Michael, Mother Mary

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The Linacre QuarterlyVolume 32 | Number 2 Article 11May 1965A Successful Hospital ProgramMother Mary MichaelFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationMichael, Mother Mary (1965) "A Successful Hospital Program," The Linacre Quarterly: Vol. 32 : No. 2 , Article 11.Available at: http://epublications.marquette.edu/lnq/vol32/iss2/11be presented. The funds required and their distribution should be out­lined. The project protocol should ?e described and an analysis of what 1s to be done and the time to bespent by the investigator on theproject should be completely stated.The hospital should not be requiredto supply large sums of money since�orthy projects usually can get out­side support. The initiation of a policy of re­search by a hospital should not bet�o involved to discourage the begin­nmg. Therefore, facilities should be available within the hospital to initi­ate small projects. There should besecretarial assistance for preparationof data. There should be funds for�uplicating and compiling informa­t10n for .the presentatio!1 within the140 staff, to local Medic the community, and medical profession. Research in medic directed primarily tc provemen t in the c person. The investig motivated primarily t, and not for personal ;; enlarge his bibliograi vance his position. In should be no compe investigators, there '. striving for priority. sense of competition couraged between hos 1 search program shouk on the basis of its owr avenues of medical res, less and the rewards o' immeasurable .  Societies, to the general should be .rd the im­of the sick r should be Hd this end tification, to ', or to ad­search there on between ,uld be no nilarly, this Juld be dis­als. The re­Je developed 1erit, for the rch are end­rue research LINACRE QUARTERLY A Successful Hospital Program MOTHER MARY MICHAEL, C.R.S.M. Ten years ago Misericordia Hos­embarked on an intensive med­education program. Why did we kindertake such an expensive and ClfllltJOversial step? Because of a deep cmviction shared by the Board of Managers; the Administrator, the Medical Director, and leading mem­lm of the medical staff - a convic­tkm. that well-conducted graduate fllining programs inevitably lead to mllence in all functions of the liospital. This conviction did not de­wlop overnight, but over a period of time covering the transitional post­waryears. While working toward re­placement of a preceptorship method of surgical training with a formal training program, we came to be­lieve that proper residency programs would improve patient care, includ­ingthat of private patients, stimulate investigative activities, and better community relations. The over-all goal of the hospital since its opening in 1918 has been ertellence - excellence in all aspects of patient care. Through the years the academic tradition prevailed-in medicine, in nursing, and among the paramedical groups. Therefore, it came as a shock to the sisters and �rs to learn, through regional llleetings of the Catholic Hospital Association in the late 1940's, that C'.tholic hospitals in general were -llotber Michael is Director of Hospitals for 6e Sisters of Mercy, Philadelphia, Pa. not meeting the goal of excellen�e in the medical care of the patient and in the preparation of the medical specialist, despite the devotion and hard work of all concerned, apparent patient satisfaction, new building programs, and ever-increasing stu­dent nurse enrollment. The criticism leveled against Catholic hospitals in general was a valid criticism of Misericordia Hospital at the time. Misericordia had experienced a long tradition of training specialists, particularly in surgery, by the pre­ceptorship method. During the war years with many of the young sur­geons away in military service, the Program lagged. After the war the preceptorship method of trammg practically disappeared throughout the cou·ntry and while the debate went on at Misericordia regarding the superiority of the preceptorship method of training, the young men went off to other hospitals to take their residency training. Finally, agreement was reached on the need for establishing formal residency programs and after concerted effort on the part of the surgical staff pro­visional approval was obtained from the conference committee on gradu­ate training in surgery. One year later the approval was withdrawn, with a statement that "the educa­tional aspects of the service do not meet the standards of the commit­tee." (Reference to Essentials of Approved Residencies and Fellow-141 ships). All concerned were obviously disappointed. After considerable cor­respondence with the accrediting authorities it became evident that approval was not going to be re­stored. Our efforts to secure approval seemed fruitless. While the clinical material was adequate and the sur-· geons well qualified, in fact, eminent clinicians, a lack of interest in aca­demic medicine hampered our efforts to provide the type of program spe­cified in the Essentials.Before revising the Program and again reapplying for approval, a de­cision was made to determine: first, is it in the best interest of all con­cerned to have a Surgical Residency Program; second, is it feasible for such a program to be established in this hospital, and if so, what steps should be taken to accomplish the goal. It seemed self-evident that patients receive better care in the teaching situation which is present in a well­conducted residency program. The Medical Director and the surgical staff were convinced that, as then organized, our Surgical Training Program left much to be desired. It was apparent that we needed an authoritative opinion on whether we should pursue the idea of a Resi­dency Program. One of or own sur­gical specialists suggested that an experienced consultant, a Professor of Surgery from another city, be re­quested to come to Philadelphia to discuss with the Medical Director, the Director of Surgery, and the Ad­ministrator the problems concerned with the loss of the approval of 142 the surgical residenc advisability of conti approval. This was agreed up tory and the facts of presented to the cc Program and the with the accrediting i: viewed, as were the and the surgical st rounds were made w· resident. Following t; tant discussed ideal r ing viewed by a si, eager student, and geon. He emphasiz, should be the best P' for the patient. The organized to provide to make him availal dent on all occasions thought and plann: times, runs counter ideas. He also broug· casionally seniority service may be supers and special preparatic­that the objectives of a whole are paramou, tives of individual su: nd also the ng to seek and the his­e case were ,ltant. The respondence _lps were re­;,sical set-up tics. Ward the surgical . the consul -.:lency train­patient, an expert sur­the expert Jn available '.aff must be e expert and to the resi­This requires which, at � established out that oc­d length of ed by ability and further, ,e hospital as to the objec-'ons. The consultant beL :ed that with proper provision for ·taff appoint­men ts and staff or; .. rnization, an outstanding Residency fraining Pro­gram could be deveJ•.ped. On the basis of his experience-:. he suggested that a competent committee inter­ested in the problem b, organized toadvise us. He judged that the com­mittee best suited for 1 he job should have an academic or medical college background and be thoroughly fa­miliar with residency training. InLINACRE QUARTERLY the interest of objectivity, which he believed to be very important in our case, he recommended that the com­mittee be composed of Philadelphia physicians interested in the problem, but not connected with Misericordia Hospital. Subsequently, by invitation of the Archbishop of Philadelphia, a com -mittee, consisting of four Professors of Surgery, was formed and after reporting their observations on resi­dency training they made the follow­ing recommendations: I. Misericordia Hospital reorgan­ize its surgical staff and place re­sponsibility for direction of this staff in a highly qualified surgeon. This surgeon should be one who is thor­oughly· familiar with modern surgi­cal training methods. He should have participated in such methods both as a resident and as a respon­sible staff member. His background should be academic. He should have. an established reputation and au­thority as a technical surgeon. He should consider Misericordia Hospi­tal and its future as his primary and full-time occupation, and adminis­trative measures to assure this dedi­cation should be taken. Complete jurisdiction over surgical activities in the hospital with direct control of ward beds and supervisory control of private patient policy should be his responsibility. He should have nominating power for staff appoint­ments made by the Board of Direc­tors. He should have an office in the hospital with facilities for private practice. MAY, 1965 2. Further, the committee believesthat such reorganization is incom­plete unless the medical service has similar objectives. Whereas,. the ma­jor work in a community type hospi-. tal is surgical, in a teaching hospital the intellectual leadership is shared with internal medicine. The organi­zation of clinics, the long term study of disease in ambulatory patients, and the investigation of fundamen­tal processes are all dependent on a high class medical service. A copy of the full report of this advisory committee was sent to each member of the surgical staff and the report was reviewed very carefully at several surgical meetings. The chairman of the advisory committee and another member of the commit­tee, met with the Director of each department of the medical staff and the Administrator and through dis­cussions and explanations helped greatly in securing acceptance of the report by the staff. The final paragraph in the Medi­cal D.irector's detailed memorandum on this meeting states: "As a result of this meeting, a pat­tern is being set for the development of residency programs in this hospi­tal, and I feel certain that time will prove this is the correct procedure to follow, and with its institution, over-all problems of the medical staff will become minimal; the in­ternship will be raised to a very much higher standard; patient care will automatically greatly improve; and every member of the Institution will take a greater pride in the work of the hospital." 143 I might add ten years later that the above statement has proven to be prophetic. Subsequently, a committee, con­sisting of the Medical Director, who was a surgeon, the Director of Sur­gery, a Chief of Surgery (senior attending), an attorney member of the Board of Directors, and the Administrator interviewed applicants for the position of Director of Sur­gery. Contact with the applicants was established through the surgeons on the original advisory committee. The Director selected was an Associ­ate Professor of Surgery at a univer­sity. Within one year the reorganized Surgical Residency Program received full approval. The Surgical Program furnished the stimulus and pattern for the successful development of residency programs in the other specialties of Obstetrics/Gynecology, Pathology, Internal Medicine, Radi­ology and an affiliate Residency in Pediatrics. At present we have a full quota of fifteen interns and nineteen residents. The year following approval of the first Residency Program, an affilia­tion was established with a medical school. A short time later a Research Laboratory opened its facilities for the purpose of encouraging inde­pendent and investigative thinking · throughout the entire staff. The Research Laboratory was busy im­mediately; federally financed and privately financed projects were un­dertaken. Findings were reported at meetings, in scientific publications,and in our own Hospital MedicalBulletin, a journal published by the144Director of Surgery staff to review what t: evaluate their results, the effectiveness of tl-When plans were the development of a gram in Medicine, th selected through the E as the Director of S1 quently, the Residern Medicine was approve cal school affiliation c enable the were doing, J determine progress. nulated for idency Pro­)irector was e procedure �ry. Subse­Program in md a medi­blished. Unquestionably, pc nts are re­ceiving better care 1 rnse of the educational program. he hospital, too, has been aided irn 'asurably by the educational prog1 1 in attain­ing its secondary goal ,f education and research. Our gc for the fu­ture continue to be cc cred on the level of patient care a the level of the educational progr. ,. Unquestionably, toe we encoun­tered many problems developing these programs. Som( ,f the prob­lems were not as weigL as others­changes and adjustmen. :tccompany­ing the reorganization ,f schedules, provision of adequa, conference room facilities, develor, .cnt of coop­eration in attendance r conferences, education of supen· ,ry nursing personnel to accept the changes nec­essary to carry out ihe program, segregation of medicine and surgery, etc. Financing of the educational program posed an im,11ediate and a long-range problem - salaries of full-time directors, increased intern and resident staff, housing, rising numbers of free care patients, and over-all increase · in use of services. LINACRE QUARTERLY Dealing with the· physical and fi­nancial problems proved to be minor compared to coping with the prob- , !em of medical staff relations. Phys­ical facilities and financial problemsare like the poor - always with us.However, medical staff relationshipproblems are delicate, but weighty,and fraught with pitfalls.From the inception of the program a small, but vocal, minority of the medical staff manifested persistent opposition. Leaders of the opposi­tion labelled the program as a step toward socialized medicine which lead to an usurpation of the rights of the individual physiciart. On the other hand, this vigorous opposition did not dim the interest of the other members of the staff- some 90%, and actually may have stimulated interest. Leaders in the teaching program and the active supporting staff be­lieve that this type of program pro­vides a level of patient care that will · insure the future of private medi� cine. From the hospital management point of view, the continued im­provement in patient care, the well­formed organization, the leadership offered by the medical staff, depart­ment directors, and supporting med­ical staff, and the response to that leadership by the hospital family have enriched the experience of all those associated with the hospital, have stimulated nursing and para­medical groups, and have made Misericordia an exciting place in which to work. Personally I am deeply indebted to the "new breed in medical edu­cation" and inspired by them to strive diligently, within the frame­work of our Catholic philosophy, to "continue to be leaders in pro­viding total patient care on a level of academic excellence in medicine, nursing, and administration." We count on the leadership of the doc­tors,· nurses, and administrators to plan, organize, develop, and imple­ment our tradition of educational excellence and compassionate care. THE VATICAN PAVILION (NEW YORK WORLD'S FAIR) HAS DECLARED JUNE 25 AS. CATHOLIC PHYSICIANS' DAY AND SCHEDULED A SPECIAL MASS FOR 1 2 NOON. CHAPEL SPACE IS LIMITED AND THOSE INTERESTED IN PARTICIPATING ARE ASKED TO INQUIRE ABOUT DETAILS AT THE NATIONAL FEDERATION TICKET AREA OF THE AMA CONVENTION IN THE NEW YORK COLISEUM. MAY, 1965 145 

A Successful Hospital Program

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A Successful Hospital Program

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