CHAPTER I.
The Hospital Housekeeper
Hospital housekeeping is intensely practical business. If it is to be successfully and satisfactorily conducted, it demands that the housekeeper be a woman of no inferior or uncertain attainments. All the elements that make for success in home housekeeping, and many more, are needed in a hospital. There must be breadth of vision, the qualities of an organizer, the ability to deal with large problems, a keen sense of justice, and the executive force needed to manage, without fear, fuss or favor, the various classes of people that touch the housekeeper’s realm. Many a man who is a success in managing a village store would utterly fail when placed in charge of even one section of a great department store. And the same may be said of the average woman in hospital housekeeping. Apart from the special knowledge of the business, that comes only by diligent study, accurate observation and experience—never by accident—the housekeeper needs special qualities of mind and heart. Indeed, special qualifications are needed by every one whose life work is to be wrought out in an institution. A hospital or any institution that has to deal with infirm, aged or unfortunate members of society, is no place for a person of strong racial antipathies. It is no place for the tale-bearer or the gossip, nor for the person who has a grudge against fate and feels she has never received justice. It is no place for the person who is discouraged, or who assumes the air of a martyr, and leads a crushed life, bemoaning the fact that her highest motives and best efforts are never appreciated. Those who would live happily in an institution must be prepared to be misunderstood, and fortified against discouragement from that source. Sympathy with the aims of the institution is a primary qualification. No one should enter an institution as a worker, and especially as head of a department, who is not prepared to have her interests centered in the people for whose benefit the institution was brought into existence. Ability to see things from more than one standpoint, to work comfortably with different classes of people, an infinite capacity for detail, and systematic business habits—these are a few of the qualities that should characterize the woman who undertakes to manage the domestic affairs of a hospital. It need hardly be mentioned that she needs a healthy body and a strong constitution.
The hospital housekeeper needs, if anyone needs it, reliability of judgment, and poise of soul. If she is to control others, she must know how to control herself. The ability to reprimand without arousing antagonism must be hers. She should endeavor to cultivate the feeling of personal responsibility in all over whom she has authority, and to make them understand that the success of an institution depends not on perfection of equipment, nor in numbers, but in thorough co-ordination of the work in all the departments, and faithful service on the part of all.
They should know that a lack of punctuality or carelessness in one department disturbs the working of the entire system. The influence of the kitchen and laundry is felt throughout the entire institution. Skillful management consists not alone in the ability to attend to the apparently important affairs with ease, but in never losing sight of the minor details. Nothing is so large as to be of paramount importance, nothing so small as to be considered immaterial, where human lives are concerned.
The Housekeeper’s Province
To define the exact limits of the housekeeper’s province is impossible, as institutions vary so greatly in size and in the number of officers. Local conditions always influence the situation. One lone woman may have to manage the domestic affairs of an institution, superintend its entire business, including its nursing, manage its bookkeeping, do the work of an interne in emergencies, and act in various other capacities, that readily suggest themselves to those who are acquainted with life in a small hospital. In another institution her province may be limited entirely to the purely domestic affairs, the purchase and preparation of food, care of linen, the cleaning, and the management of those who work in these departments. In either instance, the responsibility is great. To meet this responsibility without being oppressed by its weight, requires that the working force be completely organized, the work definitely divided and assigned. There should not be a square inch of the building for which someone is not directly responsible for its good order and cleanliness. Real success in management, however, does not alone consist in the work going on as it should while the housekeeper is there to direct and supervise. Her own health and efficiency demand that she have recreation and rest, and, as a matter of fact, depend on her not being always there. Her skill and generalship of the situation will be shown in the fact that, whether present or absent, the routine of the work is not noticeably interrupted. In every institution there should be some individual who is sufficiently acquainted with her methods to assume control and carry on the system in her absence.
Bookkeeping
In addition to the mastery of the details of the practical work, the hospital housekeeper must know how to give an account of her stewardship to those who have a right to demand it. The business side of hospital work, that which has to do with dollars and cents, is one of her many duties that has special importance. It is one of the corner-stones in the hospital foundation, and however much the housekeeper may dislike the tedious work of adding and subtracting, and reckoning, and itemizing, if she is a faithful steward of trust funds, she will give it due attention. The weak point in a great many hospitals is the looseness of methods of accounting. Frequently the board of managers are not sufficiently impressed with their responsibility to plan and demand a system of bookkeeping that will furnish plain facts in a shape that will be easily grasped; and it is not to be wondered at that the housekeeper is, if not careless, then not sufficiently careful for her books to be of any value as institutional records.
The busy housekeeper needs a simple method of accounting that is at once comprehensive and easy to handle. A simple, convenient form for a general expense book is here shown. One page can be devoted to each week’s or month’s expenditures and the use of such method makes the annual financial statement an easy matter to arrange. It is not claimed that this is the best method for a general expense account; it is one method—a simple, workable method.
In addition to this the use of a small day book will be necessary, which will show on the left-hand page the money received and on the other side the disbursements for the day. For this an ordinary blank book that has spaces ruled for dates, items, dollars and cents, will be sufficient. In this each day will be recorded the article purchased, the date and the cost. Periodically this itemized account is gone over, the articles grouped under the several heads and copied in the general expense book.
GENERAL HOSPITAL
| Receipts and Expenditures from ___________ to ___________ | ||||
| RECEIPTS | ||||
| Balance on hand .... 1st, 190... | ||||
| Received from ....................... | ||||
| Received from ....................... | ||||
| Received from ....................... | ||||
| Received from other sources .... | ||||
| EXPENDITURES | ||||
| Meat | ||||
| Fish | ||||
| Butter | ||||
| Flour, bread and meal | ||||
| Milk | ||||
| Water supply | ||||
| Ice | ||||
| Potatoes and vegetables | ||||
| Groceries and provisions not | ||||
| above enumerated | ||||
| Soap and cleaning appliances | ||||
| Fuel | ||||
| Gas, oil and light | ||||
| Bedding and general house | ||||
| furnishings | ||||
| Nurses’ uniforms | ||||
| Other training school expenses | ||||
| Advertising, printing, stationery, | ||||
| postage | ||||
| Repairs | ||||
| Stationary furnishings | ||||
| Contingencies | ||||
An “order book” should contain an account of all orders given, the quantity, cost, date ordered, date received. An ordinary blank-book may be ruled with columns for each of these entries, and the month and year. This furnishes information that is valuable from several standpoints. If the housekeeper is suddenly called away, it is easy to turn to for a list of the firms patronized, or to find the usual amounts ordered, and is valuable for comparison and reference from month to month and year to year. All dealers’ checks sent with goods should be preserved, for comparison with the itemized monthly account, before indorsing it for payment.
Hospital Inventory
In the matter of the hospital inventory, various forms may be adopted, according to the purposes for which the inventory is intended. It may be a simple list of the furnishings of the hospital, made up without any special plan, and with or without the value or cost of the article attached. In case of loss by fire, this inventory might have special value as an insurance record. Such books should of course be kept in the safe, with other documents and articles of value.
As convenient as any way of keeping a hospital inventory, is to have the contents of the building arranged under the heads of the rooms for which the articles were purchased. The kitchen, storerooms, diet kitchens, offices, reception rooms, wards, private rooms, etc., all have stationary furniture especially for them, and for purposes of reference it will be most convenient to list this in connection with the room containing it. If the value of each article is attached a recapitulation will show at a glance the total value of the hospital furnishings.
Once each year, at least, the housekeeper should make a business of finding out the average cost per day of feeding her hospital family, and the average cost of feeding one patient. This knowledge is valuable not alone for statistics, but for her own satisfaction. It should give confidence in her administration, or show whether there is a weakness that might be corrected.