BETTER HOSPITALS.

New Zealand Herald, Volume LXIII, Issue 19299, 12 April 1926, Page 10

BETTER HOSPITALS.

RESULT OF STANDARDISATION. ADOPTION IN DOMINION. DR- MacEACHERN'S ADVOCACYTHE INTERESTS OF PATIENTS. In the view of Dr. .Malcolm T, MacEachcrn, associate director and director of the hospital activities for tho American College of Surgeons, New Zealand should .adopt a hospital standardisation" or hospital betterment scheme sufch as has been operating in Canada, the United States and South America for a number of years. Tho scheme should apply to all public and private hospitals, sanatoria and related institutions. "I am particularly impressed with the deep interest of the people in New Zealand in keeping the Dominion in the first rank so far as tho prevention and cure of disease is concerned," said Dr. Mac : Eachern in an interview yesterday. "In this education co-operation and enthusiasm are required. If the public, tho Health Department, tho hospital boards and tho medical profession co-operate in this success is assured. "The organisation and facilities available in any community for the prevention and euro of disease are indeed a fairly good index to tho intelligence and progressiveness of tliat community," he continued. "This pre-supposes as one factor efficient hospital'service. "When a patient goes to a hospital ho expects, and is entitled to, three things at least:—(l) An early accurate diagnosis, (2) the best scientific care that ho can get, (3) tho roturn to health or normal state if humanly and scientifically possible in tli# shortest period and most comfortable manner. " Service to the Patient.'' " In Canada and the United States 12 or 14 years ago tho organisation of which I am associato director discovered a great need of improving our hospitals. A study of hospitals through personal investigation, correspondence and other means, covering a period of four to six years, re-_ vcaled an enormous number of deficiencies in the hospitals of both countries. Thus there grew out of this the hospital standardisation movement, which, during the past year, has increased hospital efficiency over 50 per cent, on a conservative estimate. This movement has succeeded, as it is based on 'service to the patient,' the objective or perspective upon which all activities are focussed. "It is stated that at least 3 per cent, of the people on the average are ill each day of the year. It is also stated on good authority that one out of every ten of the peoplo rcquiro hospital treatment. In New Zealand last year we find that 102,864 persons attended either as inpatients or out-patients at tho 73 hospitals under tho various hospital boards of the Dominion. In addition to this it is estimated thero were 20,000 to 30,000 treated in the 278 private hospitals or nursing homes in the Dominion, which contain some 1500 to 2000 beds. To this also must bo added the patients treated in purely Government institutions, such as St. Helens Hospitals, the Orthopocdic Hospital at Rotorua, tho Neurological Hospital at llanmer, and a number ""6f others. . Efficiency and Economy. "Hence with all this great task attention should be drawn to tho standardisation of hospitals to ensure, first, efficiency; ascond, economy. The whole movement stands primarily for a 'square deal to the patient.' The principles laid clown by this movement are fundamental, adaptable and adjustable to any hospital in the world regardless of size, type, or other features. It should be adopted by every New Zealand hospital and particularly thoso using public moneys, for the Dominion is anxious to have the most efficient and economical service possible. "In tho commercial world standardisation of commodities and procedures in manufacture, transportation and other phases has meant tho saving of great sums Qf money and increased efficiency." Standardisation, Dr. MacEachern explained, was not used with respect to lio'spitals in quite the same sense as with respect to business. Tho principles of the movement provided the following conditions: —(1) Ihc proper organisation of the institution and tho duties of its staff; (2) the provision of adequate facilities for diagnosis- and treatment, including laboratories, X-ray equipment, and the like;- (3) the provision of a competent and trained personnel for all work, whether physical or scientific; (4) the instituting of a periodic review and medical audit of tho work of tho hospital, with an investigation of deaths and unimproved complications.

Work of Classification. "Tho movement," said Dr. MacEachern, "draws distinctions between two classes of institutions. On tho one hand thero is tho proporly-equipped hospital with research facilities, the medical staff of which cau have infinite opportunities for good diagnosis and efficient treatment. On tho other hand there aro many institutions which can bo regarded as little moro than hotels for the sick, providing only bod, board, and nursing, but lacking the scientific facilities which arc the hallmarks of a real hospital." Tho movement < wits entirely voluntary. Tho work was carried on by and at tho expense of the American College of Surgeons and its 7000 members. Every institution in America with 35 or more bods was surveyed annually, tho itinerary taking in '2400 hospitals. Tho experts generally held conferences with tho staffs and gave advisory service wharo it was acceptable. On their reports, with data already in hand, hospitals woro rated and graded by tho collego. This grading was his own special work. Tho classification embodied (1) Tho approved typo which possessed all the requirements; (2) the conditionally approved institution, which was prepared to adapt tho principles required and put them into effect; and (3) tho " not approved hospital," which had none of tho facilities required. This classification had an enormous effect. Tho annual list of approved hospitals was published once by every newspaper. A person strango to a town could enter an approved. hospital in an emergency knowing that ho would receive good service. Would-bo nurses had a reliable guide in selecting a trainingground. Intending benefactors wero al»le to select institutions worthy of flielp. Thus thero was a general desire to bring hospitals up to tho standard set. Reduction ol Death-rate. Tho results camo under four heads. In three or four years tho average stay of hospital patients had been reduced from 18 or 22 days to 12 or 16. This was duo solely to bettor personnel and facilities, for moro intensivo treatment. Incompetent and unnecessary surgery had been eliminated bv better diagnoses, moro consultations and tho group-study of patients. Infection and complications had been reduced through bettor supervision and checking-tip. Lastly, the hospital death-rate, formerly 40 to 50 per 1000, had been brought down to 20 per 1000, and less in many cases. Of 1564 . hospitals under survey last year,, nearly 66 per cent, woro approved. Among them was tho Dmiedin Hospital. " Tho movement," said Dr. MacEachern, " has been woll worth while. It has been successful because it is based primarily on tho principle of servico to tho patient."