HOSPITAL POLICY.

Manawatu Herald, Volume LIV, Issue 4406, 18 October 1934, Page 4

HOSPITAL POLICY.

PROPOSED ADMINISTRATIVE CHANGES. FORMER DECISION REVERSED. Palmerston N., Oct. Hi. By ei°lit votes to six, the Palmerston North Hospital Board yesterday afternoon reversed its former decision to make important administrative changes, following a lengthy discussion, during which the whole position was reviewed, the board carried :a motion introduced by Mr A. L. Mansford to rescind the resolution under which a series of alterations in policy was adopted at the last meeting. It was resolved to call applications for the position of medical superintendent at a starting salary of £BOO a year, and to define cleai 1\ Jus schedule of duties. These decisions meant the rejection of the proposal for unified control of the whole institution, undei a managing-secretary.

Moving that the resolution relating to the altered administration of the Hospital, carried at the last board meeting, be rescinded, Mr Mansford stated to the chairman: “1 realise that every member of this board has only one interest —that of the institution and its patients —and I give credit to von and those who supported the resolution for that. The proposals were of a revolutionary nature, fine chairman: Evolutionary.) Those who supported them were of the opinion that they were in the best interests of the Hospital. Those who opposed them were of the opposite opinion. Both were entitled to their views. My main objection is in connection with the medical superintendent. 1 give credit to Mr Phillipps for being a very able managing-secretary, but in an institution such as ours the medi--cal superintendent should be the man in full control at that end. I eel that wo will not secure a hrst-dlass man lor £<soo or £6OO a year. c want a man lo take full contro in eases of 'emergency. Suppose there is a serious accident and several people are brought in badly injured at 2 a.m., when life or death may hang upon a quick decision? We will not get a man at £SOO or £OOO a year to accept that responsibility. Under the resolutions carried we will more or less be taking advantage of the honorarv staff. It is proposed that the managing-secretary should take over the residence hitherto used by the medical superintendent; probably the new appointee will live at the Hospital. I cannot see . why we want these changes all at once. 1 desire the institution still to continue on the lines under which it lias made so much progress in the past. I cannot sec the necessity for this feverish haste to change the administration from the inside of the inslituion. I think that we are making a false move. I believe we should obtain the best medical superintendent possible.” SUGGESTION OF SURPRISE. Seconding the motion, Mr V. E. Smith said lie was sorry he was not present when” the original resolution was passed, or he would have prevented the necessity for the present one being brought forward. He thought that, in the first place, the whole subject had been sprung on the board as a surprise. "When alterations ol that kind were being brought forward it was just as well that all the board members should know something of them beforehand. Again it was most unfair for the managing-secretary to he asked to draw up the recommendations, because he personally was concerned in them. The alteration would cost about £2OO more than the present system, hut in no way did it show the extra duties which the managingsecretary was to perform for the extra salary. ‘ It now apparently transspired that he was to transfer part of his duties to a house steward to bo appointed at £350 per annum. He also agreed that the salary mentioned was all absurd one to offer lor a medical superintendent. Mr G. A. Monk said that he entirely agreed with Mr Mansford that no matter flow they looked at the subject all were doing their best for the’Hospital district and the patients. Mr Mansford had suggested that they were taking advantage of the honorary staff. The doctors in the city had been very keen to do the work, and their services were appreciated. They did practically the whole of the medical and surgical work, so that not much alteration was being proposed in that direction; otherwise the situation would have been different. Some said the matter had been sprung on the hoard. He frankly admitted that when lie came to the last meeting there were proposals put forward which were quite new to him, but"'the opportunity to make a change had arisen from the fact that the present medical superintendent was retiring. He did not think they could allow Mr Smith to say, without some refutation, that the" matter had been sprung on them. He had suggested that it was unfair that the managing-secre-tary had had to draw up the report. Mr Monk did not think so. All they wanted was information, which was supplied. He thought it was correct that it should come from a man who had studied hospital administration not only within New Zealand, but throughout the world. Tliere ' was apparently a fear that the board, in not appointing a medical officer as superintendent of the Hospital, would be pursuing a line of action detrimental to the patients. Probably, and he thought certainly, the treatment of the patients would not he interfered with in any way. The statements adduced by Mr Mansford did not show that there would be one iota of difference. He had quoted the case of a sudden serious accident, but could dismiss any doubt existing in his mind. If the speaker had the slightest doubt that the patients would suffer by the change, lie should oppose it, .hut he had not. Coming to the necessity for the change, if they did not advance with the times they would soon lie asking themselves why administrative costs were so high. They must keep abreast of the times. If there was to he better administration, it must be brought under one head. Mr Phillipps had given such excellent service that the speaker, for one, was prepared to afford him the opportunity of improving upon it, and he believed that his own judgment enee bad shown that Mr Phillipps was would not be misplaced. His experia very able administrator. If they were going- to have co-ordination, they must have,the control under one head. He believed that could best be done by a layman, and not by a medical man. CHAIRMAN’S VIEW. The chairman said that men who had made a life study of the problem stated that for correct administration, without in any way interfering with the physical side, there must be one head. It would not he detrimental to efficiency and the object was to effect greater economies in administration. It was misleading to have the impression that the managing-secretary was going to receive £IOOO a year. The actual cost of the - , change being made in the administration was a little over £2OO. Dr Ward had been receiving £822 10s, plus a house, worth £75 per annum, making a total of £897 10s. Mr Phillipps had been receiving £BOO less 10 per cent., making it £720. The total thus came to £1617 10s. Under the scheme suggested the managing-secre-tary would receive £BSO a year, and not £IOOO, but on a rising scale. That had previously been moved by Mr Monk and seconded by Mr Mansford. There would be a house steward at £350 per annum. At present the institution was under four heads. Not one voice had been raised by the honorary staff against the scheme, and only one had suggested that the medical

superintendent should he paid moio. The majority thought £SOO was suth-c-ient. Unfortunately, the DirectorGeneral of Health was absent Horn the Dominion, hut the proposal had been submitted to the Munster, who had nprpoved of it, but suggested that £6OO be paid the medical superintendent. That would he in addition to his hoard, ami would he equivalent to £7OO, making a total of £1825. as against £1617 10s, under the old system. If it was approved, it was his opinion that they would save tenfold the additional £2OO in the first year without lessening efficiency. The annual estimates provided for an expenditure of £60,000. The cost of the change-over was one-third of 1 per cent, of this. Dr Campbell Begg, who was thoroughly up-to-date in hospital administration, had written congratulating the hoard on the move nlade. Both the Minister and the honorary staff considered the scheme an excellent one. It was the people who, through the board, controlled both the institution and its executive officers, and the medical profession was not going to control it, the chairman asserted. ROUTINE IN HOSPITAL. .

‘‘There seems to he contusion m the minds of members as to how treatment is carried out within the Hospital, and what are the I unctions oi the honorary surgeon or physician, the medical superintendent, and the the house surgeons,” added the chairman. “Every patient, on admission, is placed under a member of the honorary staff, except fever ward patients (these average about three), and the annexe patients, but the medical superintendent has the advice and assistance of the superintendent ol the Otaki sanatorium in dealing with these special cases. The honorary medical officer’s duty is to direct his patient s treatment from beginning to end. Tie has available the house surgeon to assist him, and, if he so requires at any time, the medical superintendent. Urgent admissions to the Hospital are soon by one of the house surgeons immediately and he reports to the honorary officer. The medical superintendent is available if emergency service is required. Major accident cases and very ill people arc seen by the medical superintendent sooti alter admission, as it is necessary for him at all times to ensure that the house surgeons carry but their duties in the correct manner. His round oi the wards is not for the purpose of treating patients, but to see that they are receiving the treatment already prescribed for them, and this is his main work. Ho has to sec that theatre service is functioning properly, that massage is being carried out as ordered, and dispensary work, etc. He is available to the public who inquire concerning the condition of patients. He has a very definite duty as regards training and instructing house surgeons, and he lias to satisfy himself as to their competence as anaesthetists, dressers, etc. “This is the work that the present medical superintendent lias been carrying out, except that he has a few beds in the medical wards under his control, and *ho has in practice controlled the male indoor domestics,” added the chairman. “Our by-laws specify.that this latter staff is under the control of the managing-secretary. Thus the real change is not so much to take away from the duties of the medical superintendent to add to those of the managing-secretary, but to give added responsibility to the latter with the object of obtaining greater efficiency in internal management matteiNone of the three heads of the Hospital could really define their province in these matters, said the chairman. What would they have to pay for the services of a man with the dual qualifications for management and as a medical officer? They could not obtain one. „ ADVANTAGES OF CHANGE. There seemed to be a fear that the new system would he detrimental to the patients, but all delays in their treatment would come under the notice of the board, the medical and surgical treatment would not deviate from the present high standard, and more cognisance could be given to disabilities in the payment of accounts, the chairman added. The advisory committee proposed was an important feature of the scheme and the proposal to set it up had the support of both the medical superintendent and the honorary staff. The Health Department luid commended the hoard’s administration, but the institution had against its credit the longest days stay for patients in any hospital. Large hospitals in London were under nonmedical management, including some of the most famous in the world. Institutions' so controlled included the Charing Cross Hospital (London), controlled by Mr Phillip Inman, one of the foremost hospital administrators to-day; the Bolinghroke Hospital at Battersea, King’s College (London), Central London Throat, Nose and Ear .Hospital; London Hospital, Whitechapel Road (London) ; Mount Vernon Hospital for Pulmonary Diseases (London) ; Prince of Wales’ General Hospital at Tottenham; St. George’s Hospital (London) ; St. Bartholomew’s Hospital (London), and !St. Thomas’s Hospital (London), the latter with 004beds. All had honorary staffs. Mr Mansford: What do they pay their medical superintendents? The managing-secretary: They have none.

Apparently, continued the chairman, Mr Mansford was concerned by the financial aspect. Overseas institutions had very little subsidy, being maintained by voluntary and generous subscriptions. Consequently great care was taken to receive full value for expenditure. When money came more easily from the Consolidated Fund, as in this country, there was a possibility that it was not safeguarded as closely as it might be. If it could be shown that greater efficiency could .not be obtained, then unified control would admittedly be a failure.

“I am enthusiastic,” concluded the chairman, “and, like yourselves, it is the welfare of the _ patients which is the consideration -with me, but Ido want you to do the right thing, and I want to absolve Mr Phillipps. This thing arose from me. I {asked him to do the research work on my behalf.” Mr Smith expressed the hope that it was not thought' his remarks were any reflection upon the managingsecretary, because he considered that if the change eventuated Mr Phillipps was the man for the position.

The chairman said he did not refer to Mr Smith in his comments, but had wished to correct correspondence which had gone out to the public, and which lie thought was manifestly unfair. VIEWS OF MEMBERS.

“I think that there is no occasion for this discussion to-day,” commented

Mr F J. Ryder, wlio added that it ‘.,.,1,1 'not"be claimed that the matter j. u l orio-inallv been a surprise. The control oT the Otaki sanatorium liad been Laium over with eminent success, and thev should not hesitate to go iorwaid

in this instance. Ur L 'l'. McLean stated that lie was more than ever convinced, lrom the evidence adduced, that the chairman was right. With anv doubts formerly m .us mind cleared up, Mr D. Collis said., ho would support the change. Air J Hoclgens observed that oe must support the motion. The chairman he stated, had insisted tnat there wo 11 111 1)0 a saving m administration. Anv such saving would not be on the commercial side, but on the medical side, and that came home to the very door of the patients, ft probably meant that a medical student without outside experience would be coming as medical superintendent. He would not have the qualifications for an A class hospital. This, to his mind, was a reactionary, and not a progressive step The board should ensure the vei\ hist service possible from the medical side. Jle would rather double or tieblc the remuneration of the medical superinto the proposed change was voiced by Mr J. Boyce, who added that at'£ooo they could not obtain much more than the services ot a house surgeon. Mr G. P. Cat ley said he was quite sympathetic with unified control under tin- one head, but considered it should lie more in line with the system iollowcd at Wellington. . . , There was no reason in his mini!, stated Mr R. L. C. Aitchison, why tin* matter should not he deferred until'next March, first-hand information in the meantime to he obtained irom the English hospitals. He- could not uiulerstand the haste as in another sis months they would sec how the Welliii"tou system had functioned, lie

v.iuihl in the absence of more complete expert information, oppose the change-over. . , . .. Mr W. Howell said that under the circumstances he would support the case advanced by the chairman. ; Mr M. A. Moody congratulated the chairman on his able presentation <>l : the information given, but he was ol : (he opinion that the services of a hrst- , class medical superintendent were required. . .. Mr Mansforil said he knew of no hospital as large as that at Palmerston North, and operating with an honorary staff, winch paid only a year, as proposed, to its medical superintendent. He failed to see also whv full information concerning every department of the institution could not he available to the managing-secretary. Me bail never vet cavilled at the salary paid Mr Pliillipps, to whom lie. gave every credit for his able administration. Concerning statements that friction might arise between the heads ol the departments, that position would not he altered by the managing-secre-tary being in complete charge. He maintained that the medical superintendent might he such in name only. THE VOTING. 1 By eight votes to six the board passed the rescinding motion, thus reversing the former decision. Those who supported the motion were Mrs 1, A Abraham, Messrs A. E. Mansion! V. E. Smith, G. P. Catley, R. L. C. Aitchison. J. Boyce, M. A. Moody and J Hodgens. Those who opposed it were Messrs J. K. Hornblow, G. Monk, D. Collis, L. T. McLcan, AV. Howell and F. J. Ryder. An absentee owing to illness was Mr 0. Me Elroy. 1 Mr Mansforil then moved that applications be called for the appointment of a medical superintendent at a salary of £BSO per annum, plus a free house, the salary to rise by annual increments of £SO to £IOOO a year. Mr Monk inquired, if flic new appointee was to be a medical superintendent with the same duties as the present superintendent, why had they continued to pay tire retiring superintendent (Dr. Ward) less than was now proposed ? Air Mansforil stated that lie assumed the conditions would he similar to those of the past, though the medical superintendent’s duties might l>e enlarged. The scope of his activities should be strictly defined. Under the hoard’s by-laws, stated the chairman, the medical superintendent was at present regarded as the official head of the institution. It was pointed out by Air Mansion! that lie had no objection to the formation of the advisory committee formerly suggested for the institution. Acting on the suggestion of Mr Monk, the board decided to set up a , small committee consisting of Messrs Hornblow, Hodgens, Aitchison and the managing-secretary to prepare a schedule of duties for the appointment of a medical superintendent, and to investigate the hoard’s by-laws with a view to their revision. Mr Boyce moved, as an amendment to Mr Mansford’s motion, that the j salary to be offered to the medical superintendent be £BSO, plus a free house, with no annual increases specified. This amendment was lost, hut subsequently another moved by Mr Monk, that the salarv start at £BOO, with free house, rising by annual increments to £950, was carried,-