Dr Tony Ko, chief executive of the Hospital Authority, is on Straight Talk this week.
Dr Ko talks about all the efforts the HA is using to attract and retain healthcare talents. He also talks about the smart systems being deployed to make services better.
Check out the full transcript of TVB’s Straight Talk host Dr Eugene Chan’s interview with Dr Tony Ko:
Chan: Good evening! I'm Eugene Chan and welcome to Straight Talk. Our guest tonight is the Chief Executive of the Hospital Authority Dr Tony Ko. Dr Ko is a specialist in geriatric medicine and moved from clinical medicine to health services management 16 years ago. He was chief executive of Pok Oi Hospital, cluster chief executive of New Territories West Cluster, and director of Cluster Services in 2018 prior to his current appointment in August 2019. Dr Ko is now leading a workforce of about 90,000 and managing 43 hospitals and institutes to deliver public health care services in Hong Kong and serving our citizens. Tonight, he has joined us to share his insights into how sustainable our public hospital system is. Welcome, Tony!
Ko: Good evening, Eugene!
Chan: Hong Kong public hospital services is renowned for its high standards of medical care, and is well-trusted by Hong Kong people, ensuring that all residents can receive the necessary medical services, regardless of their financial situation. It’s often the first choice for patients because of affordability and also the comprehensive services and maybe this is why approximately 90 percent of the inpatient treatment is done in public hospital despite the fact that the Hospital Authority only employs about half of Hong Kong’s doctors population. So, it seems like you are a victim of your own success, meaning … I'm sure you don't want to do 90 percent of the cases but because you have done so well that you are the preferred choice. Would you agree?
Ki: Well, I will say that we have been providing majority of the medical service for our patients and, in particular, as you say, 90 percent of inpatients come to us. That's why we have been continuing to work very hard to both increase our capacity as well as improve our efficiency. As you know, the Hong Kong health system has been for many years ranked among the most efficient systems in different places. So, it has been our pride. I will say that we have a very efficient system in Hong Kong to take care of our patients, as well as we are taking, at the international levels, of very good standards for our patients. There's also a reason why in the past few years we have been building our capacity. We have been building the hardware as well as the software. As you know, we have two hospital redevelopment plans, which amounts to HK$200 billion for the first 10 year plan and another HK$270 billion for the second hospital redevelopment plan. So, these are very important facilities that we built that enable us to improve our capacity. At the same time, of course, we are working very hard to improve our efficiency as well and to build our manpower capacity, etc.
Chan: Right, Dr Ko when I asked you the question, I mean the actual title of the show today is “Is our public hospitals service sustainable?” Meaning, I'm sure the first question we raised was whether it is your aim to be looking after at like 90 percent of the inpatient service because with only 50 percent of doctors and medical staff, definitely it’s going to be very taxing on your manpower. What will be your preferred allocation of cases between public and private hospitals?
Ko: I will say that in the Hospital Authority, we have got specific roles. For example, we look for the acute emergency accidents, the very complicated cases, as far as providing training and teaching as far as research. So, there are different capacities. We’ve also become a safety net for people who are more underprivileged, so that everybody's care won't be affected. But in general, I will say it's important for Hong Kong to build the overall capacity, as we have heard many times that the overall numbers of healthcare professionals in Hong Kong is still not adequate.
Chan: Right.
Ko: So, I would say that, no matter the doctors or nurses whether they belong in the public or private, the most important thing is we need to have more healthcare professionals, more hardware and also at the same time, we have to improve our standards continuously, so that we can do better each time as well to introduce more new technologies, more smart care. Everything has to put in together at the same time.
Chan: So, Tony Ko, you basically have told us that manpower is one of the very important elements in this overall puzzle.
Ko: Indeed.
Chan: When I was preparing for the show with you, I mean being a healthcare professional myself, I can see it's a very complex issue, because we have the rising healthcare costs, which is always increasing, and then the actual downturn in the economy in Hong Kong and, of course, our decrease in government reserves and, most importantly, we have an ageing population. So, how do we plan on such a complex issue? Like I mean, we are looking for talent in Hong Kong. Chris Sun, the secretary for labour and welfare, was on the show a few weeks ago and he told us that we have received like 290,000 people applying to come to Hong Kong but 180,000 were approved and 120,000 have already arrived. This is their scheme. So, has the Hospital Authority been planning similar drives, or have you benefited with people coming to Hong Kong recently?
Ko: Well, building our human resource capacity is very important. We have done a lot of work in the last few years. On one hand, we are trying to retain more of our staff; that's why we have been introducing new scheme. We have, for example, re-employed many of our colleagues who are about to retire. In the coming few years, more than 80 percent doctors who are going to retire will come back to work with us, as well as around half of the nurses after they retire, they will come back to work with us. So, this is a very important workforce. Because these people have been working with us for many years. They're very experienced and able to provide a really high quality of care. At the same time, we do work to retain our staff, more people would like to continue to work with us. For example, we notice that there has been a drop in the attrition rate of our doctors and nurses, before our measures like, we are introducing a new home loan interest subsidy scheme. We have established the new Hospital Authority Academy to provide training and support to our colleagues. So, before these works, we are consolidating and retaining our workforce. While at the same time, as you rightly pointed out, healthcare professionals are in great demand everywhere actually. And Hong Kong is not alone. So, that's why we do a lot of work to try to attract talents to come to work in Hong Kong. For example, we have been, since last year, employing more and more non-locally trained doctors. Most of them are people originally from Hong Kong who studied overseas and they come back to work with us. We are expecting that near the end of this year there'll be over 200 of these non-locally trained doctors who will come to work with us. So this is again, another very important source of workforce.
Chan: Right? Yes, Dr Ko, you mentioned nearly 200 by the end of the year and I've read that you have already successfully recruited 71 overseas trained doctors under this scheme. Are they coming at a more junior level? Or are we looking at more specialists to support the service?
Ko: Well, actually we do everything at the same time. We just started the scheme last year, when people were able to more freely travel. So, at the very beginning, we are expecting more younger people because you can imagine if a specialist is already very well-established, for example, in overseas countries, it will take more consideration and effort for them to come back, so that's why at the very beginning, we are recruiting more younger people most of the time they are still undergoing the training. And I think, in Hong Kong, we have an advantage in that. We are able to provide very good professional development opportunities for them at international standards. But at the same time, talking about more experienced people, we are having another scheme with the (Guangdong-Hong Kong-Macao) Greater Bay Area. We have a Greater Bay Area Talent Exchange Scheme. We also have a global talent exchange team where people are more experienced, they can be specialists under the training or even already in things specialist status come to work with us.
Chan: Right, Dr Ko, I'm sure the viewers at this stage will want me to ask you this particular question. We all know that Hospital Authority has been a very good training ground for our young doctors to become specialists. When they are trained, some of them might want to go to private practice to pursue their career. However, in the last few years, we've heard that there have been a lot of young people leaving Hong Kong including our medical profession, both doctors and nurses. How has that impacted our service? And has that trend ... have you seen that actually stopped right now?
Ko: Well, as I've mentioned, from the figures we have seen that there has been a significant drop in attrition rates for both doctors and nurses. So, this is a very promising trend. And at the same time, for example, last year and also this year, I went to the UK and, also, Australia, to visit the doctors and the medical students there. I noticed they have a very positive response. In fact many of them see Hong Kong as a place of great opportunities because we have a world class healthcare system, high technologies and many opportunities for them to develop. So, I sort of see that the trend is actually very promising.
Chan: Right. Secretary for Health Professor Lo has noted a trend of local doctors moving in the private sector after obtaining specialist registration. Do you think this move is just for a better package in terms of salaries? Do you think the young doctors will get what they want in the service in terms of satisfaction?
Ko: One of the special ways that we can attract more people, in particular specialists working in Hong Kong, to stay with our service is that, we let them have the opportunities to develop professionally. That's why in the last few years we have been introducing a lot of new technologies, innovation, SmartCare as you are probably aware that now a lot of things we can do with our smartphone with our new, for example HA Go app and in our hospital system there are many smart elements. Another example will be … for the nurses, we reintroduce the e-vital system so they don't have to, like in the old days, check the blood pressure and everything, and do all the charting with writing. Now everything is automatic, everything will go to the system right away. So, all this new technology, new opportunities, as well as SmartCare, IT development. I think these are all very important to attract people to continue to work with us.
Chan: Right. Do Ko, one quick question before we go to the break, I read in an article about someone suggesting that we should impose a say like three to five years post-training in terms of contracting with the Hospital Authority. Is that a possibility?
Ko: In fact, I see that most of our doctors after they finish specialist training, they usually stay with us for quite a number of years actually, because I think they found experience very rewarding to see more patients, to gain more clinical experience.
Chan: Right. Let's take a break now and viewers, stay tuned. We will be right back.
Chan: Thank you for staying with us on Straight Talk. Dr Tony Ko, CEO of the Hospital Authority, is with us, talking about making our public hospital service more sustainable. So, Dr Ko, you have told us a lot of information about the service that we are more people recruiting, coming to Hong Kong. And people finding the Hong Kong system a very good place to develop. And our specialists are staying on longer to serve our patients. You also mentioned about the Greater Bay Area Medical Talent Exchange program earlier. And I understand that initially you have recruited like 10 doctors, and 17 nurses. Can you tell us more about this program?
Ko: Yes, this program we found to be very rewarding and successful. In fact, just then you mentioned, it is actually our phase 1 program. We now have already entered phase 2 of the program, we have already more than 100 healthcare professionals coming to join us. In particular, the nurses make up the majority of that number. We found that it is eventually a mutually beneficial arrangement. The mainland nurses, they are able to bring many of their practice to us. And at the same time, our colleagues can share our practice with them. And also in particular, we know that many of our people in Hong Kong now, we like to move around within the Greater Bay Area, so it's important for healthcare professionals, we know what each other are doing, how the system is like because the patient will be moving around. And also one plus one is always more than two.
Chan: Right.
Ko: This is a very good development. And we can see the program continue to flourish and continue.
Chan: Right because there was some initial concerns about new colleagues from the mainland, in terms of for both our staff here, as well as for the patients. So, were there any issues in terms of the culture, the languages, has everything been very smooth?
Ko: It has been much better than we expected actually. Initially, we were a bit worried. For example, in Hong Kong, our computer systems are all in English, as well as the patients are all speak Cantonese, etc. but because it is a Greater Bay Area, so the nurses, they all come from Greater Bay Area, so they can speak Cantonese. Of course, the wordings sometimes, they need to adjust a little bit, but it is not an issue at all. And at the same time, we found out that they are very well prepared. Actually we have arranged programs before they come, already have familiarization programs for them, let them know about the system. And actually when they come, we have even got dummies for them to try on the systems, so most of the time, they can pick up within one or two weeks. And also we made special arrangement of buddy systems, so we have local colleagues to work with them. And I can see they developed very good working relationships. And another very important thing, I think, the friendship among our colleagues is very good, atmosphere is again, very good.
Chan: Right.
Ko: We have also sought comments from not only the mainland, the GBA, from our own colleagues, and most importantly the patients. It is almost unanimously everything that this is a very good program, and they blend in very quick, so it is very encouraging.
Chan: Right.
Ko: And in fact recently, I noticed from them, our colleagues and those who return to the GBA after the first phase, they go around and travel around all the time, and many social activities.
Chan: Really?
Ko: Yeah, yeah. In fact, you can imagine we show them around Hong Kong, show them the interesting places, and many colleagues during weekend go back to the GBA, and of course, you know that there are many places to see. So, I see this as a very promising program.
Chan: I also read in the newspaper that they are very impressed with the efficiency of our actually operating theatre, and a lot of our work. So, it is a very good exchange, then?
Ko: Yes, indeed. You can see that the specialty development system is slightly different between the Chinese mainland and Hong Kong, and each obviously has its own advantages. There are many ways we can learn from them, and we have also got many experience we can share with them.
Chan: Right, so it is certainly a good move for people in Hong Kong to know that actually we do complement each other for Hong Kong and the GBA.
Ko: Definitely. In fact, for exchange program with the mainland, we not only start off with the GBA area, we now also have further development. For example, hospitals in Shanghai, in Beijing. And also we are arranging strategic exchange development with some hospitals, some of the 3A hospitals in the mainland, which we can see that our professionals can get a lot of opportunities. In particular, you know that sometimes because in Hong Kong, we serve the people in Hong Kong; whereas in mainland, some of the hospitals, they serve a very large population area. So, the patients that they see is much more in number. So, for some specialties, where the number of cases is very important, so we would send our colleagues go for example to Shanghai, to learn about some of their advances, and also have the opportunity to see more patients.
Chan: Right. Tony, let’s get back to the title of the show because we know that we are having a great service, but we always worry about the manpower, and also the finances. So, I saw that in your annual report, you mentioned the taskforce on sustainability. Can you share with us some of your key strategic directions and initiative that has been recommended? How are you going to sort of fix this problem ahead of us, like the manpower, aging population, and more chronic diseases?
Ko: Well, this is indeed a big challenge. As you rightly pointed out that an aging population actually comes at the same time of a sharp increase in chronic diseases. So, on one hand, we continue to build our capacity, capacity in terms of hardware, which I mentioned about the hospital redevelopment plan, we build our software capacity, we recruit more people, retain more staff, get more people overseas, improve the development, establish the Hospital Authority Academy. And at the same time, we work on our efficiency. That is why we have an efficiency task force to introduce new technology, like SmartCare, more IT, more efficient smart ward. Actually we now run smart clinics, smart ward, everything is smart with a lot of technology put in because we know that just doing more of the same is not going to solve the problem.
Chan: Right.
Ko: And what this one priority is, very importantly, we are evolving, we are introducing new models of care, instead of relying everything putting in the hospital during the specialists. We have a strong commitment and support, the government's primary care initiative, we are introducing more empirical care ourselves, so that people even with the same problem, more chronic disease, we prevent it early on. Even if we can’t prevent it, we sort of slow down the pace that they develop complications. And even if they do come to it, we do it in a smarter way.
Chan: Right. See, the HA’s long established healthcare policy that you already mentioned earlier in the first part is no one shall be denied adequate healthcare through lack of means. So, you mentioned about all the smart ways you are trying to do, but I think we people will still concern how do you maintain such low cost for the patient? And what challenges you foresee in sustaining this level of subsidy?
Ko: It indeed will be a great challenge because healthcare all around the world is getting more expensive because with all the new technologies, all the new treatment, all the new drugs, many diseases or conditions which was untreatable in the past, now we can manage. But again as I said, Hong Kong has always been in the highest standard internationally, and we must maintain that level. To do that, we need to continue to introduce new technology, and do things in a smart way, in a more efficient way. So, that's why I think the introduction of technology, introduction of new ways of treating patients, as I said, the models of care. Like in the past, for example, doing surgery or doing an intervention, many times we have to admit the patient to hospital, which again is obviously a more expensive way. If we can do it early on, for example, we prevent it from happening, we do it in the outpatient setting or even day patient, these are all ways we can locate our resources in a most appropriate and efficient way.
Chan: Right, CE, so another area that I am sure the viewers will want me to ask you is about actually the emergency department because that will be your direct first point of getting into the HA system. However, we know that there is still some, I won’t use the word abuse, but a lot of cases that are not that urgent because I read in your report that under your 5 categories of urgency assigned to visiting the emergency department, the patient with the two least urgent groups make up like 55-65 percent of all these patients. So, they are taking up a lot of the time and actually making people to wait longer. So, how do you solve this issue? And maybe you can tell the viewers when shall we go to the emergency department? And when should we not go to the emergency department?
Ko: Well, I think the name itself tells something.
Chan: Right.
Ko: You can think about it is an accident and emergency department, so it is supposed to be for accidents and emergencies. I mean the name itself is already telling. But the same time, I can understand there are various reasons why patients come to us. That's why, as you say, some patients who actually do not belong to the accident and emergency group for some reasons, they still come to us. We think it is important for us to develop more primary care, so that many times a patient can seek care in different settings. And also actually within the Hospital Authority, we also strengthen our empirical and general patient clinics. And very importantly, I can share with you an experience we have is introduction of telemedicine. In fact, in the past, many patients, when they come to us, especially outpatient clinics, for example, and an elderly lady who come for a follow up in dementia, they will take the relative quite a number of hours to sort of bring them on a wheelchair, to get to the hospitals, and then get the medication. But now with the telemedicine, with the SmartCare, and the drug delivery, all these can be saved. So, we can see that the continuous evolving of our model of care should be able to help our patients, give them more choices, and help them to more efficient way in using our services.
Chan: And I've also got some data for you to explain to us as well because I saw that with all the initiatives, the number of non-urgent patients visiting the AED has reduced like 30 percent since 2018. However, the waiting time has increased from 129 to 197 minutes, so, from 2 hours to like 3 hours. Why shall that be the wait? And what shall the patient expect when they go to the AED?
Ko: Actually, again as I said, the ways we are treating patients are very different now. For example, now an acute stroke patient or an acute meconium malfunction patient – we are now all doing the fast track. In the past, for example, a stroke patient, you know that there is not much you can do, like 10-15 years ago. Now we are talking about the golden hour and all the things. So, we try to put more effort into treating all these very urgent emergency patients. Whereas at the same time, if we have to do this better, manpower naturally, we will have less people to deal with those who are not urgent and the patients who can be seen in the primary care settings.
Chan: So, in a way, the patients are better treated in the AED right now?
Ko: Indeed, in particular those who have got serious and urgent medical issues, who have to be attended to immediately. But at the same time, of course, we continue to build our capacity. In fact we are already introducing a smart AED system, so that we are better able to provide better care and also more efficient care.
Chan: Right. Thank you, Dr Ko. We do look forward to seeing all the positive and smart impacts and all the initiatives you have mentioned. These efforts of the Hospital Authority are essential for ensuring the long-term sustainability of our healthcare system.
As our healthcare policy says, “No-one shall be denied adequate healthcare through the lack of means.”
Have a good evening and see you next week!
