Ranking HK hospitals: Doctors on notice from critical patients

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Shalini Mahtani, co-founder and chairperson of The Zubin Foundation, launches a new online platform for patients to provide rankings and share comments on Hong Kong’s hospitals. The medical community is urged to treat patients as partners who help bring better healthcare.

Doctors take note: A civilian-driven platform was launched on May 18 for patients to rate Hong Kong’s 41 public hospitals and eleven private hospitals. The founders have served notice to the medical establishment that patient empowerment is taking a step up and cannot be ignored.

The platform, entitled HospitalAdvisor, was initiated by Ms Shalini Mahtani, who founded and chairs local think tank The Zubin Foundation.

“HospitalAdvisor is a social enterprise developed for Hong Kong people. It has two aims. The first aim is to empower patients with information, so that they can make informed decisions about which hospital to choose. Secondly, we want to celebrate those hospitals that place patients at the centre of their services rather than treating us as recipients of care,” Ms Mahtani said. “We are not receiving care, it is our care.”

According to Ms Mahtani, a celebrated social diversity campaigner, the idea first came into her mind when she attended a two-week programme for young global leaders in Harvard in 2014, five years after the death of her first son, Zubin, at the age of three after a swiftly fatal case of pneumococcal meningitis.

“His death was sudden and very tragic,” Ms Mahtani said. “As a mother who just lost her child, and as a person who is very pro-transparency, I was just overwhelmed when I learned from a Harvard professor that you have less negative outcomes and unnecessary death in hospitals if leadership in hospitals take quality of care seriously.”

“I found a bunch of relevant reports available in Hong Kong, but they are hard to find and indigestible to patients. Also, most of the reports are from public hospitals, so it’s not possible to compare public with private because of the information gap. And even for those reports, there is a lot of anonymity. By that I mean a lot of data is available for the 41 public hospitals, but you cannot see which hospital it is talking about.”

This series of events compelled Ms Mahtani to cast a light on the medical community. The result was an online patient experiences survey, available in traditional Chinese, simplified Chinese and English, with questions developed by Professor Ashish Jha and his team in the Harvard Global Health Institute, and validated locally by Dr Janice Johnston, Associate Professor of the School of Public Health, University of Hong Kong.


Patients who have been in hospital anytime in the past three months will be asked to fill in the survey. It consists of 27 questions: the first nine questions ask for personal details; eight questions constitute the Quality of Care score on a scale of 4; four questions produce other quality of care indicators; four are check questions; and the last two are open-ended questions. The Quality of Care score will be aggregated and updated monthly.

About 400 people from patients’ rights group had done the survey ahead of the launch. Among the groups are Hong Kong Patients’ Voices led by Alex Lam, who said, “Every person has a right to the enjoyment of the highest attainable standard of health. These rights are protected by international law. I can agree no more that information on the internet nowadays is an efficient way of assisting patients to make the right decision on medical treatment.”

“Patient experiences and patient satisfaction are not the same thing. It is not about good food or a good lobby. We are asking questions like ‘Were you treated with dignity and respect?’, ‘Did people communicate effectively with you?’, ‘Did you have your needs met?’. These are more specific questions that only patients can answer,” Professor Jha said, brushing off fears that there would be a trade-off between technical quality and patient experiences. “Both US and UK have very extensive patient experience programmes. Ultimately they all end up generating very similar results. Good hospitals get good scores, and vice versa.”

Healthcare consumerism

The professor admitted that there was still a strong resistance within the medical community worldwide against the notion of patient-centred healthcare. “Every other industry has been transformed by technology and consumer engagement, and healthcare is the last sector. I have been surprised at how many of my colleagues thought we were going to somehow skip this revolution,” he explained. “Consumerism outside of healthcare is ubiquitous, and there is no reason to think it won’t happen in healthcare…The thing I say to my colleagues over and over again, is fighting this trend is a losing battle. The idea that somehow we can live in an age where the doctors and the nurses and the hospitals got to decide what is good for all of you is completely unrealistic.”

“We need to use scientific and validated approaches to measure what matters and we need to make patients real partners and helpers. When there is transparency in the system, everybody gets better. Because even if people just fed information in, that alone will be a very powerful force [to push for better quality of service],” Professor Jha says.

Dr Donald Li, chairman of the Hong Kong Academy of Medicine, agrees with this argument and lent his full support to the platform. “To stay at the forefront of medicine, We, the Hong Kong Academy of Medicine, remind all our fellows, no matter what specialty they belong to, the doctors deal with people and not just diseases…We need initiatives like HospitalAdvisor worldwide to improve services to meet the evolving demands of the public and to give the public a voice in shaping and helping the communities.”

The politics

One issue that Ms Mahtani often came across while engaging the medical community was that patient groups were worried about any form of connections between the platform and political groups. She also claims doctors fear speaking out in support of the platform.

“Patient groups may feel that political parties are trying to build connections with them, through us, as this year is an election year. And a lot of people in the medical community have spoken with me privately and they are very supportive. But they cannot say that publicly because it’s such a closed community,” Ms Mahtani says, stressing that they have no political affiliation.

The team had reached out to the Hospital Authority (HA) and all private hospitals, asking them to participate in the project so that they can receive a notice whenever a patient writes something about them and make a response to that comment. So far, only three private hospitals, namely the Precious Blood Hospital, the Canossa Hospital (Caritas) and the Matilda International Hospital, have agreed to join.

The HA welcomes the creation of such a platform but stated they would wait-and-see. It has had its own Patient Experience and Satisfaction Survey since 2010, but the survey covers no more than seven major public hospitals (one from each Cluster) and the report only indicates general findings without showing specific ratings of each hospital.

Another concern that has been raised frequently is whether it is appropriate to put public hospitals and private hospitals on the same indicators, as a patient of private hospitals usually follow the doctor instead of the hospital itself.

Ms Mahtani challenges this notion. “Either way, we should get the same duty of care. I should not be worse off for choosing this over that. We are talking about Hong Kong, one of the richest economy in the world. What is your expectation when you go to a hospital? Care! Does it make a difference if it’s public or private?” she explains. “I think we are asking the wrong questions. We should expect quality of care wherever we go. That’s why in the survey, one of the questions we ask is: ‘Do you know which doctor is responsible for your care when your main doctor is not there?’”

Going forward

Even before the launch, HospitalAdvisor had received widespread support from the society. The Undersecretary for Food and Health Dr Sophia Chan was at the launch event. Harvard University and Dr Johnston helped develop and validate the survey questions; The Hong Kong Academy of Medicine provided the venue of the launch event. TFI Digital Media Limited developed the website; Microsoft provided the cloud service; Eversheds gave Ms Mahtani legal advice – They all offered to help Ms Mahtani pro bono. So the cost of running the platform has been the salaries of two and a half staff from the Zubin Foundation for the past year – paid out of the Mahtani family’s wallet.

“HospitalAdvisor has been established as a separate social entity with the Zubin Foundation doing the work of HospitalAdvisor. It is set up that way since we will be looking for strategic partners to support the platform’s future operations.” Ms Mahtani said. “The majority will still be owned by the Zubin Foundation so as to keep the integrity intact.”

Answering a query on whether or not the website will include a function to allow patients to rate individual doctors, Ms Mahtani said that was not part of current plans for the future. Fearing the wrath of doctors, she exclaims,  “They would kill me!”