The anonymous administrator. A five-year experience as a medical administrator in Tasmania

The task of reorganizing and modernizing Tasmanian hospital and health services during the past five years is described. It is shown that substantial improvements can be achieved, despite a lack of authority to match responsibility. The keys to achieving these improvements were: a logical development of objectives; a careful documentation of facts; a sense of timing for the introduction of new measures; the use of independent management consultants; above all, ample finance. The major problems were the anonymous nature of the work which prevented adequate consultation with those affected by the changes, and the very adverse effect on incentives caused by poorly informed community groups exerting pressure on governments. Further improvements could be achieved by the establishment of a health commission or board consisting of full and part time members responsible through a minister to Parliament.

Hospitals harbor hazards ignored in fight for life

Conventional images of the hospital create two two misconceptions in the minds of people having sporadic or casual contact with it: First, that it's not really a workplace, like a factory; and second that since the function of the hospital is to promote health and wellbeing, it's a healthy and safe place for those in it, whatever their capacity there. Both are far from the truth, as hospital administrators and the medical and operational staffs are beginning to realize and discuss with increasing intensity. Government agenicies at the state and federal level also are turning their scrutiny to the country's 7,000-plus hospitals and even-larger number of private and semi-private clinics. They employ several million people, and more millions are cared for-plus visitors and vendors who every day enter the hospital's doors, walk its corridors and are exposed to a variety of environmental conditions. In short, occupational health and safety is coming to the hospital. The hospital has many of the hazards of any workplace, such as electrical deficiencies in equipment, toxic gases in the atmosphere, noise and weights to lift. But it has countless more hazards that are unique to it: bacterial infection, ionizing and non-ionizing radiation, 24-hour-a-day, seven-days-a-week work schedules, and the fight for life in an intensive-care unit.