GROWTH IN HOSPITALS

Growth in hospitals

Growth in hospitals

Doctors and nurses, by their training, knowledge, and experience, are well placed to study the problems which beset humans at work. Yet hospitals, which could hardly be more human-oriented institutions, are often anxious, unhappy work-places. Revans showed that some of the difficulties facing nurses, junior doctors, and other staff were due to the attitudes and actions of senior sisters, doctors, and administrators. Even in the better hospitals 20-30% of nurses leave before completing their training; domestic workers may be hard to obtain and to keep; the consultants may be felt at one extreme to be uninterested, and at the other overbearing; sisters may be discontented; doctors may feel the administration is inefficient; unhappy relations may exist with governing bodies; and so on.

It was to appraise the effects of the relations of hospital workers with their fellows and with the patients that in 1964 a group of ten London hospitals was formed under the direction of Prof. R. W. Revans to study the difficulties of communication within hospitals between people in different departments and specialties, and at different levels. It was suggested that these difficulties were of a kind that only those involved in the problems could identify, analyse, and ameliorate; and that help to overcome them might be obtained from the use of methods developed by research-workers in the social and administrative sciences. The term communication was broadly defined: it included the transmission and interpretation of data, ideas, and emotions. This was considered to be a two-way process, clarifying for both sender and receiver their attitudes and roles.

The hospital was to be seen as a self-adjusting organism rather than as a fixed mechanical structure; it was recognised that attempts to correct institutional defects by mechanistic managerial methods must often fail. In this way the hospital internal communication (H.I.C.) project 2 was born. It was financed by a research grant from the (then) Ministry of Health, and run, under the segis of the department of medicine of Guy's Hospital Medical School, by an advisory committee, with the active help of the King's Fund Hospital Centre. Subjects were selected for study by individual hospitals because their existence was recognised, someone became interested in them, and it seemed possible they might be solved with the help of the H.l.c. project. Social organisms such as hospitals are not always geared for change; but internal stresses may set the scene for innovation, and an outside agency can be of great value in providing a stimulus to change, a process with biological analogues. By its mere existence the H.i.c. project often made it possible to investigate, relatively coolly and unemotionally, hospital activities and attitudes which might otherwise have proved explosive and destructive.

The patients in one hospital stay two or three times as long as those admitted to another with the same disorder; this financially and socially costly phenomenon is barely recognised, let alone treated. The list may be multiplied. Once recognised, these problems may be examined with intuitive ...