Toward the Creation of an Institutional Logic for the Management of Hospitals: Efficiency in the Early Nineteen Hundreds

This research focuses on the creation of an institutional logic—efficiency—and on its organizing principles of standardization and business practices through a study of the American Hospital Association and its publication, the Modern Hospital. In the early years of the 20th century, efficiency began to emerge as a first institutional logic for the management of hospitals. The term was defined broadly, encompassing not only economy but also quality and breadth of services, as well as access to care. This early emphasis on efficiency foreshadowed three issues that affect health policy and hospital management to this day: the pressure on hospitals to introduce new technology while containing cost, the assumption that hospitals should act like businesses, and the practice of offering large hospitals as the model for other providers.

Women Doctors and Lady Nurses: Class, Education, and the Professional Victorian Woman

The lives of the first women doctors in Britain have been well studied by historians, as have the many debates about the right of women to train and practice as doctors. Yet the relationship between these women and their most obvious comparators and competitors-the newly professionalized hospital nurses-has not been explored. This article makes use of a wide range of sources to explore the ways in which the first lady doctors created "clear water" between themselves and the nurses with whom they worked and trained. In doing so, it reveals an identity that may seem at odds with some of the clichés of Victorian femininity, namely that of the intelligent and ambitious lady doctor.

[Hospital Panorama in Zamora at the middle of the XVIIIth Century]

The XVIIIth century was an era of reforms in multiple fields, including healthcare. To advance in its study, the present article delves into the knowledge about the hospital network in the middle of said century within the territories which integrate the current province of Zamora. Accordingly, the type of establishment, its funding, organisation and operation are analysed. As a result, a panorama dotted with numerous rural refuges and some hospitals in the centre of certain built-up areas is drawn, dedicated, basically, to the reception and religious assistance of poor vagrants. Such establishments were funded, above all, by agricultural income and by census rents. They counted , moreover, on a notable, ecclesiastic presence.

'The hospital was just like a home': self, service and the 'McCord Hospital Family'

For more than a century, McCord Hospital, a partly private and partly state-subsidised mission hospital has provided affordable health-care services, as well as work and professional training opportunities for thousands of people in Durban, a city on the east coast of South Africa. This article focuses on one important aspect of the hospital's longevity and particular character, or 'organisational culture': the ethos of a 'McCord Family', integral to which were faith and a commitment to service. While recognising that families - including 'hospital families' like that at McCord - are contentious social constructs, with deeply embedded hierarchies and inequalities based on race, class and gender, we also consider however how the notion of 'a McCord family' was experienced and shared in complex ways. Indeed, during the twentieth century, this ethos was avidly promoted by the hospital's founders and managers and by a wide variety of employees and trainees. It also extended to people at a far geographical remove from Durban. Moreover, this ethos became so powerful that many patients felt that it shaped their convalescence experience positively. This article considers how this 'family ethos' was constructed and what made it so attractive to this hospital's staff, trainees and patients. Furthermore, we consider what 'work' it did for this mission hospital, especially in promoting bonds of multi-racial unity in the contexts of segregation and apartheid society. More broadly, it suggests that critical histories of the ways in which individuals, hospitals, faith and 'families' intersect may be of value for the future of hospitals as well as of interest in their past.

[The day-to-day routine in hospitals--standards and conflicts, based on the example of the Rothschild spital in Vienna around the year 1900]

The juxtaposition of official regulations and letters of complaint from Vienna's Rothschild Hospital shows, beyond the rhetoric and euphemisms of hospital reports, how lively and diverse day-to-day life was in a Jewish hospital around the year 1900. The letters of complaint query the official hospital rules and show that ideal and reality did not always coincide. Often, religious questions were at the root of the critique--such as doubts as to whether kosher dietary laws were adhered to--or conflicts between the agents involved, be they individuals or groups, patients, nurses, physicians or administrative staff. As part of this process, power structures, social hierarchies, patient rights and gender issues were called into question and renegotiated.

Indian hospitals and government in the colonial Andes

This article examines the reception of the early modern hospital among the indigenous people of the Andes under Spanish colonial rule. During the period covered by this study (sixteenth to mid-eighteenth centuries), the hospital was conceived primarily as a manifestation of the sovereign’s paternalistic concern for his subjects’ spiritual well being. Hospitals in the Spanish American colonies were organised along racial lines, and those catering to Indians were meant to complement the missionary endeavour. Besides establishing hospitals in the main urban centres, Spanish colonial legislation instituted hospitals for Indians in provincial towns and in small rural jurisdictions throughout the Peruvian viceroyalty. Indian hospitals often met with the suspicion and even hostility of their supposed beneficiaries, especially indigenous rulers. By conceptualising the Indian hospital as a tool of colonial government, this article investigates the reasons behind its negative reception, the work of adaptation that allowed a few of them to thrive, and the eventual failure of most of these institutions.

Looking back 50 years in hospital administration

Healthcare policy and hospital administration are dynamic and growing fields, oriented toward shaping the future. In an effort to understand where these fields have come from, as well as some of the re-occuring challenges faced, we conducted a retrospective analysis. Our research identified progress and major accomplishments, as well as issues that continue to challenge the field in five key areas: (1) the evolution of nursing, (2) funding and legislation, (3) hospital design, construction and technology, (4) patient care and infection control and (5) leadership. To explore these areas, a thematic content review was conducted on the 12 inaugural issues of Hospital Administration in Canada, a hospital administration periodical from 1962. All written content was reviewed, coded and categorized into major themes that represented the major hospital administration topics of 50 years ago. In this article, five prominent themes are explored and further illustrated using key stories and milestones from 1962.

The more things change, the more they stay the same

In "Looking Back 50 Years in Hospital Administration," Graham and Sibbald identify five principal themes in the 1962 issues of Hospital Administration in Canada: the evolution of nursing, funding and legislation, hospital design, patient care and infection control and leadership. These themes are of course consistent with thematic concerns regarding healthcare in 2012; in some ways, this consistency over 50 years is disappointing, but not surprising. This commentary examines some of the specific themes.

Reflections on leadership in healthcare: the past 50 years

Leadership in the hospital sector has been characterized by a state of change since the early 1960s. Heavily influenced by the emergence of the principles of the Canadian health system, leadership at the time was shaped in many ways by the post-World War II construction boom. It was significantly impacted by the developing professional unions in the clinical professions and the resultant and conflicted labour relations of the 60s and 70s. The environment of leadership was in those days predominantely a transactional style, and was frequently confrontational. But the many leaders of Canada's hospitals were also characterized by a caring cadre of often-colourful personalities who challenged, debated and strove to ensure adequate funding and a harmony among the diverse clinical, community and political interests confronting their organizations. The major restructuring of an ever-more expensive health system has set the stage for substantial innovation and reform as the leaders in the system integrate new technologies, personalized pharmaceuticals, devolving scopes of practice and entrepreneurial opportunities related to incentive funding. The development of leadership competencies such as the Leaders for Life framework across the health workforce will be essential to successfully guide our health delivery system into the future.

Fifty years of infection control and healthcare design

The examination of 1962 perspectives on healthcare provided by Ross Graham and Shannon Sibbald in their article "Looking Back 50 Years in Hospital Administration" provides an opportunity to see not only what happened 50 years ago, but how modern attitudes and concerns both match and differ from those of the past. Focusing on infection prevention and hospital design, this commentary explores the changes in procedure, policy and attitudes since 1962, and how they are affecting healthcare today.

The psychiatrist as administrator: the career of W.F. Theunissen in the Dutch East Indies

W. F. Theunissen (1882-1961) was a leading psychiatrist in the Dutch East Indies. He was the medical director of several large mental hospitals after which he became director of the Dutch East Indies Public Health Service. Theunissen was not known for his research into the causes of mental illness. Instead, he made his mark as an administrator greatly reducing the expenses of the Lawang mental hospital by expanding occupational therapy in new and innovative ways. His accomplishments earned him the position of director of the Indies Public Health Department, where he oversaw the decentralisation of health services and the development of public health initiatives.

Putting patients first. A conversation with Benjamin Chu, M.D., the new chair-elect of the AHA

The son of immigrants, Benjamin Chu, M.D., has followed an unusual life path from New York's Chinatown to Southern California, where he is now an executive with Kaiser Foundation Hospitals and Health Plan. Dismayed by the daunting challenges facing health care, the AHA chair-elect became a strong believer that the system can and must change, always keeping the focus firmly on the patient.

[Deontologic aspects in publications of Bronisław Wilhelm Sawicki (1860-1931)]

Bronisław Wilhelm Sawicki (1860-1931), an eminent Warsaw surgeon who received an extensive education at foreign medical institutions, was an expert in various problems of hospital management. The complicated problems of education of physicians in the Russian sector of partitioned Poland (the Grand Duchy of Warsaw and the Congress Kingdom of Poland) formulated by Sawicki are presented in this work. Medical education in Western Europe especially in Germany, Austria and France, is described in detail. The problems of hospital assistants in the second part of the 19th and in the beginning of the 20th century are discussed.

Conflicts over control and use of medical records at the New York hospital before the standardization movement

Historians of medicine generally credit the hospital standardization movement of the early 20th century with establishing the record as a sign of hospital and staff quality. The medical record's role had already been the subject of intense interest at the New York Hospital several decades before, however. In the 1880s malpractice and insurance concerns caused the administration to attempt to supervise record creation, quality, and access, over the objections of physicians. Contemporary concerns about the uses of the medical record were in play well before 1910.

[General Counsel for Administration of Public Hospitals in Paris: creation of a public health institution]

In 1801, Napoleon Bonaparte established the Conseil Général des Hospices de Paris, as the first centralized authority to manage all Parisian civilian hospitals. Through an examination of the debates and statements surrounding its creation, and its founding rules and regulations, its purpose will be shown to be twofold: to enforce the values of proper administration and morality, and to support certain medical advancements. The Conseil heralded the birth of a public health institution which would become, some 50 years later, the Assistance-Publique.

Stage-managing a hospital in the eighteenth century: visitation at the London Lock Hospital

London's Lock Hospital, established in 1747 to treat venereal diseases, depended heavily on charity. Its administrators tried valiantly to project a positive image of the hospital in spite of the pervading moral assumptions about its patients and doubts about whether they deserved charity. Policies governing visitation were bound up in the hospital's attempts to police itself and promote its cause to benefactors. Visitation policies served numerous ends, including policing patients, introducing moral reform, monitoring the staff, and obscuring the reality of the wards from public view, ensuring that prospective donors only saw what administrators wanted them to see.

[The hospital: reality and proposable future]

In this work we run over hospital history from Middle ages to the present time. Hospitals were charitable institutions in fact they rise inside monasterys, churches or castles with an architecture in modum crucis as a symbolic expression of Christ crucifix. During Renaissance, new scientific Knowledges and the need of technical assistance in a suitable place, lead to a new kind of hospital included into the functional centres of the city were medical practice takes the places of spiritual assistance. In XVIII century hospital is like a "human diseases botanical garden" divided into departments with a circular structure in conformity with a functional model of control. To exceed the isolation of single room, rectangular rooms born with a radially arrangement. At the end of 700's born the pavilions structures typical of hospitals until half 900's when the "monobloc" take place. Today hospital becomes horizontal, include in the context of the city, with hall as a big hotel and with trading centres in accordance with Renzo Piano model and with a new vision of hospital as a welcome place were the patient is a guest to treat as a person of consequence.

[Bavarian mental health reform 1851. An instrument of administrative modernization]

By 1850 the reformation of institutional psychiatric care in Bavaria was given the highest priority by monarchy and administration. Cooperating with experts, especially the psychiatrist Karl August von Solbrig, they provided for new asylums to be established throughout Bavaria in a surprisingly short period of time. It was, however, only at personal intervention of King Max II. that the administrative and financial difficulties which had existed since the beginning of the 19th century could be overcome. The planning of asylums done by each administrative district of Bavaria vividly reflects rivalry as well as cooperation between all governmental and professional agencies involved. Modernization of psychiatry was publicly justified by referring to scientism, the need for a more progressive restructuring of administration, and the paternalistic care of the monarchy, whereas, from an administrative point of view, aspects of psychiatric treatment, like what kind of asylum would be best, were rather insignificant. The structures established by means of the alliance between state administration and psychiatric care under the rule of King Max II. had a lasting effect on the further development of Bavaria.