HOSPITAL STANDARDISATION

Evening Star, Issue 19142, 8 January 1926, Page 8

HOSPITAL STANDARDISATION

HOW AMERICA. HAS BENEFITED A GREAT MOVEMENT ITS DIRECTOR EXPLAINS HIS PLAN. , Some few years ago doctors practising in America felt the need fur some form of hospital inspection. Surgeons and physicians alike realised that under existing conditions they could not work efficiently. Hospitals varied considerably, and it r. as felt that many were quite unworthy of the Tuuno they bore. Yet there was no competent body that could settle tho question. Ultimately' several wellknown and highly-respected members of the medical profession privately investigated the subject of hospital management, with the result that the American College of Surgeons was founded. Dr M. T. MaeKachern, who is at present in Melbourne inspecting Victorian hospitals, is one of the main forces in this international movement, which aims at bettering hospital management and facilities, and ho told tho story' of tho organisation’s growth to an ‘Age ’ reporter. This is how ho told his talc. Tho standardisation of commodities and tho way of doing things had done much for national economy and efficiency, hut it must not ho carried ton far lost it hamper individual effort. Manufacturers were finding that by paying more attention to standardising their commodities much improved and cheaper articles could lie produced. Large varieties of articles of the same class tended to Hood tho market with a great deal that was inefficient, and they had increased the overhead expenses of tho manufacturer as well as the necessary stock which had to ho kept on hand. During the past few years a Bureau of Standards, acting through tho Division of Simplified Practice at Washington, had studied this matter as far as many commercial subjects were concerned. It was interesting to note that it had found that there were over fifty-five kinds of bricks for building purposes used, and those bail now boon reduced to five or six kinds, which sufficiently mot all demands. It was also found, amongst many other commodities sold, that there wore 552 varieties of wire fencing, which had since been reduced to sixty-nine typos. There had boon forty-nine types of milk bottles, but now there were only nine. It had been slated in a recent edition of a well-known magazine that by this system of standardisation the lumber industry' in America laid saved 20(1,000.OflOdol. Recently it. had been found that there were' seventy-eight different varieties of hospital beds, whereas four typos wore quite sufficient. Hospital and hotel dishes had been manufactured in 700 different ways, but. now the number was reduced to sixty.

As with commodities, so with hos- 1 1 pitals. What was known as hospital I standardisation was now in its id nth I 1 year of development and progress, ami, ' it was becoming world-wide in its in- : ; tlncncc. That, "did not mean that all j ’ hospitals should he built, operated, and ■ maintained alike. Hospital stun- ' dardisation meant the advoenting of certain practical principles, adaptable with modifications to every institution caring for the sick. Those principles : had to be worked nut by each institu ■ 1 tion in sncli a manner as would ensure 1 the highest degree of efficiency and I service to the sick patients.' The principles, as applied to hospitals con- : eerned(l) Tho proper organisation : Of the insitutions, so us to sot forth ' the duties, responsibilities, and functions. without overlapping or omissions. (2) The providing of adequate facilities for diagnosis and treatment, ns 1; well as the safety and care of the I' patient. That was based on tho principle that every man, woman, and ! child, regardless of social status, race, color, or creed, was entitled to the best and most accurate diagnosis and efficient treatment known to medical science. Those hospitals must have laboratories, X-ray, and all sncli means | of increasing efficiency of treatment and hastening of recovery. (;}) Tiio | necessity of having a competent and trained personnel to do the work, I whether it be physical or scientific, i Each hospital to-day required a staff 1 with certain qualifications, such ns in- 1 tercst, industry, honesty and love for I the_ work. (4) Arrangements for the I periodic check-up or medical audit of 1 the work of tho hospitals by tho modi- I cal staff who accounted for all results of treatment, with a careful invcsfcigaiuto all deaths, complications, improvements, and all conditions or results not up to 100 per cent, efficiency. The hospital was no longer a comn-stay-go institution, where patients passed through it as if it wore a machine. Each patient needed individual consideration, with provision of sncli procedures in diagnosis and treatment as were necessary. MEDICAL AUDITS. Complete case, records and competent supervision and many other measures were laid down in standardisation, and a careful medical audit of the hospital was thus provided. A definite scheme of standardisation had been worked out for hospitals after years of study and investigation. Its broadest interpretation was allowed by each hospital in working out tho principles so as not to interfere with the individuality of tho institute. It haciy been proved after years of experience that those principles were applicable to hundreds of hospitals. There were instances of hospitals I with under twenty bods carrying out the scheme as consistently as the larger institutions. What was known popularly as tho minimum standard for the American hospital was the measuring stick of efficiency, and it drew the distinction ho- | tween two types of institutions. On the one hand, the one which could rightfully be termed a hospital having not only bed, board, nursing, and all the domestic and other services, but also laboratories, X-ray, and other scientific adjuncts, so that the patient and the doctor might have at their fingers’ tips every facility necessary for tho best that science could provide. On tho other hand, there were such institutions as could bo regarded as hotels for patients that provided bed, board, and nursing, but lacking the scientific facilities which were tho earmark of a real hospital. While the doctor and the nurse had many God-given natural means of doinjj groat things lor the patients, they must also have the scientific facilities to help them work out their problems rapidly and accurately, and thus where thousands of persons died formerly through lack of those modern adjuncts to medicine in the years gone by, now thousands are saved. The hospital bad become a. part of tho social life of our people, and a great national economy, for every life saved was worth much to the nation, and every day of sickness saved meant much i-3 industry, not to say anything concerning the great minimising of sufferi ing and sorrow. Hospital_ standardisation bad without question increased the ■ efficiency of hospitals in America by 50 i per cent, in the last six years. Hospital standardisation had been started ; bv an organisation known as the American College of Burgeons, an intorna- ■ tional organisation covering North and i South America, with approximately i 7.000 members. This organisation, i under the director-generalship of ■ Franklin 11. Martin, who visited Aus- ; tralia two years ago, had a board of ’ regents composed of the leading sur- > geons of America. The movement was , commenced in 1918, following years of • study concerning hospital services in i America. A vast volume of information wavS secured, and marked deftcien-

cies were revealed as far as rendering the highest quality of service to tho patient was concerned. Tho pendulum then swung from tho problem of financing hospitals to the study ol results of services to the patient. Tho minimum standard required covered only one page of literature, arid it was well known in every homo in America; in fact, it was a by-word. Every hospital of thirty-five beds or over in America was visited annually by specially-quali-fied representatives sent out from headquarters. Tho objects of such visits were; (1) To familiarise hospital trustees, executives, personnel, medical staff, and others with the requirements of a standardised hospital ; (3) to make an inspection of tho institution to determine if it was complying with the requirements; (3) to render every' possible assistance to the management of the institution by increasing administrative and scientific efficiency'; and (4) to keep up interest and enthusiasm lor development and progress, as well as preventing tho institution slipping back, in short, the movement carried overv possible sendee to the institution absolutely free of cost. Tho organisation of surgeons paid the entire expenses of the representatives. _ Alter full consideration reports were issued, ami the hospital thus inspected was either “ approved,” “ conditionally’ approved,” or ‘‘not approved.” If approved or conditionally approved public notice was given in the Press and various magazines, and a very attractive certificate placed in the entrance hall of tho institution, so that tho public might know that in such hospital they aero reasonably sure ol receiving tlie host treatment that the country could provide. At tho request of the Government of America federal hospitals were included in tho annual survey, such as the army, navy, public health, military veterans’, and‘other hospitals. The list of hospitals pub-, lislicd annually served as a guide to patients seeking hospital service, for they knew that in the approved institution they could be assured of everything that was necessary' lor comfortable, sale, and efficient treatment. The American Railways Association, an industrial organisation of great magnitude, had instructed its 14,000 surgeons to send their patients only to hospitals which had been inspected and approved. Young women desiring to outer the nursing profession selected an approved hospital. Students graduating for their degree demanded as one of the. fundamental requirements when selecting a hospital for training that it ho approved. Philanthropic institutions and Governments when railed upon to assist, hospitals financially generally ascertained first ot all whether the hospital was approved or not. Conductors on trains had _ lists of approved hospitals, so that il a stranger travelling in a Stale where he or she knew no one from whom to ask advice were taken il! the conductor could furnish n list of approved hospitals In which the patient might go. THE ULTIMATE ALMS. Over J,(X)U hospitals in America in tho past lew years had closed their doors and gone out ol business because of their failure to reach the standard of efficiency entitling them to an approved report. However, 800 new hospitals ol a very high standard had taken tiicir places, 'the ultimate aims ot hospital standardisation wore chiefly four in number--!..1) The shortening ot tbo average number ol (lays the patient remained in the hospital. It was undoubtedly true that the clays spent by the patients in the institution had been considerably reduced, dropping from 17 or .18 to' 12 or 14 in the past Jive or six years. (21 The elimination ol incapable and unnecessary surgery. The quality of surgery was now much higher, and that was duo to better means of diagnosis. There were now an increasing number ot consultations, group study of patients, and more modern technique and procedure. Formerly many abdomens wore, opened in order to make a diagnosis, but now the splon- | did clinical facilities in hospitals en- | aided tlie surgeon, physician, and specialist to make their diagnosis more accurately’ without resorting to discover tho cause of the trouble. (41 The reduction of infection and complications. 'that was due to better supervisioli and check up, and improved technical procedure. (4) The lowering of tlie hospital death rate. UndnuhtI edl.v the hospital death rate under 'standardisation was deercasing, because | one of the requirements was that each | death had to ho thoroughly investigated j liv the medical staff and hospital authorities as well. Moreover, the rechiei t ion in Hie death rate was subsequent lon the better hospital service. For- ] mcrly tho hospital death rale ranged j from' 40 In Oil per 1.000 patients I treated, which in itself was not a, had | record, hut in the last few years the I rate had dropped to 80, 20, and oven | less in the, J ,000. HOSPITAL GRADING.

Hospitals wore graded as (a) siagnaivfc, (b) commercial, (<■) minimal, (d) mediocre, (c) progressive, (f) eminent. The latter two typos had some distinctive physical and character background, and were characterised by such iimdamcmtal qualities a.s thoroughness, fearlessness,’ honesty, unselfishness, justice, and other attributes which tended, to keep them human, and thereby render the best possible service^ to the patient. In Dr MacEachern’s opinion, the quality of personnel counts most in any hospital. But more efficiency will not suffice. The spirit of the institution must be right, and the personnel imbued with a high degree of intelligence, earnestness, sincerity, honesty, industry'. and, enthusiasm in doing the best for the patient. Every hospital, public, denominational, or olherwj.se, _ must give an account to the community 01. .its stewardship. “ The patient,” the doctor explained, “ is the product which reflects the type of service tion is rendering. To-day (v>.7 per cent, of all the hospitals in America are meeting the requirement laid down, whereas in 1918 only 12.9 per cent, reached the standard. The movement has succeeded because it is based on all the. principles which mean the best earn of tbo sick.”

It is remarkable that all this exceedingly valuable service to the community'eonerally. and the medical profession in particular, is rendered free of charge. Dr Mncßachern explained that frequently when their representatives were, visiting different States they retpiested that no hospitality should ho given them, because they did not wish to be under any obligation to anyone. The members of the American College of Surgeons, numbering 7,000 and representing thirty-five countries, pay icr everything. Rut the work does not terminate with the inspection of the hospital. ■ 'Lectures propaganda, and round-table conferences arc bold all over the country, so that the movement is thoroughly and eflieientlv. directed.