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The hospital as a community facility: effectiveness and efficiency in hospital management and the interdependence of health services.

THE main purposes of my foundation are the regional coordination as well as the improvement of hospital and associated medical services. In my experience, therefore, the hospital, as a completely independent species and an isolated management entity, is well on the way to extinction. It would be ridiculous, of course, to suggest that the most expensive institution concerned with medical care is moribund. But in relation to what is required to tend to the health of the mass of the people in this day and age, and to the objectives of medical care as they are beginning to be refined, the hospital cannot exist in isolation from the community; and few if any hospitals can be effective as health service institutions if they seek to do so. There is, however, a paradox here, for many of the greater hospitals are justly proud of the belief that so far as effectiveness is concerned they are at the highest level ever of their operation; it is certainly true that if there is disquiet and anxiety about their financial states such a problem is by no means a new one; the ill will always pour out their treasure on earth to be well again; and, since those charitably inclined are likely to have a soft spot for institutions which are concerned with the care of the sick and the alleviation of illness, it is a fair guess that those concerned with the management of hospitals have some basis for being optimistic about their financial viability in the long run. There are, however, strong indications that the management objectives of health service organizations are in a course of change to a degree of complexity which calls for special consideration now in advance of their achievement.