Volume 179 - Issue 11
Political correctness in the modern hospital, or, PC in 2003
Authors: Dominic A Fitzgerald and David Isaacs
Med J Aust 2003; 179 (11): 663-664. || doi: 10.5694/j.1326-5377.2003.tb05743.x
Published online: 1 December 2003
Published online: 1 December 2003
We’ve downsized and upgraded,
We’ve amalgamated too.
We’ve splurged, and surged, and urged, and merged
From here to Timbuktu.
There’s just one little problem,
With all that we’ve been through,
We can’t remember what it is
That we were trained to do.
(Anonymous administrator)
The hospital system the world over is in turmoil. The burgeoning cost of healthcare is ignored by governments more concerned with weapons of mass destruction than trivial matters such as the health of the nation. Even the perpetual smile on the faces of the Public Relations Department personnel has become fixed into a risus sardonicus.
Is there no cause for optimism? Of course there is. When things look particularly grim, we should never neglect the past. There is always the option to look back to the future. As patients increasingly turn to alternative medicine, we suggest embracing a combination of the ancient philosophies, such as feng shui (a belief that energy can either flow or stagnate according to the shape of one’s surroundings, determining success or failure in any endeavours), and the contemporary, holistic approach to medicine.
Holism is the concept that, in the function of complex systems, the whole is greater than the sum of its parts. Until now, hospital medicine has lacked a holistic approach. Indeed, it might be suggested that hospital administration has adopted the opposite approach, in which the whole is less than the sum of its parts.
Consequently, in this article we propose a hybrid model for changes to the hospital milieu, incorporating practices inspired by ancient philosophies and holism, in the pursuit of improved healthcare delivery for patients, clinicians and administrators alike. This model will be known as the Hospital Intergenerational Transcultural Solution, or “HITS”.
Hospital Administration
Before HITS
The Hospital Administration’s main role is to write a Mission Statement. This should not be confused with the Vision, which is in the realm of the Almighty (see Box). The Vision, usually shared by a select few, transcends the immediate tangible concerns of clinicians and, indeed, transcends reality.
Mission Statements resound with platitudes, even though it is widely acknowledged that platitudes are the last resort of the intellectually destitute. For example, the standard children’s hospital Mission Statement aims to “improve the health and wellbeing of all children”. The major advantage of such statements is that it is impossible to argue with their sincerity and impossible to evaluate them.
After HITS
It has been said that leaders are born and not made. But why not both? The genetically modified administrator (GM-A) of the future will have all genes for empathy deleted and replaced by genes for transcendental obfuscation. All members of the executive will be dressed along the lines of the Raelian cult, pending the first successful cloning of an administrator. For the inner spirit to escape the confines of the daily routine, the hospital boardroom will be refurbished with futons and a small but tasteful jacuzzi in the corner.
The Vision will be placed in the hands of a new Department of Iridology.
Finance Department
Before HITS
The modern Finance Department aims to correct the archaic notion that a hospital’s primary role is patient care, and re-direct it to revenue raising. The MD should defer to the MBA. When revenue raising proves too difficult, the modern Finance Department turns its hand to revenue recycling: each department bills other departments for services rendered, ensuring the circulation of imaginary money to the extent that rational budgeting is impossible. This cleverly hides the fact that the Finance Department is incapable of rational budgeting. Any clinical department hoping to achieve an increase in its working budget is advised to read Beckett’s Waiting for Godot.
After HITS
As all hospital departments will be created equal, there will be no need for a Finance Department. Instead, there will be a Community Chest, shared on the basis of harmony and mutual goodwill. Over the Chest will be a framed photograph of the Director of Finance, clad in saffron robes, with a garland of rose petals. Candles and incense will be available for purchase, all profits going to the Community Chest.
A barter system will be introduced for staff. For example, staff may elect to be paid in kind with offers of coronary artery bypass graft surgery instead of long service leave. In an innovative strategy, patients will be charged on a step-by-step basis once they enter the hospital. Those in wheelchairs or on trolleys will be charged per wheel rotation. This is considered a revolutionary approach to finance.
Service Improvement Unit
Before HITS
Previously known as the Quality Improvement Department, the Department of Continual Improvement, or the Department of Perpetual Audit, this fashionable construct of redeployed middle management thrives despite the fact that none of the quality improvements can be quantified. Put simply, Quantity begets Quality.
Public Relations Department
Before HITS
Public Relations is believed by those working there to be the most important department in the hospital, responsible for Corporate Image, which necessitates changing the hospital logo with bewildering frequency and pestering the press to a greater extent than the press pester anyone else.
After HITS
The PR Department will be painted beige to emphasise calm, belying the turmoil of bed shortages. A glass “ideas box” will be situated on each Departmental member’s desk, and emptied annually, if necessary. Photographs of the smiling “Fundraiser of the Month” will become mandatory screensavers on the computers in all departments.
Summary
Our advocacy of the introduction of HITS to the hospital represents an attempt to meet the needs of the modern patient and adhere to the expectations of clinical governance using a root-cause analysis approach in a no-blame culture. Notwithstanding these ever-present administrative mantras, we would implore you to embrace the concept of holism whole-heartedly.
