Following revelations about taxes owed by Chang Gung Memorial Hospital, newspapers have quoted doctors at the hospital as saying that they have always honestly paid their taxes and made their National Health Insurance payments according to hospital regulations, so they now find it hard to accept being labeled tax evaders.
Minister of Health Yaung Chih-liang (楊志良) was correct when he said that because the National Tax Administration only asked doctors at the hospital to make up for the shortfall in their tax payments, and did not fine them, the doctors should not be branded as tax dodgers.
But who should be held responsible for this incident?
The root cause is that healthcare in Taiwan has long been treated as a business and this has caused concepts of hospital management to lose their way.
On June 10, 2004, I wrote an open letter to the National Science Council (NSC), published by the media. In the letter I complained that almost all the research projects supported by the NSC in college departments and institutes of hospital management equated hospitals’ competitiveness with profitability, and that this amounted to covertly encouraging hospitals to become more commercialized.
I said that this trend was extremely harmful because it did nothing to raise the quality of treatment and eroded medical ethics. The result today is that hospitals in Taiwan are managed in such a way that they are losing sight of their mission of caring for patients. They have come to focus on financial management alone, while overlooking quality of care management.
For example, many public and private medical centers have not seriously tackled the problem of emergency patients having to wait for beds. While letting their emergency departments get as crowded and disorderly as a vegetable market, they have instead invested a great deal of personnel and equipment to set up five-star high-tech health test facilities and beauty and weight-loss centers.
This ridiculous phenomenon shows the extent to which making money has become the main concern for many medical centers. Another story that emerged at the same time as the tax issue was that a certain Dr Chang (張) had resigned from the Chang Gung Memorial Hospital after he operated on the wrong foot of one of his patients. This incident, too, is closely connected with hospital management.
In 1999, the US Institute of Medicine published a report entitled “To Err is Human: Building a Safer Health System,” which rattled healthcare systems around the world. The main point of the report is that anyone can make a mistake, so it is the responsibility of hospitals and clinics to set up fail-safe systems to stop mistakes from occurring.
The report stresses that when patients are prescribed the wrong medicine or the wrong surgery, it is usually the result of an unintentional error and such incidents can be prevented by establishing standard operating procedures.When things go wrong, the doctors and nurses involved must of course reflect on their mistakes, but individuals should not be penalized, the report says. Rather, organizational systems need to be reviewed, processes corrected and hospitals should take responsibility for the mistakes.
Seen in this light, Chang’s resignation is regrettable, regardless of whether he left of his own accord or was pressured into doing so.
When doctors’ lack of professional skills leads them to make incorrect diagnoses or give unsuitable treatment; or when their poor judgment leads to unnecessary surgeries or needless medication; or when they misjudge the severity of someone’s illness, it is the patients who suffer and this is what health professionals and the general public should be most concerned about.
Mistakes resulting from inadequate skills or poor judgment often go undetected by outsiders. Hospital managers must carry out their promise of ensuring patients’ safety by helping doctors seek professional betterment and by frequently assessing doctors’ work performance. At the same time, the overall quality of care should be improved continuously through mutual help and observation between colleagues. To put it in a nutshell, quality of care management is the core task of hospital management.
Andrew Huang is president of the Koo Foundation Sun Yat-sen Cancer Center.
TRANSLATED BY JULIAN CLEGG
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