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Health Minister Chiu Wen-ta

An Outsider Faces Big Challenges

An Outsider Faces Big Challenges

Source:Ming-Tang Huang

Having gained a name for corporate-style hospital administration, will Taiwan's new health minister be able to apply the benefits of business management to master the daunting complexities of public health in Taiwan?

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An Outsider Faces Big Challenges

By Ming-Ling Hsieh
From CommonWealth Magazine (vol. 466 )

Taiwan's new Department of Health minister, former Taipei Medical University principal Chiu Wen-ta, has been busily making the rounds the past couple of weeks in preparation for his first interpellation session before the Legislative Yuan.

Taking over a high-profile Cabinet post with one of the highest turnover rates in government, how has the 61 year-old Chiu ended up here? And as the first among the 14 DOH ministers to date to emerge from one of Taiwan's smaller hospital systems, Taipei Medical University, just what kind of minister can we expect him to be?

With a reorganization of the Executive Yuan slated for next year, the new caretaker charged with managing nearly NT$500 billion in National Health Insurance expenditures will be "the final minister" at the DOH, but also may ultimately be the guiding hand with the greatest direct impact on the lives of the people as the first head of the new "Ministry of Health and Welfare" following the amalgamation of government social welfare functions into a single agency.

Although a trained neurosurgeon who also boasts doctorates in epidemiology and neurology from the United States and Japan, Chiu more closely resembles a thoroughly goal-oriented businessman in the way he accomplishes things and deals with people. Over the past several years he has become best known for the business management capabilities he demonstrated running the health care system at Taipei Medical University.

Doctor vs. Businessman

In 1996, when Taipei Medical University was awarded operate-transfer rights to administer Wan Fang Hospital, Chiu headed preparatory efforts for the transfer and later became the publicly owned, privately operated hospital's first superintendent.

His accomplishments there were remarkable. In its first year of formal operations, it managed to break even. And in the three years from 2000 to 2002, it paid off its NT$360 million in debts. Since then it has contributed NT$30 million in rebates to Taipei City Government coffers every year. Within seven years Wan Fang Hospital was upgraded to a medical center.

Although he never formally studied hospital administration or enrolled in a master of business administration program, he ran his hospital like a business.

Chiu was born into a medical family in Yilan. His father was born in Miaoli's Tongsiao Township and studied medicine in Japan before going on to earn a master's from the University of Pittsburgh in the United States and becoming hospital administrator at Ilan Provincial Hospital. Chiu is the youngest of his siblings. His two elder brothers are both doctors, while his sister is a pharmacist.

After Chiu graduated from Chung Shan Medical College (today Chung Shan Medical University), his parents visited the home of noted neurosurgeon Shih Chun-jen, asking him to take Chiu under his wing as a protégé. Shih was at that time the director of the Neurosurgery Unit at Tri-Services General Hospital and Chiu subsequently embarked on a five-year unpaid residency there.

After Chiu completed further studies in Japan and the United States in the 1990s, he returned to Taiwan and entered the field of public health. His most well known efforts in this area have been his promotion of legislation requiring the use of motorcycle helmets.

Every day or two during his tenure as an attending physician at Taipei Medical University Hospital, he had to perform surgery on a young person with a massive head injury after being involved in a motorcycle accident while not wearing a helmet. A good friend of his surnamed Wen who worked selling and delivering newspapers also suffered severe brain injuries in a motorcycle crash that left him a vegetable.

These experiences filled Chiu with a determination to seek passage of the motorcycle helmet law. After his master's and doctorate degrees in epidemiology from the University of Pittsburgh, he returned to Taiwan and set up a database of 180,000 head injuries and used these statistics as an appeal to the public on the importance of wearing safety helmets, which he highlighted in public hearings in towns large and small throughout Taiwan.

National legislation requiring the use of helmets was finally passed in 1997. Fatalities resulting from motorcycle accidents on the nation's roads fell dramatically, from more than 6,500 in 1997 to just over 3,400 in 2009. For his efforts, Chiu was presented with the Health, Welfare & Environment Foundation's 17th annual Medical Dedication Award.

Management by Objective: Mission Accomplished

Despite his background in medicine and public health, Chiu has become best known for hospital management during the past several years.

In a short period of time, Chiu managed to lead Wan Fang Hospital, a new facility located in an out-of-the-way neighborhood, into the black and get it upgraded to the status of medical center. What he relied upon was goal-oriented management.

Each year he sets clear objectives for the hospital, including various evaluations and management benchmarks. Once the objectives had been set, he demanded they be achieved. Through a series of campaigns large and small over the past several years, some staffers have come to privately refer to him as "the great evaluator."

He has even taken the battle international. In 2005, Wan Fang unilaterally submitted the totality of its operational data to the World Health Organization to become Asia's first WHO-certified "health promoting hospital." In 2006, Wan Fang became one of two Taiwanese hospitals to pass the accreditation standards of the Joint Commission International (JCI) hospital accreditation organization in the United States. These benchmarks and evaluations have done much to raise Wan Fang's visibility.

He has also urged "benchmark studies" to compare management indices to others in the health care industry and even with non-health care industries. Wan Fang learned the ins and outs of customer service with E. Sun Bank and etiquette with the Landis Group.

In addition to strict goal-oriented management controls, he has also led Wan Fang's rapid expansion into highly profitable, relatively easy specialized markets such as health check-ups and cosmetic surgery while attracting high-profile patients such as Foxconn chief Terry Gou and Chin Hou-hsiu, the mother of Taiwanese president Ma Ying-jeou, to Wan Fang for annual physicals and other treatments, bringing substantive benefit and publicity to Wan Fang.

Under his leadership, over the past two years the Taipei Medical University system (Taipei Medical University Hospital, Wan Fang Hospital and Shuang Ho Hospital) has become even more dedicated to developing its international health care operations, even forming alliances with local hotels and travel agencies.

Some describe Chiu's extreme goal-oriented management style as "militaristic," and he is often characterized as a workaholic. According to Jian Jia-hui, Chiu's secretary, who has accompanied him over to the DOH, Chiu often begins with meetings at 7:30 a.m. and sometimes works until 2:30 a.m. Wan Fang vice superintendent Lu Lan-chin relates how on weekends Chiu would have two different groups come in to work with him, such as doctoral research students and hospital administrative staff; the two groups would set up in adjacent rooms and Chiu would shuttle back and forth between the two to supervise.

High EQ, Wide Circle of Acquaintances

Once objectives are set, one must be able to motivate those around them to quickly move ahead, and Chiu is well equipped to lead and deal with people. He is widely known for his high EQ and ability to deftly and tactfully handle problems.

Jian Jia-hui says she has never seen him get angry or rattled, even in an emergency situation.

He understands how to communicate with others and is humble. As one nursing staff member who worked closely with Chiu observed, when his emergency room would be packed and numerous patients and family members became impatient and started grumbling about the wait, he would stand up as soon as they entered the examination room and gently pat the patients or family members on the back and say, "Don't be upset. If anything has been done improperly, I apologize."

He truly understands what it means to be of service to others and how to deal benevolently with subordinates.

Lu Lan-chin recalls an episode five years ago when his father was brought back from Guangzhou, Fujian Province to Taiwan for medical treatment. Chiu put together a team that waited at the hospital until past 1 a.m., then personally handled the treatment straight through until 4 in the morning.

Despite his rich circle of acquaintances and administrative successes, Chiu has in recent years been the subject of a fair share of criticism. As a recognized medical center, Wan Fang should by all rights be involved in the treatment of a great number of acute and severe medical cases. Last year, however, former DOH minister Yaung Chih-liang shocked many when he characterized four local medical centers, Wan Fang among them, as being "substandard" due to their relatively low acceptance rates of patients with acute or severe conditions.

Profit-Public Service Tradeoff

Many others furthermore believe that the Taipei Medical University system has come to view medical care as an industry and that it has become overly commercialized.

And having emerged from a privately run medical system with this kind of management orientation and profit motivation, will Chiu bring that type of management style with him to the DOH? That is what worries many the most.

"If the DOH is run like a business, it will be difficult to avoid making a choice between profitability and the public good," says National Health Insurance Civic Surveillance Alliance spokeswoman Eva Teng.

What's more, with the National Health Insurance reform bill having recently passed the legislature and the pressing need to attend to planning for a long-term care system, the DOH will now need to devote a massive effort to promote reform and is itself facing a dramatic transformation.

Will Chiu be unable to extricate himself from the burden of his background as a physician and hospital administrator, thus tying his hands and leaving him unable to accomplish anything? Or will he be able to combine his talents for unity, coordination and management and put them to use to build a better health care system and culture for Taiwan? A lot of people are waiting with bated breath to find out. 

Dr. Andrew Huang, president and CEO of the Koo Foundation Sun Yat-sen Cancer Center, for example, expects Chiu to take the high road and lead Taiwan's health care system back to its intrinsic not-for-profit nature.

Paraphrasing Peter Drucker, he says: "The bottom line in health care is not profit, it's changing lives."

And how shall the DOH go about leading the medical establishment in a re-examination of National Health Insurance to return it to the path of ensuring the health of the people and encouraging high-value, result-oriented health care rather than merely "seeing patients"? And how shall long-term care insurance be planned so as to avoid the numerous unforeseen consequences resulting from the rush to get the National Health Insurance program underway 16 years ago? As Huang rightly notes, these will also be among the challenges Chiu will be facing as DOH minister.

As a former hospital administrator and milestone-setter in public health, what mark will Chiu Wen-ta's current foray into the sphere of public policy leave for his own legacy and the history of public health in Taiwan?

Translated from the Chinese by Brian Kennedy

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Keywords:

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