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poor. There are no hospitals for those who can afford to pay only a moderate amount and yet desire to pay
without a feeling that they are recipients of charity. It has been taken for granted that a hospital cannot both
serve and be self-supporting--that it has to be either an institution kept going by private contributions or pass
into the class of private sanitariums managed for profit. This hospital is designed to be self-supporting--to
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give a maximum of service at a minimum of cost and without the slightest colouring of charity.
In the new buildings that we have erected there are no wards. All of the rooms are private and each one is
provided with a bath. The rooms--which are in groups of twenty-four--are all identical in size, in fittings, and
in furnishings. There is no choice of rooms. It is planned that there shall be no choice of anything within the
hospital. Every patient is on an equal footing with every other patient.
It is not at all certain whether hospitals as they are now managed exist for patients or for doctors. I am not
unmindful of the large amount of time which a capable physician or surgeon gives to charity, but also I am not
convinced that the fees of surgeons should be regulated according to the wealth of the patient, and I am
entirely convinced that what is known as "professional etiquette" is a curse to mankind and to the
development of medicine. Diagnosis is not very much developed. I should not care to be among the
proprietors of a hospital in which every step had not been taken to insure that the patients were being treated
for what actually was the matter with them, instead of for something that one doctor had decided they had.
Professional etiquette makes it very difficult for a wrong diagnosis to be corrected. The consulting physician,
unless he be a man of great tact, will not change a diagnosis or a treatment unless the physician who has called
him in is in thorough agreement, and then if a change be made, it is usually without the knowledge of the
patient. There seems to be a notion that a patient, and especially when in a hospital, becomes the property of
the doctor. A conscientious practitioner does not exploit the patient. A less conscientious one does. Many
physicians seem to regard the sustaining of their own diagnoses as of as great moment as the recovery of the
patient.
It has been an aim of our hospital to cut away from all of these practices and to put the interest of the patient
first. Therefore, it is what is known as a "closed" hospital. All of the physicians and all of the nurses are
employed by the year and they can have no practice outside of the hospital. Including the interns, twenty-one
physicians and surgeons are on the staff. These men have been selected with great care and they are paid
salaries that amount to at least as much as they would ordinarily earn in successful private practice. They
have, none of them, any financial interest whatsoever in any patient, and a patient may not be treated by a
doctor from the outside. We gladly acknowledge the place and the use of the family physician. We do not
seek to supplant him. We take the case where he leaves off, and return the patient as quickly as possible. Our
system makes it undesirable for us to keep patients longer than necessary--we do not need that kind of
business. And we will share with the family physician our knowledge of the case, but while the patient is in
the hospital we assume full responsibility. It is "closed" to outside physicians' practice, though it is not closed
to our cooperation with any family physician who desires it.
The admission of a patient is interesting. The incoming patient is first examined by the senior physician and
then is routed for examination through three, four, or whatever number of doctors seems necessary. This
routing takes place regardless of what the patient came to the hospital for, because, as we are gradually
learning, it is the complete health rather than a single ailment which is important. Each of the doctors makes a
complete examination, and each sends in his written findings to the head physician without any opportunity
whatsoever to consult with any of the other examining physicians. At least three, and sometimes six or seven,
absolutely complete and absolutely independent diagnoses are thus in the hands of the head of the hospital.
They constitute a complete record of the case. These precautions are taken in order to insure, within the limits
of present-day knowledge, a correct diagnosis.
At the present time, there are about six hundred beds available. Every patient pays according to a fixed
schedule that includes the hospital room, board, medical and surgical attendance, and nursing. There are no
extras. There are no private nurses. If a case requires more attention than the nurses assigned to the wing can
give, then another nurse is put on, but without any additional expense to the patient. This, however, is rarely
necessary because the patients are grouped according to the amount of nursing that they will need. There may
be one nurse for two patients, or one nurse for five patients, as the type of cases may require. No one nurse
ever has more than seven patients to care for, and because of the arrangements it is easily possible for a nurse
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to care for seven patients who are not desperately ill. In the ordinary hospital the nurses must make many
useless steps. More of their time is spent in walking than in caring for the patient. This hospital is designed to
save steps. Each floor is complete in itself, and just as in the factories we have tried to eliminate the necessity
for waste motion, so have we also tried to eliminate waste motion in the hospital. The charge to patients for a
room, nursing, and medical attendance is $4.50 a day. This will be lowered as the size of the hospital
increases. The charge for a major operation is $125. The charge for minor operations is according to a fixed
scale. All of the charges are tentative. The hospital has a cost system just like a factory. The charges will be
regulated to make ends just meet.
There seems to be no good reason why the experiment should not be successful. Its success is purely a matter
of management and mathematics. The same kind of management which permits a factory to give the fullest
service will permit a hospital to give the fullest service, and at a price so low as to be within the reach of
everyone. The only difference between hospital and factory accounting is that I do not expect the hospital to
return a profit; we do expect it to cover depreciation. The investment in this hospital to date is about
$9,000,000.
If we can get away from charity, the funds that now go into charitable enterprises can be turned to furthering
production--to making goods cheaply and in great plenty. And then we shall not only be removing the burden
of taxes from the community and freeing men but also we can be adding to the general wealth. We leave for
private interest too many things we ought to do for ourselves as a collective interest. We need more
constructive thinking in public service. We need a kind of "universal training" in economic facts. The
over-reaching ambitions of speculative capital, as well as the unreasonable demands of irresponsible labour,
are due to ignorance of the economic basis of life. Nobody can get more out of life than life can produce--yet
nearly everybody thinks he can. Speculative capital wants more; labour wants more; the source of raw
material wants more; and the purchasing public wants more. A family knows that it cannot live beyond its [ Pobierz całość w formacie PDF ]