Hospitals

The American Hospital Association met on the Steel Pier at Atlantic City last week and brought forth such frank criticisms as are seldom heard at association meetings. Three representatives of each of the one thousand member hospitals of the association were present. In addition two thousand others of their personnel attended. Each of them--the men and the women, the laity and the profession--had given of their time, their money, their lives, on committees, on staffs, on patient registers, to hospital work. And, as there is no anger like that of the hampered welldoer, each wanted to speak forth on the injur ies to his intentions. Some criticisms and suggestions: Trustees. "They are often woe fully ignorant of even the pressing problems of their institutions. They employ officers and condone methods which they never would tolerate in their own enterprises. They inter fere in the conduct of business and meddle in professional matters and still wonder why their hospitals do not function efficiently and why they have difficulty in securing the right type of personnel. "The remedy is obvious but not always easily applied. Boards of trustees should determine policies and concern themselves chiefly in employing a great, competent executive who can be trusted to exercise authority and responsibility and whose advice on the many problems of hospital management can be depended upon as being sound and impersonal. When there is a lack of confidence on the part of governing boards in the executive who should represent them, there will be unrest, discontent and even disloyalty, permeating the whole organization." -- Dr. Christopher G. Parnall, Rochester (N. Y.) Gen eral Hospital. Personnel. A low standard of morale and tawdry esprit de corps in hospital organizations is "the pernicious anemia among chronic hospital ills. . . . Discipline in a hospital must necessarily be strict, but I am not in sympathy with militaristic methods. Meagre pay does not encourage loyal service. Too long, in hospital administration, have we been expecting something for nothing. . . ." -- Dr. Parnall, further. Equipment & Supplies. Too many sizes and kinds of bedpans, towels, linens and other supplies exist. They should be limited to one or two standardized types for each item. Between 70% and 91% of the hospitals who answered the questionnaire on the topic sent out by Margaret Rogers, St. Luke's Hospital, St. Paul, Minn., agreed to adopt standards. Dr. W. P. Morrill, Columbia Hospital, Washington, complained of the increasing price of catgut (for operations), due, he said, "to the control of the raw material by packers and an apparent intent on their part to attempt to control the manufacture of this product." Cost of Cure. The most impor tant problem facing hospital administration is the caring for people of moderate means who can not afford the cost of private rooms in hospitals and do not wish to suffer what seemed to them the humiliation of free wards. Alba Boardman Johnson, onetime (1911-19) president of the Bald win Locomotive Works and for years trustee of the Jefferson Medi cal College and Hospital, Philadelphia, suggested that wealthy patrons endow hospitals sufficiently so that these could afford to charge patients only $2 daily. "Probably 80% of the people may be classed as people of moderate means. The other 20% is divided between the rich and the indigent, and they are all well cared for now. A system similar to industrial insurance protection to spread the inevitable expense of illness has also been proposed. While it is satisfactory in certain cases, I cannot conceive of it as a general solution. "I propose a special endowment of moderate-priced rooms as the solution. It has been said people who cannot afford to pay the charge for hospital service ought to go into the free wards." Massachusetts General Hospital, Boston, is building an eleven-story hospital with 300 beds and inexpensive facilities for just such people. Adequate nursing will be covered by a single hospital charge, Dr. Frederick A. Washburn, of that hospital, said. He agreed with Dr. Edward A. Schumann, of Philadelphia General Hospital, that special nurses and services make hospitalization prohibitive to those of moderate means. Dr. Schumann went further and blamed hospitals for making too detailed an examination of patients when such is not essential: "A complete study of every patient is in some respects ideal and a great safeguard against the over-looking of an incipient or disguised pathological condition. However, there are so many illnesses of so obvious a character, their diagnoses so comparatively simple and the indications for their treatment so obvious, that the most intensive laboratory studies play no part whatsoever in the management of the case, or in the prognosis, although the expense to the patient is immeasurably increased." If some reduction in charges does not come soon, there may be recourse to "state medicine," warned Dr. George P. Stephens, Winnipeg (Can.) General Hospital. Social Work. "The average doctor is more than skeptical in the whole matter of so-called social work and this attitude is a curious blend of prejudice and experience which those of us who see otherwise cannot afford to ignore. For the doctor knows the bitter pride of the poor, their longed-for privacy so much denied them, and he suspects the humanity of all organized charity. He feels that the hand and heart of welfare work is cold."--Dr. John E, Jennings, Brooklyn (N. Y.) Hospital. "To bring about better under- standing it is imperative the social worker be attached to the staff of the visiting physician."--Elsie Wulkop Masschusetts General Hos- pital, Boston. This has long been the dictum of Social Worker Luba Wies of Boston.--

--For survey of U. S. hospital facilities, see TIME, Apr. 19.