The Control of Hospitals

Press, Volume LXXIII, Issue 22271, 9 December 1937, Page 10

The Control of Hospitals

The report of the discussion between representatives of the Auckland Hospital Board and the Health Department on proposed staff changes in the Auckland Hospital suggests the need for the appointment of a Royal Commission to inquire generally into the problems of hospital management in New Zealand. There can be few undertakings, either public or private, which present more baffling problems of organisation and administration than do the public hospitals of New Zealand. There is, in the first place, the need for separating business management from the management of surgical and medical work without creating undesirable conflicts of authority. In addition, the hqnorary system, which has much to commend it, has nevertheless the disadvantage that it may, in certain circumstances, lead to an unfortunate dispersion of responsibility. And finally, there is the danger of conflict between hospital boards consisting of lay members coming into conflict with their surgical and medical staffs. It is not by any means inevitable that these difficulties should lead to friction; nor is it possible to devise any system of control which would completely eliminate the possibility of friction. There are many hospital boards the affairs of which, thanks to goodwill and a spirit of tolerance on the part of the chief officials, are run as smoothly as could be desired. But disputes are frequent, and in the case of the Napier Hospital an investigation by a commission revealed a state of affairs which shocked the general public and could be attributed directly to faulty organisation. Moreover, the rising cost of hospital administration and the heavy building programmes which many hospital boards have embarked upon in recent years make it increasingly important that management should be efficient and economical. It is not easy, however, for the layman to see what changes are necessary to improve the quality of administration, and it may be suspected that most hospital boards are baffled by the situation which confronts them. The commission which investigated the

affairs of the Napier Hospital reported that most of the trouble was caused by a division of powers among the medical superintendent, the managing secretary, and the matron, and recommended that the medical superintendent should be, in fact as well as in theory, in charge of the hospital. The Auckland Hospital Board, after long discussions and after an independent investigation by an accountant of its administrative organisation, decided to abolish the office of medical superintendent, to appoint instead of this officer a physician and a surgeon who would be directly responsible for medical and surgical treatment respectively, and to place business management in the hands of a secretary-manager. The Health Department has approved the proposal to appoint two senior medical men to the staff, but recommends the appointment in addition of a medical superintendent on the grounds that “ there *• is still a large amount of administrative work “ which ... could not be satisfactorily discharged by a lay secretary.” If the board adopts the department’s proposal, it will thus be faced with the need to appoint four executive officers whose salaries will probably aggregate not less than £6OOO a year. The sum is not too high if it is going to lead to more efficient and more harmonious administration. Whether it will have this result is at least doubtful,