An analysis of the decision making process of the public crisis management in Hong Kong : 2003 SARS outbreak
1.1 Chapter Overview
This dissertation aims at exploring decision making process of the health crisis management in handling the SARS epidemic in Hong Kong in 2003. This chapter serves to outline the framework of the dissertation. It begins with an introduction of the research background. This is followed by a number of reviews on the purposes and significance of the research as well as the research methodology adopted. A description of the structure of the thesis will be presented in the final part of this chapter.
1.2 Research Background
In 2003, there was an outbreak of a highly infectious disease known as the Severe Acute Respiratory Syndrome (SARS) emerged in Hong Kong. During the epidemic, 1755 people were infected and 299 died subsequently of the disease. The source of infection was traced to an infected Guangzhou professor who travelled to Hong Kong in late February 2003 and subsequently triggered off a chain of outbreaks in Hong Kong (Chantler and Griffiths, 2003: 5-6). The SARS was first recognized in Hong Kong on 10 March 2003 when 11 healthcare workers (HCWs) of the Prince of Wales Hospital (PWH) came down with the disease simultaneously (Ibid.: 70). The epidemic turned out to be a severe and prolonged epidemic affecting the livelihood of the Hong Kong citizens at large. The impact of the SARS
outbreak lasted well beyond the end of the epidemic. The HKSAR Government and the Hospital Authority (HA) have to provide comprehensive support including monetary compensations and medical follow up treatments to the families of the deceased and people who have been infected. The SARS outbreak has had profound psychological, social, economic and political impacts on Hong Kong as a whole.
During the SARS epidemic, the HKSAR Government and HA have adopted a series of measures such as "making SARS as a statutory notifiable disease, imposing of quarantine measures, designation of the Princess Margaret Hospital (PMH) as a SARS hospital, suspension of classes, issuance of the isolation and removal order on Amoy Gardens, handling of outbreak at PWH, etc" to contain the spread of the outbreak. The HKSAR Government and HA came under serious public criticism for their poor and ineffective handling of SARS outbreaks.
To better prepare for the possible outbreak in the future and to identify lessons learnt from the incident, the HKSAR Government and HA realized that there was a need to review the performance and shortcomings of actions taken during the SARS outbreak. The HKSAR Government and HA have conducted their reviews and published the reports in October 2003 (Chantler and Griffiths; Leong, C.H., 2003). Having reviewed the report prepared by the SARS Expert Committee appointed by the HKSAR Government, the Panel of the Health Services commented that the Expert Committee's Report had
chosen to put the focus on lessons to be learnt rather than ascertaining the responsibilities among different officers of the HKSAR Government and HA.
The Legislative Council passed a resolution on the appointment of a select committee to assess the performance and to find out the accountability of the officers at the policy-making and management level. The report was subsequently issued on 5 July 2004 (Law, C.K. et. al., 2004: 2-3). The Legislative Council Select Committee report identified certain officers of the HKSAR Government and HA should be held responsible for the devastating outcomes of the SARS outbreak. The reports produced by the SARS expert Committee, the HA Review Panel and the Legislative Select Committee identified a number of lessons to be learnt and highlighted a number of management deficiencies in coping with the outbreaks of infectious disease in Hong Kong. In order to increase its preparedness for future outbreaks, the HKSAR Government and HA have implemented structural reforms on the management of infectious disease outbreaks after taking into consideration the recommendations set out by the review reports.
1.3 Purposes and Significance of the Research
The traumatic experiences of SARS have sparked a public outcry about the performance of the public health agencies including the Health, Welfare and Food Bureau (HWFB), the Department of Health (DH) and HA as well as the HKSAR Government, particularly the decision making processes in
managing the SARS outbreaks. Both the review reports conducted by the SARS Expert Committee, HA Review Panel and the Legislative Council Select Committee as well as prevailing studies pointed specially to the lack of a clear command structure, absence of contingency plans and poor communication structure within the public health care system as the major weaknesses contributing to devastating outcomes of the SARS outbreak. The aforementioned inherent structural problems prevented Hong Kong to manage the outbreaks of infectious diseases in an effective manner.
In view of the huge public concern with the management of the SARS outbreak, the purpose of this thesis is to examine to what extent the various decision making models can explain and are applicable to the decision making process in managing the SARS outbreak in Hong Kong. The thesis will focus on the analysis of the aforementioned structural problems based on the two decision making models in organizational theories including the limited problem solvers model (LPS) and the coalitions theory.
The purposes of this dissertation are as follows:
? To explain and analyse the decision making process adopted by the HKSAR Government and HA in handling the studied structural problems;
? To evaluate the performance of the HKSAR Government and HA in dealing with the structural problems during the SARS epidemic;
? To study the post SARS structural reforms implemented by the HKSAR Government and HA in handling infectious diseases outbreaks; and
? To explore recommendations to enhance effectiveness of the outbreak management of infectious diseases in Hong Kong.
1.4 Research Methodology
In order to have an understanding of the framework of the two selected decision making models, I begin my research by reviewing literatures on various decision making models. Such literature review enables me to draw up the core arguments of the decision making models which can facilitate the analysis of the study. In addition to the literature review, I will rely on government documents and reports issued by the SARS Expert Committee, the Hospital Authority, the Legislative Council Select Committee and existing studies relevant to the SARS epidemic to support my arguments put forward in the thesis.
To examine to what extent the various decision making models can better explain and are more applicable to the decision making process of policy makings of the HKSAR Government and HA within the context of the three major structural problems, I will conduct a qualitative analysis to review the policies and measures formulated and implemented by the HKSAR Government and HA during the SARS outbreak. The information
will be obtained derived from the published review reports. Based on the findings and results from the literature reviews and document analysis, I will workout a relationship among the core arguments of various decision making models and decisions made by the HKSAR Government and HA during the SARS epidemic.
In order to evaluate the performances of the policies and measures implemented by the HKSAR Government and HA in handling the structural problems, I will apply the qualitative analysis using data extracted from newspapers, journals, books as well as current opinion surveys on the SARS event. I will consolidate the information through an in-depth study on the latest infectious disease outbreak plans developed by the HKSAR Government and HA in order to study the Post-SARS structural reforms implemented by the HKSAR Government and HA in handling outbreaks of infectious diseases. Together with an analysis of deficiencies of the current contingency plans, a review of literature on effective crisis management will provide a foundation to explore recommendations to enhance effectiveness of management of infectious disease outbreaks in Hong Kong.
1.5 Structure of the Thesis
This thesis is structured into seven chapters. Chapter 2 is a literature review of the core arguments of the two decision making models in organizational theories. The selected decision making models will include the
limited problem solver model (LPS) and the coalitions theory. In Chapter 3,1 will present the pre-SARS decision making structures in relation to the infectious disease outbreaks management in Hong Kong with particular focus on three structural features such as command, communication and contingency plans. Chapter 4 will turn to the analysis of the three major structure problems. Beginning with the application of the selected decision making models to explain decision making process with respect to the three structural problems, an evaluation on the performance of the actions taken by the HKSAR Government and HA in handling the structural problems will be presented in the second part of each section. Chapter 5 is an in-depth study of the post SARS structural reforms formulated by the HKSAR Government and HA. This chapter will be divided into five sections covering the establishment of Centre for Health Protection (CHP), alert and response systems, contingency plans of the HKSAR Government, contingency plans of HA and other improvement measures. Recommendations to improve the current structures of the contingency plans of infectious disease outbreaks will be put forward in Chapter 6. Concluding remarks follow in Chapter 7.
2 THEORETICAL FRAMEWORK:
DECISION MAKING MODELS THEORIES
2.1 Chapter Overview
The decision making models in organizational theories encompass a range of concepts in explaining and predicting the behaviour of organizations and individuals in the course of decision makings. To examine to what extent the various decision making theories can explain and be applied to the decision making process of policy makings of the HKSAR Government and HA in dealing with the three structural problems mentioned above, I will offer a literature review of two theories of decision making and organizational behaviour. The limited problem solver model (LPS) and the coalitions theory. This is followed by the reviews of the core arguments of two theories of decision making and organizational behaviour. A review of the implication of the theories on the three structural problems of command, communication and contingency plans in the context of health crisis management will be conducted afterwards.
2.2 Limited Problem Solver Model
2.2.1 Core arguments
Limited problem solver model (LPS) is derived from a concept of bounded rationality. Criticisms of classical rationality on the rational actor model led Herbert Simon to propose the notion of bounded rationality
School:The University of Hong Kong
School Location:China - Hong Kong SAR
Source Type:Master's Thesis
Keywords:sars disease government policy china hong kong crisis management in case studies public administration decision making
Date of Publication:01/01/2005