Replacing the Missing Link

ONE facet of administration that is missing in nine out of ten hospitals is Medical Administration the supervision, coordination, and evaluation of patient care." ¹ This quotation is taken from an article entitled "How the Medical Director Can Help Improve Patient Care," by Kenneth Babcock, M.D., director of the Joint Com mission on Accreditation of Hospitals from 1954-1964. It points out how this responsibility, covered by a volunteer chief of staff, becomes the province of a physician chosen by the staff who, because of a busy practice, usually has little time to devote to this critical area of concern for the quality of medical care.

This article was written in 1965 and since that time the need for such an individual on the administrative level is becoming recognized by more and more medical institutions. In Maine, three or four hospitals have appointed medical directors. Maine Medical Center, the largest hospital in the State, recently appointed such an individual because, as they state, "We feel that the time has come when proper direction and coordination of the professional activities can no longer be done adequately by an elected staff president, serving voluntarily on a part time basis." ² The bulletin that announced the physician chosen stated, "In general _____ will serve in the role of coordinator, catalyst, educator, expediter, liaison officer, and, not infrequently, the conscience of the Maine Medical Center Medical Staff." ³ Could this be considered an insignificant assignment?

Smaller hospitals also see the need. Augusta General Hospital, with 150 beds, and Thayer Hospital, a progressive hospital with 100 beds, in Waterville, Maine, have recently appointed a physician to a similar position on the administrative staff.

Thus the Director of Medical Services becomes the coordinating individual between the Medical Staff, the Administrative Staff and the Board of Trustees. One can readily see that his duties are primarily those of influencing the activities of all three groups without dictating policy. The person in such a job must be flexible enough to arbitrate the differences of opinions occurring so often in hospitals.⁴

Need Is Recognized

As one studies the growing literature on this subject one is impressed with the fact that hospitals are becoming increasingly aware of the need of one individual a physician who, as a member of the administrative team, is concerned with the over-all delivery and quality of medical care which is the primary reason for the hospital's existence.⁵ The relegation of this to voluntary, constantly changing chiefs of staff elected for one or two years does not give the continuity this important facet of hospital care demands.

As a representative of the administration and board of trustees, the medical director fulfills his role as "coordinator, catalyst, educator, expediter, liaison officer," and he must be able to do this in the capacity of a motivator, because this is the crucial area of possible conflict. Some staffs have been willing to accept the medical director as the permanent chief of staff. In other institutions he is the director of medical services and is an active member of the staff and ex-officio member of all staff committees, excepting the nominating committee of the medical staff. If he is going to function effectively this is the minimum responsibility that he can be granted, other wise he will be ineffective with no opportunity to influence, coordinate, or motivate.

Medical Director in SDA Hospital?

What about the role of medical director in a Seventh-day Adventist hospital? Do similar reasons for the medical director exist? I think the need and the challenge here is even greater than in the average hospital. We like to think that an Adventist hospital has a unique contribution to make to the community in which it is located. We say we minister to the whole man, the physical, the mental and the spiritual perhaps distinctive, but not necessarily so! Other hospitals non-SDA have similar objectives. They have staffs who are excellent scientists; they have chaplains and also conduct health-education programs, and are interested in bettering the health of the community they serve.

But we do like to think that perhaps, as Adventists, we have a different motivation. We want people not only to be healthier and better-adjusted citizens but also we would like to see them become acquainted with a better way of life. Our objective is more than a healthy community it is to represent Jehovah, and to demonstrate His love to our fellow men. By practice and education we present inspired principles of healthful living that will lead to a better way of life. We desire to minister to their spiritual and physical needs in the frame work of scientific excellence.⁶

All of our hospitals are governed by a Board of Trustees who are Seventh-day Adventists. The administrator, a Seventh-day Adventist and the board's principal contact with the hospital, is a qualified business man who directs the fiscal, personnel, and public relations activities, et cetera, of the hospital. His contact with the medical staff is usually through the chief of staff and, frequently, a joint conference committee. The chaplain, a Seventh-day Adventist minister, directs the spiritual program of the hospital and sometimes the health-education activities.

The missing link is the Seventh-day Adventist physician, or medical director, a qualified physician who can represent the principles and objectives outlined by the Board of Trustees to his colleagues as an equal and in a responsible fashion. Strangely enough, this physician is missing only in America where we have large hospitals with open staffs, the majority of physicians being non-Seventh-day Adventists. In these institutions we have no real medical head to our medical operation, while in mission areas where we tend to have a closed staff made up of all Seventh-day Adventist physicians we have a medical director.

One could argue that this is reasonable because an open medical staff should be a democratic organization and the chief of staff is concerned principally with seeing that the staff rules and bylaws are maintained. But who represents the administration on the professional level? I believe this is the crux of the problem. The hospital has been called the doctor's workshop, and, with the increasing emphasis on hospital-based medicine, the physician's role as an important person in hospital operation is becoming even more significant. In fact, to get into a hospital, one has to be referred there by a physician and the financial success of a hospital would appear to depend on the number of busy physicians the hospital has on its staff.

Why SDA Physicians in SDA Institutions?

The quality of care in the hospital is determined by the quality of medicine practiced and demanded by these physicians. So, too, will the carrying out of the fundamental principles that should govern the operation of our Seventh-day Adventist medical institutions be influenced by the attitudes of the physicians using the hospital. For example, how does the medical institution present to patients God's care, concern, and love if the physicians are not interested in this concept? Seventh-day Adventists believe health education should have a prominent place in the hospital program, yet some physicians could care less, and if the chaplain directs the health-education program in the hospital it is hard to convince patients and physicians that these health principles are not religious dogma.

Proper Sabbath observance is difficult because physicians in the area may look at it as another workday and order routine tests, and freely admit and discharge elective cases. Who is to tell the physician these tests aren't necessary at that time, or to keep operating room usage down to bonafide emergency cases on the Sabbath? A medical director could evaluate these situations and probably judiciously and effectively explain to his colleague the principles involved.

In a time when our existing hospitals are growing and new ones are developing it would seem to me we should take a closer look at our hospital administrative organization. With the proliferation of hospital facilities we are finding that an in creasing number of the paramedical personnel are non-Seventh-day Adventists. In some hospitals, a bare handful of key administrative personnel are Seventh-day Adventists with no Seventh-day Adventist physician on the staff or, if he is, he is at best a Seventh-day Adventist medical consultant ex officio.

A Workable Operation

I believe this could be a full-time paid position in the larger hospital, or a part-time, part-pay position in the smaller hospital.⁷ With a stipend, the physician could be expected to produce meaningful results and to carry out duties as assigned by the board of trustees. We have seen this program in operation here at Parkview Memorial Hospital for twelve years. We believe it has been one of the factors in the development of a strong, effective, and progressive Seventh-day Adventist hospital, where the basic principles we espouse are effectively carried out.

The duties of the medical director, although covered in principle in the preceding paragraphs, should be outlined by the board of trustees. Dr. Babcock does cover these in his article and they can be summarized as follows:

1. He is the medical coordinator be tween the board, the administration, and the medical staff of the hospital.

2. He acts as an expediter to see that the medical staff is organized in harmony with the rules and bylaws; and that it carries out its functions in regard to patient care, records, and routine hospital functions; and he is ex-officio member of all staff commit tees.

3. He acts as medical consultant to the administrator, who is the chief executive officer of the hospital and will keep abreast of the changes in medical care as they affect the practice of medicine in the hospital.

4. He serves as chairman of the educational committee and actively promotes health education on all levels for the medical and paramedical personnel, as well as for the community.

5. He should be licensed to practice in the State in which he resides and may, at the discretion of the board of trustees, have a limited practice. In doing this he is obligated to avoid any evidence of favoritism.

To Dr. Babcock's list it would seem pertinent to add:

6. He should be a well-trained, loyal Seventh-day Adventist physician who under stands and practices the health principles of his church.

7. He should be responsible to the board of trustees to see that the basic principles which make a Seventh-day Adventist hospital distinctive are communicated to the medical staff and paramedical personnel and work closely with this group to see that they are implemented.

With a medical director completing the administrative team it would seem that our Seventh-day Adventist medical institutions will more effectively fill their place as skillful medical centers where patients are not only physically helped, but where they will catch a glimpse of a better way of life. Local physicians, paramedical personnel, many of whom are non-Seventh-day Adventists will also, hopefully, be impressed with this concept.