hospitals Flashcards
3 ways the hospital has transformed
charity for the poor
temple of science
complex bureaucracy
hospitals as charity for poor - in past
run by religious institutions
- general hospital owned by municipalities
- relied on unpaid labour : nuns + student nurses = lived on hospital, not married, female, undifferentiated work
- go to hospital if no where else to do.
- richer = doc comes to you
what did the flexner report find?
marked the beginning of the transformation of the hospital into a temple of science - aspire to highest ideals about how ppl should be taken care of when sick
recommendations from Flexner Report
hospitals as places of learning for medical students (few docs attached to hospital in church. now more in addition to practice)
-> medical schools to be affiliated with unis (embody highest ideals - science + knowledge)
how purpose of hospital changed?
no longer dispense charity.
provide best diagnostic + therapeutic facilities available.
evidence for transformation into a temple of science
- growing revenues
- changing clientele
- changing skills of the hospital worker
how growing revenues are evidence to transformation
?
Ontario
1880: average cost (0.57), patient fees account for 9% of revenue
1920: average cost - $2.84/day and patient fees are 65% of revenue
average cost increases, new services, greater attention to hospital.
how changing clientele is evidence to transformation
increased number of patients, shorter stays
how changing skills of hospital worker is evidence to transformation
- education
- still poorly paid
from temple of science to complex bureaucracy
- rising operating cost (greater investment in system)
- increase # of employees
- increased differentiation + specialization of hospital work
how operating cost rose?
1948: 130 mill. wage =50%
1973: 4.8 billion wage=70%
2003: 16.5 billion wage =75%
(more wage when more dominance)
how number of staff changed?
1934 - 67 workers / 100 beds
1991- 185 workers per 100 beds
- more beds, more external services, more workers
how differentiation and specialization increase
- structured hierarchy of workers = diff tasks assoc w diff functions. = male, docs are highly paid. -- less important jobs- varied ethnicity - power imbalance
describe how mass production of automobile - factory style
start mass produce cars, lower cos, took assembly line idea
-standardized output (same product)
- intensified division of labour (assembly line)
-less skilled labour = single repetitive task (less control to workers)
- increased mechanization to achieve steady flow of production
== greater productivity + greater control over pace/intensity of work by owner.
how is HC like a factory?
- standardized output (deliver care in certain/prescribed order)
- intensified division of labour (many diff ppl interact with - each has special function + in charge of that)
- less skilled, repetitive task (no, highly specialized)
- mechanization for steady flow of production (track movement thru hospital - recorded info = yes, tech involved)
- result?
how are hospitals a health risk?
superbugs
workplace safety
what did charles taylor do?
took studies - noticed how ppl make things. break task into components and make each person do one of those = assmebly line. more efficient.
examples of superbugs
- what are they?
MRSA, VRE, C. difficile
- resistant to most advanced antibiotics
how many ppl infected yearly? how many deaths?
200,000 in canada yearly.
1/12 hospitalized acquired
8000-1200 deaths a year
who is most at risk for exposure to disease/bacteria?
compromised immune system, old, young, long-time care, low hygiene.
why is threat of superbug growing?
lax hygiene: improper sterilization + inadequate cleaning/hygiene
over-prescription of antibiotics. breeds resistance
farmers use antibiotics to animals.
pharmaceutical companies focus on chronic > antibiotic treatment
CDC says rapidly approaching?
post-antibiotic era
->lose ability to treat infection. concern about safety of hospital.
how workplace safety is health risk?
stressful work conditions(worker alienation, lose attachment to work bc dont see reward)
and injury, illness, violence
result of stressful work conditions?
high absenteeism, turnover, burnout + low job satisfaction
= psychological + physical threats
how stressful work conditions effect workplace safety?
high work demands,
inadequate staffing, poor work morale/low social support, work-life balance (manned 24 hrs a day, out of sync with family)
how injury, illness, violence affects workplace safety?
injury: musculoskeletal injuries accound for greatest number of time-loss injuries among healthcare workers
illness: exposure to bodily fluids + sharps - contagions,
violence: sick are vulnerable. sometimes angry, over-react, anger.
attacked at work in HC > prison/police
great risk for physical assault
emotional abuse and threats of violence
