The Hospital Committee
By FRANK HART* ARECENT article in a national newspaper contained an arresting sentence: a complaint made to a Hospital Committee about a patient's treatment, it said, had elicited the reply that 'the Hospital was concerned with the patients' physi- cal care, not their emotional state.' Of course, this report may have been untrue. It would be sur- prising if any hospital authority made such a public admission. But many Hospital Committees do not in fact appreciate the extent to which the emotional needs of the patients are their concern.
Those of us who work in hospitals are only too familiar with the phrase. 'The hospital exists for the patient.' It is frequently uttered at confer- ences. It is often the theme of after-dinner speeches. But to what extent is it borne out in practice? How often do Committees actively concern themselves with the humanitarian aspects of the hospitals they are governing?
If they spend much less time than they should, it is because the problem is greater than they realise. Official complaints made by patients are infrequent; and of those received some are frivolous, mischievous, or untrue. It is easy for a Committee concerned with the difficulties, of meeting their hospital's needs on a fixed budget, or with the defects of their buildings, to be per- suaded that the patients—and their patients' re- latives--are satisfied and content.
Nevertheless, many patients do complain— not to the Committee, but to their friends, to their relatives or to each other. The majority do not complain officially because by and large they are genuinely grateful : grateful for the skilled care and attention given to them by the doctors and nurses, appreciative of the kindness received from various members of the hospital staff. Their complaints—or, more accurately, their reserva- , tions—are concerned primarily with human failings, which occur in hospitals just as they do everywhere else: unnecessary waiting in the out- patients departments; insufficient knowledge of what treatment is to be carried out—why, and when; short notice before being admitted; brusqueness or incivility on the part of some members of the hospital staff; insufficient oppor- tunities for discussion about the patient's illness (so often causing unfounded fear and worry); and inadequate or tardy information given to the patients' own doctors on discharge.
Hospital staffs, especially in this country, are normally actuated by high ideals and a sense of vocation. Many make considerable financial sacrifices in deciding to work in hospitals. Yet, over the years, due to the strain of their work, over-concentration on the technical nature of their duties, and the quenching of the fires of youth, their sense of vocation may dwindle; and this is where the governing bodies of our hos- pitals have an especial responsibility. If they decide, as a matter of fundamental policy, that the hospital or hospitals they are administering have a reputation for kindness and understand- ing, there is much they can do.
A hospital's policy can only be carried out if * House Governor, Charing Cross Hospital, the stall conform to the principles clearly laid down. Thus, the Committee's first task must be to see that all their stall—doctors, nurses, clerks, radiographers, physiotherapists, technicians, porters, domestics—are made fully aware at the time of their employment that it is the policy of the hospital that their patients shall be treated hospitably, just as guests would be in their own homes. The senior staff and heads of depart- ments should have the added responsibility of conveying these feelings to all the junior em- ployees working under them, especially those in direct contact with the patient To enable this aim to be more clearly under- stood, all staff should realise that every patient, whether an occupant of a bed or an out-patient, is not a wholly normal being. As we all know, even the most trivial of illnesses or injuries is disturbing or irritating, causing us to be less tolerant or understanding than usual. But when the cause of our illness is unknown, our anxieties are greater, and may at times be almost unbear- able. Many patients, especially in-patients. have additional anxieties: the fear of the treatment itself; the fear it may be unsuccessful, resulting in either permanent disability or even death, the fear of loss of income and consequent financial worries; the embarrassment at having to enter a hospital, perhaps for the first time, and having to meet fresh faces and become part of-an un- familiar new world; and the concern at leaving behind at home wife or husband or children The Committee, acting largely but not entirely through its chief officers—the Matron and Ad- ministrator—should by encouragement or ad- monition ensure that the staff realise this, and work on these principles throughout their service. And of course this means it is essential that any grievances the staff themselves may have are ventilated and, if possible, removed. A dis- gruntled staff are unlikely to give. of their best; and it is harder for them to act with humanity and understanding when they themselves are .
frustrated or resentful. The patients themselves, too, must be made aware of the hospital's policy and know that they will not be discouraged from making comments or suggestions, or need fear re- criminations if they do.
There is little doubt that the British Health Service is widely envied. So it should be, for it has given security and a first-class medical ser- vice. But there is a danger. Its very size, and the remoteness of the governing bodies of the in- dividual hospitals may, if we are not very watch- ful, result in the patient simply becoming part of a huge machine.
He may receive sound medical or surgical care, adequate nursing and satisfactory food. But somehow he will be lacking that individual touch of humanity that is the proud possession still of many of our great hospitals. It could be the boast of them all, but only if a determined effort is made to achieve it. A great responsibility rests on the members of the Hospital Committees, in- dividually and collectively, to see that their hospital caters for the emotional needs of the patients no less than their physical care.