As part of our lobbying efforts towards achieving The Vision, we formulated a series of short informative articles which define some of the service features of the children’s hospital we envisage, as well as some interesting facts. We hope you find them interesting.
1. What are ‘specialist services’?
Care of a highly specialised nature typically provided to an inpatient in a centre of excellence, where there is a concentration of senior experienced doctors, nurses and allied health professionals. Conditions for which children require specialist services may include cancer, severe renal, heart and neurological diseases, plastics, burns and vascular surgery.
Many specialist services are interdependent, such as renal services and vascular surgery; certain types of oncology and surgery; or muscular dystrophy and orthopaedics. In keeping with the latest medical thinking, concentrating specialist services for seriously ill children will enable the best possible treatment by increasing doctors’ expertise as they will see more patients in their chosen specialty.
2. The 4D's of children's health care
|DEPENDENCY||Children are dependent on other, most often their parents.|
|DEVELOPMENT||Children and their health care issues change rapidly with time because childhood is a period of rapid growth and development.|
|DISADVANTAGE||Children are disproportionately poor, in a minority, and unable to speak for themselves.|
|DIFFERENT EPIDEMIOLOGY||Children are generally healthier, but when sick, tend to have a wider array of rare conditions than do adults.|
3. The demand for specialist services
There are around 1.4 million children (0-19 years old) in Hong Kong. That’s roughly 20% of the total population. Hospital admissions for this age group total around 150,000 each year. Of these admissions, around 25% are for children requiring specialist treatment.
(Source: Census and Statistics Department; Hospital Authority ICD-10 data)
4. Respecting the special needs of children
How a hospital manages pain is a benchmark for how it manages all forms of distress in suffering children.
A children's hospital should be a place where all children are happy to come for treatment. Children will be actively involved in their treatment, and parents will be included in the health care team as ‘experts’ in understanding their children’s pain and helping them to deal with it.
Wherever possible, patients at a children's hospital should be grouped in inpatient units according to their age and condition. That way, teenagers can be surrounded by those their own age, and likewise for younger children, toddlers and infants. It also allows for easier contact between the multi-disciplinary teams at the hospital when a variety of specialists and health care experts may be treating infants, children and adolescents with similar conditions.
A children's hospital should be a nurturing and gentle environment for young patients and their families – a place where art, colour and open space are more common than white hospital coats.
5. Family facilities
At children’s hospitals around the world, family facilities include fully-reclining chairs next to all beds, kitchen facilities, lounge areas (with access to computers and Internet connections) and bathroom facilities.
Private spaces, such as family consulting rooms and resource centres, provide comfort, convenience and sanctuary. Play, educational and work support spaces provide a continuity of lifestyle during the hospital stay.
6. Care co-ordination
Effective care coordination helps families and children enjoy the highest quality of life throughout the continuum of care. It also reduces the cost of care by minimising hospital visits, absence from school and parents' absence from work.
At the proposed Children’s Specialist Hospital, care management and planning will commence before admission or treatment, and will be undertaken in conjunction with admitting teams, ward areas, medical subspecialties, referral sources, allied health workers, patients’ own family doctors, parents and carers, and other providers involved in on-going care. Designated Care Coordinators will assist in:
- removing barriers to care and discharge, including referrals to health care providers in the private sector
- ensuring continuity of care and consistency of information
- providing a central point of information for all stakeholders
- promoting patient and family education
- providing linkage to community services and schools
- providing phone support to families and community service providers
- facilitating review and re-admission, if required
- developing clinical pathways that outline care to be provided, outcomes to be achieved, and timeframes in which to achieve them
- coordinating the clinical team, including nurses, doctors and allied health team members
- planning transition to adult health care services, whether to primary, secondary or tertiary, public or private
7 - volunteers on the Children's Cancer Foundation's Task Force formed in November 2003 to pursue the establishment of a Children's Specialist Hospital for Hong Kong
99,411 - words in the 328-page proposal submitted to government in June 2005
232 - copies of the proposal circulated among stakeholders in government, academia, the medical community, children’s charities and others
327 - medical professionals who responded to questionnaires in the stakeholder survey
1,202 - parents in the general population who took part in telephone interviews in the stakeholder survey
73 - individual interviews conducted among academics, medical professionals, children’s charities, child patients, and parents
6 - focus groups conducted among parents of seriously ill children
105 - meetings, workshops and forums the Task Force has held with government officials, stakeholders and corporate leaders in Hong Kong
3,951 – people who receive each issue of The Vision
HK$1.10 - if each member of Hong Kong’s population contributed this amount each day for the next twelve months, there would be sufficient money generated to pay for building the Children’s Specialist Hospital
To care for patients in the main public wing of the proposed Children’s Specialist Hospital will require 249 doctors practising in 19 medical and 10 surgical subspecialties. They will be supported by 458 nurses, 595 allied health and patient contact staff, and 691 administrative and support staff.
Patients in the private wing will be cared for by 248 medical, nursing and patient contact staff, supported by an administrative staff of 91.
9. Overcoming anxiety
Surgery is frightening enough for an adult, so it’s not hard to imagine the worries about pain, separation from parents, or the scary hospital fantasies children may entertain prior to an operation.
Surgical suites at modern children’s hospitals are designed as safe and friendly environments for children. Many children’s hospitals organise family tours of the suite, allowing children to see and touch medical equipment they may come in contact with, and they are encouraged to ask questions. Children also meet nurses and anesthesia staff as they journey through the pre-operative area, operating and recovery rooms. By talking, playing and exploring, children feel happier and more in control.
Nervous parents equal nervous children, and so these tours are a great time to let parents know the best way to prepare their children for surgery.
10. Designing a healing environment
While there is no formula for designing a ‘healing environment’ in children’s hospitals, several factors are known to be effective in promoting wellness. These include:
|Opportunities for movement||permitting children to freely locate spaces, assume different postures, create boundaries, reach new territories, and manifest power;|
|Comfort, security and stimulation||creating variety and change in the child’s sensory environment;|
|Control and identity||allowing children some ownership of their environment by controlling visual, acoustic and lighting levels;|
|Access to the child's social support network||providing comfortable accommodation for family members and caregivers; and,|
|Positive distractions||incorporating elements that elicit uplifting emotions without stressing the child. The most successful distractions include music, art, laughter, natural scenes, and visits from pets and other non-threatening animals.|
11. The long journey
The need for a dedicated children’s hospital has been debated in the Legislative Council four times in the last 35 years - 1970, 1978, 1982 & 1983.
12. World city rankings
Today, Hong Kong is the only city among 20 generally recognised “world cities” that does not possess a dedicated children’s hospital. Beijing has two, Shanghai has three, Guangzhou has one.