The lack of careful instruction in the use and abuse of hospital supplies and the absence of conscientious, competent supervision may always be expected to result in general waste. If in the very beginning of an interne’s or nurse’s course in a hospital, some pointed, practical and definite instruction could be given as to the cost of supplies, and the avoidance of common methods of waste, much might be accomplished. If a sense of individual responsibility can be cultivated at all, efforts in that direction cannot be begun too soon. It is lamentably true that there is perhaps no class of employees who carelessly destroy so much that is useful as those whose names appear as students and employees of our institutions. Usually what is common property is no concern of theirs. A loss to the institution is no loss to them. Whether or not a feeling of responsibility can be aroused in all hospital workers is an open question, but it is worthy of diligent and constant effort. One thing specially needs frequent emphasis, and that is regarding the misappropriation of appliances. “Use an article for the purpose for which it is intended and for no other.” This cannot be too thoroughly drilled into them. How many valuable hospital instruments are broken annually because nurses persist in using them to take corks out of bottles because no corkscrew is in sight. This is only one common illustration out of hundreds that might be cited on this point. A rigid rule requiring a money return or a replacing of the article and a careful account of the articles in each department is the only way to force a study of economy. The abuse of appliances which renders them unfit for use, in an unreasonably short time, can be met in the same way, requiring also that every article reported unfit for use be submitted for the inspection of the head of the department, before being condemned or thrown away as worthless.
Careful Accounting
Watching the Expenditures
By careful accounting (and only in that way) can be ascertained the average amount of supplies that should be required in caring for a given number of patients. If this average amount is generally known or understood by heads of departments, internes, and nurses, it will be found that more care will be exercised to keep at least within ordinary limits. Very frequently the necessity for economy is never brought to the attention of the workers. Heads of departments too often seem in no way to be concerned with the cost or consumption of supplies. When this condition exists somebody is to blame. The superintendent, if he is the head of the hospital, as his official title would indicate, holds more of the power of checking waste in his hands than any other one or two persons. If he does not keep his financial eye on the expenditures of different departments, if he does not give time and study to the question of how to keep current expenses down to the minimum and at the same time do good work, if he does not, up to a certain point, regulate the purchase and distribution of the enormous quantities of supplies needed in the hospital, and insist on his colleagues in charge of departments doing the same thing, then waste is inevitable. If the father of a family simply pays bills for supplies without having a voice in controlling the consumption or use of those supplies he need not wonder if he finds the figures on accounts creeping higher and higher each month, and that is probably what is occurring in some hospitals, where the expense is excessive as compared with other institutions doing the same amount and same class of work. That economy and efficiency are quite compatible can be easily shown by actual results in hospitals that have never adopted the plan of running the institution on a deficit, that either have to pay their bills promptly or close their doors.
Dietetic Department
No doubt the dietetic department of the hospital can furnish more concrete illustrations of waste than any other. Some of this so-called waste is legitimate and inevitable; much of it represents material that should not be saved, that has been rendered unfit for use by handling, but there is no question that a large proportion of this waste of food comes from a failure to fit the amount and character of the food served to the needs and tastes of the individual patient. A wise discrimination on the part of the one who serves the food would prevent much of it. Another important cause of waste comes from imperfect preparation of the food. Food cooked in bulk, and with no bond of connection between the one who cooks and those who consume the cooked product, is almost sure to be handled carelessly, overdone or under-done or unpalatable. Food that is properly cooked and tastefully served, so that it will appeal to the eye and to the palate as well, is much less likely to be wasted or rendered unfit for use by handling.
Pecuniary economy, a large part of it at least, and also hygienic economy of food and nutrition, depend greatly on the manner of handling of food in the kitchen, in transit, and in the wards. Success in fitting the food to the consumer, then, demands skill and care in cooking and serving. It demands discrimination, a proper sense not only of the physiological demands of the consumer, but of his tastes, and it demands, besides, proper facilities for getting the food to the patient in its most palatable and attractive form. Without these three factors being recognized, waste is inevitable. Then, too, the buyer of food must carry a good deal of responsibility. The quality of food purchased, the place in which it was stored, and various other features enter into the question of waste. Without proper storage facilities “intelligent economy” in purchasing and caring for food is impossible. Buying over the telephone is one of the methods to be discouraged. Careful selection of perishable goods in open market is the only sensible way. Some hospitals have succeeded in reducing the expense from food waste by disposing of the garbage to contractors for a stipulated sum.
In the heating of a hospital there is room for a great waste of money. One small hospital, this last winter, one of the most severe seasons in years, saved two hundred dollars on the cost of fuel as compared with last year, as the result of “the intelligent economy” practiced by the engineer. A very considerable reduction in the expense of machinery, light and repairs is attributed by the board to the same source. Intelligent economy! The term deserves to be popularized, for of all things in hospitals it needs to be studied and cultivated.
This system of daily accounting for supplies is one that can be managed in even the smallest hospital. An inventory book in which is listed all the articles found in a department at a given time, such as hypodermic syringes, feeding cups, drinking glasses, medicine glasses, rectal tubes, catheters, etc., can also be used for requisitions or for noting, as furnished, additional articles of that class.
System