HOSPITAL MANAGEMENT

Otago Witness, Issue 3756, 9 March 1926, Page 82

HOSPITAL MANAGEMENT

LECTURE BY DR MACEACHERN TAY WARDS STRONGLY ADVOCATED. Dr M. T. MacEachern, formerly superintendent of the Vancouver General Hospital, and at present director of the Hospital Standardisation Movement for Canada and the United States (with residence in Chicago), delivered an illustrated lecture in the Medical School on Tuesday evening on hospital administration and policy. The lecturer was introduced by Mr A. F. Quelch. He said they were extremely fortunate in having Dr MacEachern with them. He had been in New South Wales and to Victoria to report to their Governments on hospital administration and policy, and they were indebted to the New Zealand Government for his visit to Dunedin. The first part of the lecture was illustrated, and at its conclusion Dr MacEachern made some very valuable suggestions. Mr Simpson manipulated the lantern in his usual efficient manner. Dr MacEachern said it was hard to put their hands on any perfect hospital system, and so they must always keep before them the changes tending towards improvement. Ke wished to illustrate six principles for hospital administration. These six principles were—organisation, co-ordination, co-operation, service, economy, and efficiency. If they could get these six principles into the New Zealand hospitals they would be all right. First of all, they must have a board or trustees, and a chief executive officer or superintendent. The board should determine the policy, and vest it in the executive officer i to Carry it out. The system then went on from the exeentive officer to the other members of the staff. There should be a proper line of communication back and forward. Unless they organised every day in their work they could not get along well. A plan was screened of the Dpnedin Hospital, and the lecturer said he thought the best was being done under the circumstances. A superintendent must deputise most of the '•ork, because a superintendent should be chiefly an administrator. They must have co-ordination, and must all pull together. The best way to have co-operation was to have a meeting of the heads of departments once a week. They should be made to unfurl their story, and clear up any troubles, around the table. He explained the system of service to bo adopted, and pictures were screened showing the best arrangement to be adopted. Then the hospital must be exemplification of service. Everything must be ready in cases of emergency. The greatest wastage in hospitals to-day was in the I'uen and the foods. Some of the linen could be repaired, some could be reclaimed, and some would have to be thrown away. TTiey should reclaim or repair before they throw away. He was glad to sec they had a dietition in the Dunedin Hospital. Australia was following on these lines, and was considering the possibility of obtaining cbotiiions from' this country. Pictures were uhown to illustrate how dietitions had presented wastage in the commissariat. He Mioiurht the most important thing was the inspection daily of the garbage, to see that •ood food was not thrown away. Economy fn a hospital was a most important thing. View's to demonstrate how the best efficiency could be obtained in the protection of patients waiting to undergo an anaesthetic, etc., wshown. The proper .acili ties to deal wit* all phases of sickness were only to be found in the larger hospitals. Every doctor should have laboratories to enabl? him to make his diagnosis, and he got ail these in the well-regulated hospital In a well-regulated hospital the patient was under a" protective control, and a doctor who made a bad operation would not be able to get away with it. No hospital did greater work than a hospital attached to a university such ns theirs and no hospital could do better work than a hospital of this kipd if it had the necessary organisation Every hospital should have, a complete record of a case, and everything should be duly recorded The doctors should review the work of the hospital to see that everything was moving smoothly and in the be9t. interests of the patients. Hospitals should not be concerned over financial surpluses or deficits. The whole point was their surplus of cures. The institution must have a physical background. it must have a mental background —in the way of teaching and educatoin—and it must have a moral background. iNurses had a very serious task in'taking cafe of the patients. They must have the right spirit behind the institution. Victoria had gone through a thorough survey, and now had the best system he had ever analysed.—(Applause.) Views of the hospitals there were shown, aud the system obtaining explained. There they hod the metropolitan hospitals, and then the base hospitals, distributing, cottage, isolated, find bush nursing hospitals. They had fully-equipped laboratories in each of the base hospitals. These base hospitals were self-contained. In Victoria they had one of the most unique hospital systems he had ever examined. Pictures were screened slip wing what was being done in Victoria. Somebody ha I said to him that the day of the honorary and voluntary staffs had gone for ever in New Zealand. lie would say “God help them” if that were so, because then they would have a group of routinlsts of machinists. Voluntary efTort lmd got everyone on their feet In Victoria. He had not intended to show these Victorian pictures here. He whs going to take them home to America to make the people there sit up and take notice. [Victoria had taken a decided stand, and they agreed that the honorary system must continue there. They were also going in for pay wards, and better investigation of the patients’ financial position, particularly in the out-patients’ departments. They had independent boards there which were completely lifted out of politics. He would sooner have a patient with the bubonic plague walking through his hospital than a politician.— (Laughter.) The out-patients’ department in Victoria were cut fair. These people did not or could not pay, and on the other hand they would not enter a hospital under the class for necessitous cases. The pay wards lessened the responsibility on

the public. In Victoria they had church hospitals—Anglican, Catholic, Presbyterian, and Methodist. They were maintaining themselves on a system of intermediate feet from the patients. In Sydney they were putting in pay wards to their hospitals. Here they had community hospitals. Here the patients were sent in by the doctors who arranged with the patients for his fees. The patients also arranged with the hospital as regards their fees. Here the system of pay wards was progressing very favourably in the one hospital building. In Victoria they did not believe in a rate system, because the people could say they paid the money and they were going to use the hospitals. The upkeep was paid from Budget. While the rate was for the treatment of necessitous cases the people who subscribed would consider they should also get treatment. They should have pay wards for those who could pay. If they were to staff their hospitals with full-time officers they were going to drive the honorary staffs cut. and their profession was going to suffer. The doctors gave a lot of tneir service free, and he thought they were entitled to be on the boards. With pay boards they reduced the payment from the consolidated fund. He favoured voluntary effort, and they should try to cut out Government and municinal effort as much as possible. The speaker referred to the fact that a doctor should not be expected to treat any paitent who was well able to pay free. He therefore, as he had stated, favoured the pay ward system. He would be able to get treatment by all the latest known medical science, whereas in a private hospital he could hardly expect to receive the advantage of such up-to-date treatment. In his concluding remarks Dr MacEachern said he thought that in Dunedin they should very seriously consider the adding ©f pay wards to the Dunedin Hospital. If they wanted to do the best for the community, for their board, and for the profession they should endeavour to do that. He thought that if they had a central board appointed by the hospital boards it would help things very much. The lecturer explained how the central board could be set up to give a fair all-round representation. Such a central board would in a great measure prevent the matter of too many districts and the breaking up of districts. It would greatly increase the efficiency of the present system. He thought they had a wonderful group of boards, and he commended the interest they displayed in their work.

Let them try to get something between the - boards and the Government. Further, let them try to stimulate more voluntary effort in connection with their hospitals. He had never seen research initiated and developed yet but by voluntary effort.—(“Hear, hear”) He thought that voluntary effort was a very fine thing to have in the background, or on the side some.vhere.

They should add to their hospitals pay wards, and maternity wards, as far as they could, and children’s wards, too. They could carry them on under the regulations which had been carried on successfully in 6000 hospitals in America. These hospitals were running very smoothlj'. They were not an experiment—it was an old and tried thing. Get their honorary staffs in full activity. If they slackened, stir them up and get them to move to better endeavour. Every hospital must be a teaching centre. They must make their training schools great institutions. The assets of the Royal Hospital in Montreal stood at 20,000,000d0i, the result of voluntary effort.— (Applause.) This had been achieved not by wealthy men. They had had one or two big donations, but all the people who had cause to feel grateful for treatment at this hospital had contributed.

He had been delighted to go over the Dunedin Hospital. He wanted to congratulate them on their Medical School, their University, and their Hospital. He wanted to congratulate them for doing one thing, and that was a far bigger thing than they realised. They had created in New Zealand a nursing affiliation with the University. This was a fine achievement. New Zealand must be self-contained. They could not draw on other countries, and they, must develop their own pereounel.

He had been delighted to see their household science department, and to find that he could get three or four women here for positions in Australia as dietitions. He hoped they would be proud of these things, and that they w'ould put their shoulders to the wheel and push this along. He must again congratulate them on the graduate system for nursing. They had adopted the same system in his own city as a result of his efforts, and when he returned to America he was going to tell them what had been done in New Zealand. He hoped the Otago Hospital Board would have the admirable kitchen they had planned in the hospital built as soon as possible; and keep it in line with the rest of the institution. He would like to see them develop a hospital for incurable chronic patients at Wakari, and to arrange to build an infoctious diseases hospital there too. The present site of the infectious diseases hospital was not a good one. A psychopathic hospital at Wakari was •Iso to he desired. Mental patients could thus be studied and observed, and treated, and perhaps many of them would never have to go any further. They should try to have a clearing house to the mental hospital.—(Loud applause.) On tho mofTon of Mr J. Scurr a hearty vote of thanks to the lecturer was carried by acclamation.

Mr R. M. Watson, S.M., had a few things to say to drivers of lorries at the Bulls Court the other day. He reminded them (says the Feilding Star)- that they did not own the road and t! other motorists wore entitled to room to pass. The traffic inspector (Mr Berry) stated that ho had followed one defendant for three-quarters of a mile, repeatedly sounding his horn, without the lorry giving way an inch.

The quality of the fruit in the Gisborne district this year is Well above the overage. Usually hundred* of cases of apples are affected with blauk spot, hut this yoUl the blight has not shown itself. The growers ordered 4000 cases for the export trade, but ore now endeavouring to obtain another 2000 cases.