetric services, neonatology Intensive care24-hr OPD

Ability to deal with emergencies

30

3-yearly exercise CME requirement Credentialing for invasive new technology Mandatory clinical audit Full professional indemnity Medical Council disciplinary orders

Renewal of Admission Privileges

31

Exponential rise in MPS fees Dislocation of certain specialist services Each specialty different risk premium No cap on damages 30% legal fees for civil litigation 100% legal fees for alleged professional

misconduct

Professional Indemnity

32

Improved communication with patients

Audits, alerts, and accreditation Continuous professional development

Certification of skills Clinical protocols and guidelines Professional integrity and courtesy Do not test the Medical Council

Prevention the Best Cure

33

Increasing complaint culture Compensation common objective Threat to invoke media Proper handling by designated staff

essential To what extent must hospitals give in?

Avoidance of Scandal

34

An apology, an offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty.

Compensation Act 2006, U.K.

35

An apology made by or on behalf of a person in connection with any matter

does not constitute an express or implied admission of fault or liability by the person in connection with that matter.

Apology Act, B.C., Canada

36

Mediation -as the way forward

37

Non-adversarial process in which a neutral 3rd party assists in resolving a conflict between two or more other parties. Mediator facilitates communication between the parties, helps them focus on the real issues, and develops options that meet their common interests and needs.

Mediation

38

◦On 15 January 2006, the first medical negligence dispute case was successfully co-mediated by Mr. Roy CHENG, a professional mediator from the HKIAC and Dr James Chiu.

 ◦Case resolved in 4 hours with monetary

settlement.

Mediating Medical Disputes

39

A dispute resolution protocol for doctors and patients, introduced by the Singapore Subordinate Courts, became effective on 2 January 2007.

Mediation in Singapore

40

To promote court-related mediation. Legal Aid Department to limit its initial funding

of persons who qualify for legal aid to the funding of mediation

Court should have power, after taking into account all relevant circumstances, to make adverse costs orders in cases where mediation has been unreasonably refused

Chief Justice’s Working Party on Civil Justice Reform March 2004

41

suggested 4 ways to help in the development in mediation:◦ the different mediation bodies should consider

ways of co-operation and collaboration, and indeed even merge together.

◦ the accreditation process should have the benefit of external assessment and advice to maintain international standards.

◦public awareness of the benefits of mediation must be generally raised.

◦ there should be broad access to mediation, with the help of Legal Aid and pro bono work.

Chief Justice on Mediation 2007

42

Not necessarily religious, but respect those with faith.

Do not have Christian vision or motive. Achieve humane goals without expecting

afterlife. May hold beliefs contrary to Catholic Moral

Principles.

Altruistic Healthcare Workers and Providers

43

Partnerships & other institutionsMorally licitAvoidance of scandalReligious organizations

44

Catholic Healthcare service Response to the challenge of Jesus to do as he did

Not only to restore and maintain health

Spiritual service testifying to final healing transcending life on earth

45

Thank you