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 institutions
Morally 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