Medical staff and the hospital

A 1907 editorial in JAMA entitled The medical staff and the hospital noted: “The importance of hospitals to the community is now so universally acknowledged that it needs no comment; the organization of hospitals, on the other hand, and the proper relationship which should exist between the medical staff, the administrative officers and the public is a matter which has been treated in this country in far too haphazard a manner.” One hundred years later, in Australia in 2007, this relationship is even more “haphazard”.

Medical staff and other health professionals have been progressively side-lined in the management of hospitals. These are now mostly micromanaged by top-down structures more attuned to political whims than public wishes. It should be no surprise that this dysfunctional type of management has coincided with a time when our public hospitals have lurched from crisis to crisis.

The latest crisis involved a major metropolitan teaching hospital in New South Wales, when disregard of a patient having a miscarriage in the chaotic environs of a busy emergency department sparked media outrage and community dismay and disgust.

Within days, the media exposed other instances of perceived poor patient care, and the public’s already shaky confidence in their hospitals plummeted. In the ensuing blame game, it emerged that medical staff had been effectively pushed aside in the running of their hospitals.

It seems that hospital management has become the business of distant bureaucratic silos, populated by people obsessed with bottom lines, meetings and memoranda.

However, hospitals exist for the public, and for health professionals who seek to serve the community. Health professionals’ views about and contributions to the management of their hospitals must be acknowledged and actively sought. Undoubtedly, further bureaucratic failures to involve them in management decisions will perpetuate the crisis culture in our hospitals.