HOSPITAL STANDARDISATION.

Otago Witness, Issue 3756, 9 March 1926, Page 65

HOSPITAL STANDARDISATION.

EFFICIENCY AND ECONOMY. DR MACEACHERN INTERVIEWED. THE MEDICAL SCHOOL. “I was particularly impressed with the splendid tutorial facilities the new buildings will provide, and with fine research work already being carried out there/’ With these words Mr Malcolm MacEachern described the new Medical School now being erected for the University of Otago, after he had been taken on a tour of inspection through the school. When interviewed by our representative on Saturday. Mr MacEachern said he had greatly enjoyed his visit to the Medical School, and he admired greatly the organisation which had been built up there. The new buildings uoav in course of construction would give Dunedin a splendid institution. Referring to the research and tutorial work, he said there were many diseases that had not yet been conquered, and the medical profession was looking for more light on such conditions. An example was arthritis—a- chronic form of rheumatism which was very prevalent. Infantile paralysis, cancer, and many other conditions were being continuously investigated in the laboratories at Che Otago Medical School. A PROGRESSIVE MOVEMENT. Dr MacEachern then went on to speak of a movement that was doing much to improve hospital efficiency. This was hos pital standardisation. "New Zealand is no doubt anxious to have the most economical and efficient hospital service possible. In Canada and America a movement known as hospital standarisation has done more than anything else to accomplish these two obisotives —economy and efficiency.” ITS USE IN COMMERCE. “ In the commercial world,’ he said, " standardisation of commodities md procedures in . lanufacture, storage, and transportation has meant che saving of great sums of money and increased efficiency. Standardisation must not be car ried far enough, however, to allow of any risk of hampering individual effort. Manufacturers find that by standardising commodities they can soon provide an ini proved and cheaper article. Large »arie ties of articles of one kind tend to flood the market with a lot of inferior quality which really increases the cost of produce tion. It is interesting to note that whereas at one time 55 kinds of bricks were in use for building purposes, the number of varieties has now been reduced to five or six standard types. It is also stated that 552 varieties of fencing wire have now been reduced to the modesv total of 70. “ As a result of a survey of hospitals it was found that there were 78 types of beds in use, whereas four types are quite sufficient. It has also been stated m authority in America that the standardisation of the lumber business as regards methods of production and transport lias saved the country a total sum of about 200,000,000 dollars.” APPLIED TO HOSPITALS. Dr MacEachern then went on to show in what manner this system had been applied to hospitals. It had been used ho 9aid, in a somewhat different sense in respect of hospitals. The hospital standardisation movement was in its ninth year of progress and development in America. This was done by means of the establishment of practical principles, adjustable and adaptable with modifications to every hospital in the country and yet in no way embarrassing individuality. The movement, said Dr MacEachren, was based on tho theory that every man, woman, or child entering a hospital shmild have the benefit of the best service possible so far as present-day knowledge was concerned. PRINCIPLES OF SCHEME. The principles of the standardisation movement as applied to hospitals provided the following conditions: —-(a) The proper organisation of the institution setting forth duties and responsibilities and functions without any overlapping or omissions. (b) The provision of adequate facilities for diagnosis and treatment, entailing lo installation of laboratories. X-Rav and other facilities, in addition to lied, board, and nursing, in order to increase the efficiency of the treatment and hasten convalescence, (c) The provision of a competent nnl trained personnel In each hospital to do r.ll the work, whether it he physical or Hceintific. <d) The Instituting of a periodic review and “check up” or medical audit of the work of the hospital, which condition would provide for a careful investlgatoin of deaths, unimproved complications, and other conditions not coming up to the standard of 100 per cent, efficiency. Under such administration, said Dr MncKaehcrn there could no longer be a "come-stay-go” institution where patients pc s through like a machine. Each patient

should have individual consideration and access to the best facilities for diagnosis and treatment Under these principles there would be kept complete records concerning each patient. The broadest interpretatoin of the principles would be allowed each hospital in working out its own administrative policy, so long as the ultimate objective was attained, and that is, first and last, service to the patient. These and many other requirements of a practical and simple nature constituted what was popularly known as the "minimum standard”—"the measuring stock of hospital efficiency.” WORK BEING DONE. Speaking of what was being done in these countries which had already taken up the movement, the doctor had some very interesting data to supply. ‘‘The movement,” he said, “draws distinctions between the two classes of institution which undoubtedly exist. On the one hand we have the institution which can rightly be called a hospital, having not only bed, board, and nursing, aud the necessary domestic services, but also the scientific aspect, with proper X-ray equipment, laboratories, and research facilities, so that the medical staff can have infinite opportunity for good diagnosis aud efficient treatment. “On the other hand there are many institutions which can be regarded as little more than hotels for the sick, providing only bed, board, and nursing, but lacking the scientific facilities which are the hallmarks of a real hospital. “While doctors and nurses have many God-given poWers of ministration, such as eyes, ears, and fingers, they must also have certain scientific equipment at their disposal with which to work out the problems which are continually confronting them, readily and accurately. It is such movements as this one that can account for the fact that where thousands died formerly through the lack of good facilities, thousands are now being saved annually, and the hospital has become an inseparable part of the social and economic life of the community. Every life saved means much to the nation, and every day of sickness eliminated means a great deal to indn try, to say nothing of the value of minimising suffering and pain. AN INTERNATIONAL ORGANTS V TION. "This work is being carried out by an intern >tional organisation known as the American College of Surgeons, having a membership of 7000 outstanding surgeons, chiefly from Can.ul.i and America, but also from South America, New Zealaro Australia, China, and many other coun tries. The organisation is under the director-generalship of Franklin H. Mar tin, who visited New Zealand two year •igo. and returned home greatly impressed by the New Zealand hospital system and her medical prof ision. “The hospital standardisation movement is entirely voluntary and means no extra cost to the institutions adopting it, the money being found by the College Surgeons itself, and provided by the annua) levies from membership and the in terest accruing from endowments.” The movement continued Dr MacEachern. was brought before the notice of hospitals annually by means of a personal visit .from hospital experts, who went to every institution in America that possessed 35 beds or over. The itinerary took in 2400 hospitals While visiting these places the experts made a thorcugh survey and wrote reports on each institution, and generally held round the-table conferences with boards or medical staffs, giving an extensive and advisory service wherever possible. Their reports were sent to headquarters, and the report of an institution together with additional data already in hand, determined the rating of the hospital by the College. The rating was done according to a certain classification A PUBLIC GUARANTEE. This embodied three types of hospitals: (1) The approved type, which possessed all the requirements (2) The conditionally approved institution, which was prepared to adapt the principles required and put them into effect and (3) the “Not approved hospital,” which had none of the facilities required. This classification had an enormous effect in stirring up hospital interest and efficiency so as to meet the standard necessary. Each institution complying with the requirements was given an attractively illuminated certificate to be hung in the front lobby oi seme conspicuous place, as an assurance t i the public that the hospital was meeting the requirements which would reasonably safeud it and assure a good service when il was found uecessary to go to the hospital on account of sickness A strang taken suddenly ill anywhere in Canada or the United States could easily find out whore tho nearest approved and listed hospital was, and he would be nably safe in his seelction of a doctor.

Young women desirous ot training us nurses consulted the approved list before selecting fheir training grounds. Government and philanthropic organisations gave their money guardedly to institutions not on the approved li t. Two or three years ago surgeons were instructed through their association to send their patients only to those hospitals accredited under the standdardisntion system Thus this movement brought an extensive background of service free to each hospital as well as an equally thoroughly educational compaign calculated to show what the hospital was and should be. RESULTS TO DATE.

“The chief results of the movement to date,” said Dr MacEachern. “can be summarised under four heads. The fir9t is the reduction of the average number of dajV stay of patients in hospital, dropping as it has dono in three to four years from 18 to 22 days to 12 to 14 days. Indeed, operating under the standardising scheme saved one hospital 6000 free days. This is solely due to the .better facilities and better personnel and organisation, with more intensive treatment to be found in the approved hospital. “ The second result is the elimination of incompetent and unnecessary surgery, due to better diagnoses and an increased number of consultations and the group study of patients, accompanied by more technique. Formerly it was necessary t? opeu many abdomens to make a diagnosis, but now the clinical facilities in the scheme, with well-equipped laboratories and A-ray enable surgeons, physicians, and specialists to make diagnoses more accurately and without resort to such radical proceedings.

" The third result is the reduction of infection and complications through better supervision and checking up. “ The fourth point worthy of note is the lowering of the hospital death rate through thorough investigation of each d«ath and the practice of many other well laid down constructive theories. The death rate has dropped from 30 to 40 pe • If 00 to 20 per 1000, and may lessen many cases.

To-day the movement embraces public, private, and Government hospitals, the army and navy, and public health services, and the Veterinarians’ Bureau During 1925 there were 2380 hospitals under survey, and 1564 were approved—a percentage of 65.7. "The movement has therefore been well worth while, and its influence is widely increasing. At present there are several hospitals outside of the Continent of America operating under the system, including the Dunedin Hospital, a few in Australia, a number in China, South America and elsewhere. It has been successful because it is based primarily on the slogan ‘ Service to the patient/ ”