OUR HOSPITALS.

Press, Volume LXII, Issue 18670, 20 April 1926, Page 6

OUR HOSPITALS.

DR. M AC EAGHERN GIVES ADVICE. CARE OF PATIENTS. PLEA FOR HONORARY MEDICAL STAFFS. (rBESS ASSOCUTIOX TELEGRAM.) WELLINGTON. April 19. Following are extracts from Dr. Malcolm MacEachern's report on hospitals : "Greatly increased voluntary effort and community interest is desirable in connexion with the public hospitals generally of the Dominion of New Zealand. No hospital can attain its maximum usefulness and 'efficiency without these two valuable features. While there are numerous ways and means through which voluntary effort and community interest could be increased to a much greater degree, I would particularly suggest the following:—

(a) Increased systematic effort to secure voluntary gifts and benefactions in the way of (1) annual and life governors (2) funds for special purposes, and (3) endowments. (b) The organisation of women's auxiliaries, guilds, associations, oi societies, in each hospital district, to supplement the work of the Board oi Trustees, wiho give their time and energy voluntarily, freely, and gratuitously.

"The importance of having the right kind of trustees on every hospital board cannot be over-estimated. The system of election as it prevails in New Zealand may not always bring out the best type of membership suited for hospital needs, such as I find from long experience may be more assuredly obtained through the nomination method. However, under the present mode of financing hospitals in the' Dominion, that is, through the rates, the election system prevails. Hence, in order to secure and maintain a properly qualified Board of Trustees, electoral support should be given only when the following condition is fully complied with, namely, that membership on the Board of Trustees of any hospital should be confined to: (a) Such persons as are representative of broad community interests and varied callings of life, whose natural talents can be readily turned to the advantage of the hospital, and (b) such persons as would be willing to make hospital work their hobby, and give of their time and energy freely and gratuitously. "Various interests should be linked up to the hospital through the Board, such as business, educational, legal, press, labour, women's, medical, etc. These basic considerations should t be kept in mind when maldng nominations, and when casting ballots.

Too Many Districts. "There are at present forty-six hospital districts in the Dominion, whereas approximately twenty-one would be sufficient. This means expensive and unnecessary duplication, which is detrimental to the best interests of economy- and efficiency. There are several hospital districts in the Dominion which'* cannot maintain a proper setup, as each district should have. Great economy could be effected, and a much higher degree of efficiency maintained, if there were the proper number of hospital districts, each with a standardised set-up. It is indeed to be regretted that originally the hospital districts did not correspond! with the health districts, thus providing four metropolitan hospital districts, namely, Otago, Canterbury. Wellington, and Auckland, with the necessary subdistricts or hospital areas. Under present conditions, however, approximately twenty-one districts would be. sufficient grouped around the following hospitals respectively. (a) Metropolitan—Auckland. Wellington, Christchurch, and Dunedin. (b) Base—lnvercargill, Oamaru, Timaru, Ashburton, Blenheim. Nelson, Greymouth, Masterton, Napier, Gisborne, Rotorua, Hamilton, Whangarei, Palmerston North, Wangamii, Hawera, and New Plymouth. "I would therefore strongly urge a complete survey of the whole Dominion with a view to a redistribution of hospital districts in the interests of greater economy and increased efficiency."

Paying Wards. On the much vexed question of paying wards, Dr. MacEaohern says: "The public hospitals of the Dominion should be so constituted as to provide for all sections of the community, namely, (a) Those unable to pay anything; (b) those able to pay for maintenance; (c) Those able to pay for maintenance and medioal attention. In this way the public hospitals, with their fine organisation, eqffipment, and personnel, would bo at the disposal of all sections of the community, rather than of open class or section as at present, namely, i the supposedly necessitous poor. This is missing at present in the hospital system of New Zealand. There is great need for accommodation for the intermediate class oi patients particularly, who wish to pay their own way and have their own doctor attend them in the hospital. The addition of pay wards to the public hospitals presupposes: (a) That there should .be various grades of accommodation and charges; (b) that the question of professional charges should be a matter between the doctor and his patient; (c) that th« treatment those who voluntarily enter the paying wards of the hospital, and those who are deemed by an investigating official of the hospital to be able to pay professional fees in addition to maintenance should make their own arrangements for attendance with the doctor of their choice, and not be under tho medical or surgical control of the resident medical staff: (d) that private patients entering wards should not lie attended by the stipendiary staff but by a doctor of their choice. Fialing to have a choice, or not beinE able to make selection, nothing should rrevent a member of the honorary staff from attending that patient in his private capacity. It is hoped that hospital boards will seriously take up this problem, and make provision for the estension of the sen-ices to the very larsre group of patients desiring to take advantage of hospital facilities, having a doctor of their choice and paying their own way.

Staffing. "There should be a uniform policy of staffing in the hospitals in the Dominion. The policy of full or part time medical officers, with dual responsibility, clinical and administrative, should be abolished, as it is entirely opposed to highest qualify medical services as well as efficient administration. "The appointment of an inspector or director of hospitals of the Dominion would be a great advantage. Such person should be a doctor, having long and successful experience in all phases of hosnital administration. The inspection of hospitals, when eystemati-

cally carried out by an experienced officer of this kind, cannot fail to be of the most constructive value. With this arrangement a multiplicity of inspectors would not be required, but only the maintaining of the present service of experts, now attached to the Department, who could be called upon to go where requited as indicated and approved by the inspector or director of hospitals for the Dominion. Maternity Wards. "Each hospital district should provide the necessary accommodation and service for maternity patients, apart from, but in close proximity t so far as possible, to the general hospital, and under the same administration. In this connexion it is also recommended (1) that each nurse in training, and resident medical officer, should have carefully supervised instruction and experience in this work; (2) that there should be one of the honorary medical staff resident, at each confinement to supervise technique, and be prepared for any or complication which might arise at any moment; and (3) that ante-natal clinics be under the direct supervision of the honorary medical staff, and that resident medical officers be present as well as nurses.

Divided Control. "The principle of more than one head of a hospital, or the triple administration found in many of the Dominion hospitals, is not in the best interests of efficient administration. In this triple administration, tho medical superintendent, the matron, and the business manager or secretary, aro each more or less responsible directly to the hospital boaid, and are on an equal footing so far' as this is concerned, though the superintendent is usually the senior officer of the three. This is not sound administration. The hospital board should invest in _ the supc intendent entire responsibility for t'he carrying out of its policy-, and he or she should be the chief executive officer of the institution, with the entire personnel responsible to such an officer. More thah one head to an institution or organisation leads to confused administration, and may retard the best progress.

Medical Care of Patients. "It is recommended that medical patients in the hospitals throughout the Dominion receive more attention from members, of the medical staff of the hospitals, and not be left chiefly in the hands of resident medical officers with limited experience in-this particular field. This is also particularly true in the case of infectious diseases. An equal attention to that which is given to surgery should be given to medicine.in every hospital. This very condition is due to two factors, mainly: (a) lack of honorarv medical staffs in many- hospitals; (b) the permitting of medical superintendents to use the position as n stepping stone to surgery. Having with him only a limited staff of resident medical officers, generallyfresh from college, upon whom a great deal of responsibility for the care of medioa] and infectious cases is thrown, he lacks the supervision of the honorary medical staff so essential in every hospital. A good medical service is'indispensible in every hospital."