HOSPITALS SYSTEM.

Hokitika Guardian, 21 April 1926, Page 4

HOSPITALS SYSTEM.

DR Me: EACH Eli N’ S REPORT

MANY RECOMMENDATIONS. WELLINGTON, April 19. Following are extracts from Dr MacEachern’s report on the New Zealand hospitals':— Greatly increased voluntary effort and community interest is desirable in connection with the public hospitals generally. No hospital can attain its maximum usefulness and efficiency without these two valuable features. While there are numerous ways and means through which voluntary effort and community interest could he increased to a much greater degree. I would particularly suggeset the following : (a) .Increased systcinatc effort to secure voluntary gifts and benefactions in way of (1) Annual and life governors. (2) Funds for special purposes, and (If) Endowments. (b) Organisation of women’s auxiliaries, guilds, associations or societies, in each hospital district to supplement the work of the board of trustees who give their time and energy voluntarily, freely and gratuitously. The importance of having tile right kind of trustees on every hospital hoard cannot be over-estimated. THE ELECTION SYSTEM.

The system of election as prevails in New Zealand may not always bring out the best type of membership suited for hospital needs, .such as f find from long experience may be more assuredly obtained through the nomination method. However, under the present mode of financing hospitals in the Dominion, Lhat is through rates, the election system prevails. Hence, in order to secure and maintain properly qualified hoards of trustees electoral support, should he given only when the following condition is fully complied with, namely, that membership on the board of trustees of any hospital should lie confined to—(a) Such persons as are representative of broad community interests and varied callings in life, and whose natural talents can be readily turned to advantage of Hie hospital, and (b) Such persons as would he willing to make hospital work their hobby and give of their little and

energy freely and gratuitously. The various interests should be linked up to the hospital through a board combining business, educational, legal, Press, labour, women’s, medical interests, etc. These basic considerations should be kept in mind when making nominations, and when casting ballots. TOO MANY DISTRICTS.

There are at present forty-six hospital districts in the Dominion, whereas, approximately, twenty-one would lie sufficient. This means expensive and unnecessary duplication, which is detrimental to the best interests of economy and efficiency. There are several hospital districts in the Dominion which cannot maintain the proper set-up that each district should have. Great economy could lie clfected and a much higher degree of efficiency maintained if there were the proper number of hospital districts, each with a standardised set-up. ft is indeed to lie regretted that originally the hospital districts did not, correspond with (lie health districts, 1 1ms providing four metropolitan hospital (listriels, namely, Otago. ( anlerlmry. Wellington and Auckland, with Hie necessary sub-districts or hospital areas. Under present iiniditioiis, however, approximately twenty-one districts would lie siill'n. ion. grouped around the following hospitals respectively : (a) Metropolitan—Auckland. Wellington. Christchurch and Dunedin. (Ij) Base— Invercargill, Oaniaru, Tiinarn. Ashburton, Blenheim. Nelson, Groymoulh. Masierlon. Napier. Oi-borne. Rotorua. Hamilton. W'liangnrei Palmerston North, Wanganui. Haw era and New Plymouth. 1 would therefore strongly urge a complete survey of the whole Dominion with a view to redistribution of the hospital distri ts in the interests of greater crononi’ and increased efficiency. PAYING WARDS. On the mueli vexed question of paying wards. l)r MacEnchern says:—The public hospitals of the Dominion should be constructed as to provide lor all sri lions of the community, namely—(a) Those tumble to pay anything. <li) Those ailin’to pay for niain-

tenance. (c) Those able to pay for maintenance and medical attention. L In this way the public hospitals with , (heir line organisation, equipment and personnel, would lie at tho disposal of t , all sections of the community rather s than of one class or section as at pro sent, liamely the supposedly necessitous poor, This is niissing at present in the hospital system of New Zea- _ land. There is a great need for neeommodation for the intermediate class of 5 patients, particularly those who wish t to pay their own way and have their ( own doctor to attend them in hospital. The addition of paying wards to . the public hospitals presupposes:— 1 fa) That (here should he various grades of aeeomniodal ion and 5 charges. (h) That iho question of profes- ( sional charges should he a matter bo- , tween the doctor and his patient. (<•) That the treatment of those > who voluntarily enter the. paying wards of the hospital and those who are deemed by (he investigating official of flic hospital to be able to pay professional fees in addition to innin- [ tenance. should make their own ar- ; raiigoinents for attendance with the j doctor of their choice and not be mi- | del' ihe medical or surgical control . of the resident medical staff, i (d) That private patients entering wards should not he attended by I lie stipendiary staff, but by the doctor of their own choice. Failing a choice, or not lieing able to make a selection, nothing should prevent a member of tile honorary staff from attending that patient in his private capacity, ft is hoped that hospital boards will seriously take up this problem and make provision for an extension of the services to the very large group of patients desiring to take advantage of the hospital facilities and have a doctor of their choice and pay their own way. UNIFORMITY TN STAFFING. There should he a uniform policy of staffing the hospitals in the Dominion. The policy of full, or part-time medical officials, with dual responsibility, clinical and administrative, should he abolished. as it is entirely opposed to the highest quality of medical services as well as efficient administration'. 1 The appointment of an inspector or director of the hospitals of the Dominion would be a great advantage. Such a person should be a doctor having a long and successful experience in all phases of hospital administration. Inspection of hospitals, when systematically carried out by an experienced officer of this kind, cannot fail to he of the most constructive value to each institution. With this arrangement a multiplicity of inspectors would not ho 1 required, but there should be retained 1 the present service experts now attach- < cd to the Department, who could be 1 called upon to go where required as i indicated and approved by the inspec- ( tor or director of hospitals for the f)o- 1 minion. , c

MATERNITY CASES. Each hospital district should provide

tho necessary accommodation and service for maternity patients, apart from, but in close proximity, so far as possible, to the general hospital, and under the satno administration. In this connection it is also recommended:— (1) That each nurse in training and the resident medical officer should have carefully supervised instruction and experience in this work. (2) That there- should bo one of the honorary medical staff present at each confinement, to supervise the technique, and he prepared for any emergency or complication which might arise at any moment; and (3) That ante-natal clinics be under the direct supervision of the honorary medical staff and the resident medical officers be present as well as

nurses. TR IP L E A DMIN ISTRAT ION

The principle of more than one head to a hospital, or triple administration found in many of the Dominion hospitals. is not in the best interests of efficient administration. In this triple administration the medical superintendent, the matron and the business manager or secretary are each more or less responsible directly to the hospital board, and are on an equal footing so far as this is concerned, though the superintendent is usually the senior officer of the three. This is not sound administration. Hie hospital hoard should invest in the superintendent the entire responsibility for the carrying out of the policy, and he or she should be the chief executive office ol the institution, with the entire personnel responsible to such an officer. More than one head to an institution or organisation loads to confused administration, and may retard the best progress. MEDICAL ATTENTION.

It is recommended that medical patients in hospitals throughout the Dominion receive more attention from the members of the medical Mali of the hospitals, and not lie left chiefly in the hands of the resident medical officers, with limited experience in this particular field. Tins is also purtieulaliv true in the case ol inlcetious discuses. Equal attention to that which is given to surgery should lie given medicine in every hospital. The present condition is due to two factors, main-

fa) Lack of honorary medical stalls in many hospitals.

fb) Permitting medical siipennlen. dents to use their position as a step-

ping-stone to surgery, having with them only a limited staff or resident medical officers generally fresh from college, and upon whom a great deal of tlie resnonsibility for the care of the medical and infectious cases is thrown.

They lack the supervision of an honorary medical staff so essential inevery hospital. A good medical service is indispensable in every hospital.