COMMITTEE FOR THE STUDY OF PHYSICAL FACILITIES FOR THE

COMMITTEE FOR THE STUDY OF PHYSICAL FACILITIES FOR THE HEALTH SCLENCES

CLINICAL MEDICINE AND HOSPITAL PLANNING SUB-COMMITTEE

Hospital Task Force

Minutes of Meeting May 3, 1965

Present: James Staphan, Chairman, Gerard Frawley, Gertrude Gilmcn, Mallor IIollan~i and Angus Stoecz (for Norman Holte), Robert Laur , Joim 'diles ternan

Absent: James Carey, Donald Cowan, Florence Ju l ian

NEXT =P,%ING, MONDAY, MAY 24, 1965 #3 HOSPITAL DXNING ROOM, 11 :45 sA.M,

(Go. through l ine and bring t r ay t o room)

Mr , Stephan reviewed the following statement which was authored by

Dr, Ted Howell, Director, ZIenry Ford Hospital, Detroit, Michigan,

Essential elements of optimum health services are:

1. A team approach t o eha care of the individual, i n which the

heal th professions providing services aze integrated and

coordinated under the leadership of the physician.

2, A spectrum of services tha t includes diagnoais, spec i f ic

treatment, rehabi l i ta t ion, education, and prevention.

3, A coordinated cornunity and/or regional system tha t incorporates

the f u l l spectrum of health services and provides for coor-

dination of care from ehe time of the pa t ien t ' s primary contact

with the system through the commugity hospi ta l t o the University

hospi ta l and/or medical center and other heal th agencies. Each

should provide the portion of the t o t a l spectrum of health

services t ha t is feaaible i n terns of the type of community

it serves and the overal l pattern of heal th f a c i l i t i e s of the

region i n which it exicrs.

4, Continuity among the hospi ta l aspect of pat ient care, the

comunity, the physician, and the heal th agencies rendering

perticul.ar services.

S, Organization of the hospi ta l care of both ambulatory and bed

pat ients i n to a continuum with common or integrated services,

6 Continuing programs of evaluation and research i n the qual i ty

of the servioes ptovided and i n theit. adequacy i n meeting

needs of the pat ient and the community,

After the group read through the a t a t emnt , I&, Stephan suggested

t h a t when tbe ro l e of a medical center Ir defiued, fhetl the hospi ta l

should be itniolved in a teaching program t h a t w i l l f u l f i l l the definit ion,

The Hospifal Task Porce is limited in what it can undertake a t thias

tin14 because i ts par t ic ipat ion i n teaching a d xesearch prodram8 must

await deaisione by other sub-committees, The hospi ta l can look dt i ts

parkneterr, bf ssrviae* Later on such baseline da ta as inumber of studente,

faculty, Btcc w i l l , beoome dvailable, Mr, Flsrtwley and Miss Cilman were

asked t o consider and list some f o the present roles of University

Hospitals, We could then proceed t o examine some of the services i n

l i gh t of the ro l e of the hospital,

Certain current trends were noted,

1, University Medical Centers are becoming more integrated with the

community+

2. The MBdical Center is becoming more integrated with the

University.

3, The new patterns must be reconciled with the former r e f e r r a l

principle now so widely understood by so many people,

4, A l l pat ients are defined as teaching patients but more under-

standing is needed whan describing the relationehip of teaching

with ce r t a in service program obligations,

5, The University continues t o have a primary responsibi l i ty f o r

the indigent of the state,

6. Dental care w i l l play a greater par t of the overal l health

care program,

Once we have decided the ro le of t h i s University Hospital, we can

then look a t the f a c i l i t i e s and questions of design, I n developing t h i s

space program, we f ind out *hat is needed i n t o t a l square footage, and

then see i f it can be f i t t e d on the available site i n a functional,

a t t r ac t ive manner.

Certain pat tern changes w i l l come about, The University now gets

over $4,000,000 f o r the s t a t e indigent on a 50-50 county/st a t e matching

basis, When new health leg is la t ion is passed, a pattern of care may

be interrupted i f the counties,switch t h e i r over 65 pat ients t o the

90-10 fed/s ta te program, which allows for the f ree choice of the

physician, Conceivably, hospi ta l out-patient c l i n i c s and chronic

in-patient wards could dry up, Also the exis t ing faculty pat tern of

practice i n t h i s i n s t i t u t i on may change.

The operations and objectives of the health service were discussed,

It was pointed out tha t i n some areas our University lagged behind others

i n the big ten, par t icular ly with regard t o faculty care and periodic

exams fo r students. Should t h i s Bperation be integrated i n t o the medical

center teaching program? Are the reasons for not having house s t a f f

members see students s t i l l val id today? What kind of resource would

t h i s be fo r the teaching program? These and other questions indicated

tha t the Health Service is one area t ha t needs t o come under the review

of the Learn Committee.

Mr, Frawley and Miss Gilman were asked t o report on the ex is t ing

use of space and the respons ib i l i t i es of the University Hospitals not

re la ted t o Teaching and Research. Mr, Westerman w i l l a s s i s t i n evaluating

the space f igures i n Dr. Gault8s ofEbce,

Respactfully submitted, John H. Wasterman Executive Secretary

COKWTTEE FOR THE S r w P OW R:NS3rcCa PACXLITIES PC9 TEIR IIEALXB SC:I'.IWCZEi

?rsaanf: : .T.~;n?en S taphxa, ChaSrman, James Csmy , Ger~rd Prclwl.oy, Gertrude Gi Rruax: , Biorence ,Pc?%ian, P?.~il . l ip Kexnan (Pss Donald Cowan), RobarZ tacr , 5~S7.n b1in7ae taman

23X2F2 NGETILSG I~lQ32AY, 3tE33 7, 1965, I1 ~4.5 A, $la , JIO$PS.FAL D1NXI.G ROO14 ihS (Go thrcugh l.s'.ne and bring tray t o roam)

I, Chn-Refsnen Stepha:% pxcaeatccl a dxaf b wh.l,~'I'L cwhzed t3.e 4~f&2~j&:$;-2$~,~g ros~ics:!, cents? r?nd !:lie ~ Q ~ ~ ~ ~ P L " , ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ $ , o H ~ The purpor;e o f n.. .-."&.-a -2 r r r r r r * r u l t l * U o

thc ci !:act i 9 b;o be& t:bc tenk force put: patam~ters axotin,d vl~at they are doing, 1,'. ~ ~ T C Y sugc3r:l:eel Chat Fra adti e:ho m,rfr12,r?,r of ?dT'E;P~ under poizs2: 4 and that we; ~.r~cZade a bs~i<k?uwn of the EI'CI~%O:C o,t facul$y, 131, SEeph-a askad I%, W6x&ertnan {:I.: cJar-: 5% :I.% :mr, pn:+s%bh to ge t a nut~jmx of fcsczll~p off."ices, secret;ard.es, i,!S>gt~~::!ss, con.?~;..,=e:.~cc 3'00as cecc 9.11 a4.iditf on t~ the number o f faculty,

2, Lk, Fra~q2~y ,:epo~teal h9n ir~renslons of 'sba Dean's OEBPce spaca. E$$ilt09 aa they XQJ.&$:C t3 t b ~ )11!.0820~: r,:f Ch:h $8012 ~ O Z C B ~ b k o FrawPey C ~ E @

PC$ th$.nk t1119 f%g1~8f i ~I:B p : i ~ t i ~ u l a r l ~ - y heXpf~11 in tI~eflr pres~nt S : O P ~ ~ tS!te ILgza:es 9x27 I:1c9.~da Ixospik;!P Q~?ECB 138 $2 At7 U S C ~ gar mad3-cszl echoal t@ilc;h%r;g, rn.1 ,~a.?s, 1.x:dical records, phaxmscy, eBc are $10'; 3:L?.el..Luded, F$csk i a Sncl.~?ded $.I Cxukosa JGGE bxko apaca ~?rsd >y i:l1*3 vt~:rAcua ~cjg?~..cdaIh&&o , . hfllon eumaxy f i g ~ i r e o 8x2 ~ . i l a : t . . l ~ b 1 ~ ~ t"t)w-y mzy b6 heh2Ev.J. i n clatetrnb.a.i,ng apace per n.uraiag fPaor, %P L':L~ , SIc+phaa p:trtes31:L 079k .?..$at ~v~.nt~ ia .Z?c~~ y01rl. t~f.l.1 need nat vaa3I.e honp%%a?. npace (Whj,th a fa6:Lux c j f 5[:.:.m63% added to arc5,ve at g~:ons ncjuare f o o t n g ~ for kota2. coat eii?~.~~ria$:ioaa) brolr@n down into toachiog, reaea'r:cb, and aesv%ce.

3, The task Force reviewed the statement of basic puvposos o f a, m~~d!,cd. ccate-b, The reason for this statement is that tho gtxrpsses have t o ba t ie l l t o the square footage calculat.j.nns and coet asabgnsr? t o dnform the U L I ~ . T ~ ~ I : F E ~ ~ ~ ~t:61 S t ~ t o I ~ P % 2t wP21 cost t o carzy out the desired pro,orm, %Zzm a cax~wldara$iorr 05 8.vadla'ble la3d will I..a.ve to be mgaBc3e, tLn Ifgilt: 0% t h ~ defined program, It cottXd tiTs out, fo:: exmpls, that- it ~513. cost 60 u\.i'l.l.iori dol lars to accompfisb our goal^ on $;his ndmitted1.y lgmtted and co$prouzined site, x<?h$la an e n t i m l y ;MW complex could ha cogakrucled on a dlffe;:sa.t: sdta for 80 million dsllnns,

I7 ~hc ; ;:ask foscs waa In gsnzga!. sga:aement w i t h E ~ R ~ i . 2 ~ ~ D % G & B ~ 1.t: WQS

suggo~tad that the tsa%nLng o f n ~ ~ ~ ~ n i 1 7 e ~ I ~ c ~ X pcremae9 should ba tmjludsd, DR, KUR4.H AHD DX, CARE? F%PE MILTD TO C:&WFULLY REVSRW Ti?$ E'31&Xlt,PEm LTD R;?PORT TIBIR XE@WSSXONS AT ZIE FEXT PiZETXIE, NCSS GZuWN t?IZZ %V3RW HCS PL1CA.L FLU8 FOR MATERIAL PBOm TEB STATUTORY Pb3POSES 02 UNZWRS TTY HOC PITALq,

4., The t a ~ k force diocuenad various featuren of the existing plant, I t was ~ v g g e s t e d th;l.e expanstoon plan8 hwe t o be baoad on sound concapta. The ddaa bchfincl the existing layout of Mnyo Towen- cvas qyeationed, It may have been pzeforabls t o stack thts aa;%a%ng u:lits and let the stuclanto move hori- zont:4.P~,, are tnl.kiag about as1 envArosrnen% f ~ r the pakJ,enfz, the atudazht, and the stxff, Zn 3cm aawn the nrJe GP space wi.311 overla?, Horqavcs, soma

re la t ionshlps j.n 2he "ucapltal cause r e a l problems,

The location of the Btacteriol.og:y b9b acmes from S ~ G I Emergency Room fs 0x38 exa?fip:Lea Larga n#urnbn,rs of students spill ou$ o f the 1.ab and are disectl:.~ cor~Pa.o~*..n;l?d by cFa;F,"s.ng asu l n t tves of ER pat ien$s, Another exaaple i a the sf:ack:ing of reueezch labs over the ZlearL: Hoepi te l Pediafiric FXmd, An obvious shortcoming is tb poasibil icy s f an j*nfraguont dioaster l i k e the socane £Are i n tIlc reseai:ch P,rOaa Them am al.r;o more sub t le dai.1.y drf,stwrl;- fiaccs thaQ suggest it would be wiser t o keep pat ient areas separate from rasearch areas, A t h i rd shortcoming t h a t was mentioned i s the use of cori:irio~s -?cr;: pa'dicnt and supp3.y tresasgor?~l$.o3, The use of t 3e X-ray Department as s .-.+ i.i.nEfir, route t o Dletal IIa13. 1~3 partir,~Iaxl,;)r af:l-'enaiv@, It would al.ao be h l p w fv.1 t E apace were available adjacent t o tho mwaing s ta t ioae fo r aacilL.sry 'i33rt'w onrielc

5. Dka K~.man inform3d the group of the j.m,dj-aea gXans af the Student HsaI.CE Service, A two f l a o r uni t wtX1 be ca~.~stx-~~ctad i n tb.e apace bst:.rqsen t k h Ssudent E ~ n l s h Selmtdce and the Child Reh8.b bv,llding, This w i l l p::evii49 addit ional @pace for c l i n i c a l outmpatient oc t iv i t l es . They are also inves- tf.gating systems t o a l l ev i a t e t h e i r space problems with medical records,

A question was rzised about plans To- a centrakizad approach t o ~ e d i c a l aacox9s and i;zfoxmatLo;~ systems for tb.e I . k ~ ~ X t ' b l ~ c & e h c e ~ ~ Dr. Johnson has a l ~ p i h d for a mS damon~tration grant, hut the scope of h i s a c t i v i t i e s a l the w t s e t w i l l be confined t o a cancer regict ry , a cardiac registry, and a psychiatric regiszry. For the past 18 months, Nfss S a r a McKinney, RRL and Research Assistant , h ~ e : been study3.tig the f e e s i b i l i t y of applying da ta proceosing procedures t o the medical records a t Uzha r s i t y Hospf t a l s , O n Plr;rch 30, 1985, she issued a report , ' l@ollection of Daea About: Patient Wtth IIezrt a9.d Blood Vaonel Dieease,'' and on A p r i l 6, 1965, issued a report on "Exam2nalioti of R ~ c e n t Experience with Cancer at UM3, "

Czppcrontl-y b;f.~cre 2.s 00 hospi ta l i n the country t ha t has put the medical record on a com$uter. Tularse and Roswell Park abandon t h e i r systems af reconding subjective data because tha physicians did not deacribe thefr ~baexarations i n tha same manner, There i s no problem recording objective data on a computer,

MR, FRAWLEY, MR. LAUR, AMD MIX, W S T E W N WERE ASKED TO LOOK UP TIE 'PAYZA NECESSARY TO FILL IN TEE DEFINITION OF A MEDICAL CEPER, MISS JULIAN WILL CHECK WITH MISS FRITZ ABOYn THE SCHOOL OF NJRSL8G PROJECTIONS FOR A. CLIaXCAI, SPECIALIST PROGIRAM* MISS JULIAN WILL ALSO CFECK WITH MXSS MURPHY ABOUT PUBLIC HEALTH hWRS ING PROGRAMS,

EaepectfuLI.g submitted,

John H, Westerman Executive Secretary

TILE UNXVZRSITY OF 2lXNIJESOTA WDICAL CENTER

The Medical Center s h a l l include a l l buildings t o support:

1 - The dducation of up t o medical students per year. 2 - Tha bducation of up t o interns per year. 3 - The education of up t o residents per year, 4 - The education of up t o : nursing students per year. 5 - The education of up t o laboratory technicians per year. 6 - The education of up t o physical therapy students .year. 7 The education of up t o occupational therapy s t u d e ~ t s per yeas. 8 - The education of up t o isotope students per year. 9 - The aducaelm af up t o medical soc ia l aervice workers per year. 10 The education of up t o baccalaureate degree nurses per year, 11 - The education of up t o master's degree nurses i n nursing educakicsn ,

per: yezv, 12 - The education of up t o master's degree nurses i n nursing servLca paxt,,

year, 13 - The education of up t o master's degree nurses i n c l i n i c a l specialties

pe r year* 14 - The education of up t o predoctoral agudants i n basic sciences. 15 - The education of up t o predoctora; students i n c l i n i c a l sciences, 16 - The education s f up t o postdoctoral students i n basic sciences. 17 - The education of up t o postdoctoral students i n c l i n i c a l sciences. 18 - The education of up t o other graduate students i n basic sciences, 19 - The education of up t o otkos undergraduate students i n basic s c i ~ n c e e ~ 20 - The conduct of research i n c l i n i c a l and basic sciences, and i n hospi ta l

administrative services, 21 - T5e care of up t o inpat ients i n the hospital. 22 - The oare of up t o outpatient v i s i t s per year. 23 - The beaI.th care of up t o undergraduate students i n the health service, 2 4 - The heal th care of up t o members of the faculty and t h e i r dependents* 25 - Tho health care of up t o graduate students and t h e i r dependente, 26 - The care of emergency pat ients fromthe University community and from tiha

University section of the c i t i e s of Minneapolis and St. Paul, . 27 - The conduct: of postgraduate programs fo r the physicians and the a l l i e d

heal th workers of the S t a t e of Minnesota,

Rastc Furposes of the Medical Center -.

1 - It must conform t o the purpose fo r which the buildings were and w i l l be constructed. I n the case of che Medical Center, i ts purposes are teaching, cam of the sgck aud ipjured, research, pat ient r e f e r r a l and public education i n t ha t order of priori ty.

2 - It must provide an environment t h a t w i l l enhance pat ient recovery wieh due regard t o the privacy and comfort of the pat ient and, most important, with regard t o hhs protection against fur ther sickness and injury, With f u l l recognition of the major responsibi l i ty of tlte Medical Center for exemplary teaching and research,

3 1 It should provide a f a c i l i t y which w i l l increase job sa t i s f ac t ion of hospi ta l employees and the medical and other teaching s t a f f ,

4 - The physical f a c i i i t i e $ muot enhance the trainiag of the physl.cinn of the future in compkehensivd niedical cam: the integkation of the c l i n i c a l and baaic eciencen; the in tegra t ion of the 14edical Cccter with tho ovexall University; the in tegrat ion of the Nedical Center with the community and with the S t a t e of Minnesota.

5 - The physical f a c i l i t i e s must be constructed i n such a manner as t o take advantage of the in tegra t ion of c l i n i c a l and supporting services, teach$-n* f a c i l i t i e s , and research EaciLFties t o the end thaE construction cost and operating costs can be minimized,

6 - The hospffal building must be deeigned so as t o in tegra te the variotrs c l i n i c a l services (medicine, surgery, pedia t r ics , psychiatry) and t o in tegra te the c l f n i c a l services with t h e i r c l i n i c a l o f f i c e s and t h e i r research spaces. Such an arrangement w i l l enhance the t ra in ing of exemplary medical and hosp i ta l personnel. The qua l i ty of care t o be rendered i n the fu ture by graduates i s largely dependent upon the qaaPts; of care which is present i n t he base University Hospital - t h i s eats titi: goals and ac t s as a nodel.

COMMLTTEE FOR THE STUDY OF PHYSICAL FACILITIES FOR THE HEALTH SCIENCES

CLINICAL MEDIC I PIE AND IIOSPITAL RLAIWING SUB-COEIMLTTEE

Hospital Task Force

MAxautes of Meeeing June 7, 1965 (113)

PresanE: James Stephan, Chairman, Donald Cowan, Gerard Frawley, Gertrude Gilman, Norman Holte, Florence Julian, Robert Laur, John Westermaa

Absent:: James Carey

NEXT MEETING MONDAY. JUNE 28, 1965, at 11 : 45 A.M. . HOSPITAL DINING ROOM #3 C

1, Chairman Stephan asked W, Westerman to review the activities of the ocher nub-cormnittees of the Learn Committee*

2, Mr. Stephan summarized the activities of the first two meetings and outlined an agenda for today' s meeting.

a. Miss Gilman reported on the statutory requirements that affect the role and objectives of University Hospitals. Before the next meeting she will circulate a list of these requirements along with a list of the building dates of the various hospital components and the source of funds for capital construction.

In a prelinlinary report, Miss Gilman stated that free care was provided until a 1921 law establishing Minnesota General HospiSal* This act provided for the reimbursement for hospital services by the counties of the state. A 1925 Cancer Institute gift proposed further conditions of eligibility for care. In particular, Miss Gilmn is searching for the 1912 statement by the Board of Regents that created University Hospitals.

b. Mr. Westerman handed out a table showing the enrollment figures in the various colleges or divisions from 1945 to 1964, Data is available on the 27 items listed in May 24 mtnutss and will be gixen out at the next meeting.

3. Dr. Cowan outlined some of the concerns of the University Health Sewice planning cornittee* The group is using the following figures for 1975 projections :

East Bank students West Bank students 20; 000 St. Paul students 10,000

Total 50,000 Dr. Coti~an pointed out that since Che projection was made, there has been a tendency to downgrade the figure because of higher admission ,

s twidards . QW8TLON: Bse the University placed a ceiling on the number of students? No

There have been proposals t ha t would c a l l f o r the development of an indus t r ia l type health service. Other considerations have been t o add new programs t o the UHS, perhaps an outpatient department fo r minor i l l ne s se s and a vaccination administration c l in ic . To what extent should the UHS get i n to family care? Family care for foreign students only? It has been D r , cowan's experience t ha t Health Services tha t promise t o do the most fo r more people usually end up offer ing l e s s t o the student, Our UHS doesn't have the s t a f f o r the room to expand services and i s not philosophically inclined t o embark on new programs fo r a t l e a s t 10 years, DR. COWAN WILL PROVIDE THE GROUP WITH FURTHER INE'ORMATION ABOUT WHAT THE UHS IS NOW DOING UJD WHAT I T INTENDS TO DO AT THE NEXT MEETING,

QUESTION: Haw many are now enrolled i n the Faaul.Cyt.Ernployee Health Plan? Approximately 1000, The upper l i m i t would seem t o be 1500,

QUESTION: What i s the s ta tutory provision t ha t a f f ec t s the ro l e of the UHS? There i s no s ta tu tory provision. In 1918 the Board of Regents s e t up a Student Health Service t o meet the health needs of the students,

QUESTION: W i l l you be moving t o an executive type physical exam- inat ion program? Perhaps, It has been talked about i n the past , It depends on the demand. Mr, Stephan pointed out tha t the reason the Hospital had t o know about these plans was t o an t ic ipa te the load the UHS would be put t ing on the Hospital i n ce r t a in areas (lab and x-ray, f o r example). What the UHS i s doing. i s an important con- s iderat ion i n the formulation of Hospital programs.

QUESTION: Do you foresee greater independence from the Hospital i n the next 10 years? It is t rue t ha t we have become more independent a s our s i ze increases. We do more laboratory and x-ray procedures with our larger pa t ien t load, We are very conscious of the manor i n which we use the students money and never increase our services u n t i l i t becomes economically feasible. Actually, the UNS has very l i t t l e standby equipment,

QUESTION: The daneer of the trond of duplj-cating too many f a c i l i t i e s , i s t ha t you lose your qua l i ty control , 1s it your des i re t o maf;ataln separaee f a c i l i t i e s fo r the students? K i l l t he services ever merge with the Medical Center? This question came up when the Camprehen- s ive Cainic Program was introduced. Our judgment at t h a t tlttne was t ha t students need a prompt and service ordented organization, This concept cannot be reconctled wit11 fihc objectives of the Compre- hensive Clinic, I f the Hospital ever developed a prompt service oriented pragram, then you could consider a mergez. However, we do share in te res t ing cases and w i l l cooperate with the IIocpital a s we have i n the past,

QIJBSTION: Turndng %he question around, and lookPng a t the needs of the medical student, is there evidence t o show tha t the heal th service type pa t ien t would be advantageous fo r medical education. Does t h i s pa t ien t approximate what the physiciaa w i l l see i n px2vate practice? No answer, There a r e some kfedi~al Fellows who par t ic ipa te i n the Health Service program,

QUESTION: Mho docs the indus t r ia l health work for ehe Hospits~l and Medicel School e.nplcyees? There i s a ph-jaicban .in the Hospital Employee Health Service, He a l so has an appointment with the UHS. The UHS does take any emergency during the day and uses the Hospital Emergency Room a t night.

QUESTION: Might the Hospital move in to a more comprehensive indus- t r i a l heal th service on i t s otm a s employees demand i n the Medical Center increases? What a r e the advantages of the UHS managing the indus t r ia l program? The Nospital i s not l i ke ly to embark on i t s own program a s long a s the UHS service i s available, The advantage of the UHS managing the program i s t h a t they have the experts on t h e i r s t a f f and the organization t o administer the program.

The group spent some time t rying t o es tab l i sh the ra t iona le 05 where the UHS-Hospital programs join, and where they separate. That: has been the i n t en t of the above questions.

QUESTION: Any plans fo r a UHS uni t on the West Bank? Not: a t present.

QUESTION: What i s the Dental School's re la t ionship t o the UEIS? What kind of services a r e the Dental School l i ke ly t o want from the Hospital i n the future? There i s a dental program i n the UI3S. The Dental Cl inics a r e unlike the UHS o r Hospital Cl inic i n t ha t any student, employee, o r s t a f f member may come t o the Dental Cl inics , Dr . Schaffer outl ined t o the Hospital Department Weads, some of his ideas about the future Hospital based dental programs. DR. H0'LTE WILL EXPLORE THIS POINT WITH DR. SCW'AE'YER.

QUESTION: What do the people i n Cl inical Medicine think a5out the value of various groups fo r teaching programs? For instance, it could be tha t students would not be a good group because they are so t rans i to ry but faculty-employee groups would be excellent , The select ion o r use of a group for a teaching program might change the ro l e of the c l i n i c , Has there been consideration of t h i s point? No answer. SHOULD THIS COMMITTEE B9 LOOKING AT TI-IE S O W E OP PATIENTS FOR VARIOUS EDUCATIONAL PROGRN~S~

Respectfully submitted,

John W. Westerman Executive Secretary

~tidilrmilir, d'emes karey, dtilirid Cowan, Gerard Frawley, kdrtaan Holke, ~iorence Julian, Robert Laur, John

we akkrdidh

Giaedk : ~c(cCliih Bras field

8bsent : None

bTXT MEETING MONDAY, JULY 26, 1965, at 11 : 45 A..M. . HOSPITAL DINING ROOM 1/3

1. Chairman Stephan reviewed the minutes of the last meeting. Dr, Cowan poixized out that with regard to the number of people enrolled in the Faculty- Employee Health Plan that the figure 1500 represents a projection or estimate of the number that will be enrolled in the plan, not a ceiling or upper limit.

2. Dr. Cowan made three documents available to the group:

a, Biennial Report of the University Health Service and Publications of the Faculty, 1962-64.

b. A booklet given to students, entitled, "Your Health Service," dated June I., 1964,

c. A paper entitled, "University Health Service Plans," which was prepared by Dr. Cowan for the Hospital Task Force Planning Committee. This paper is a summary of work of the University Health Service Planning Committee.

Dr. Cowan suggested the committee members read these documents and he :rill try and answer questions about the material at the July 26th meeting,

3. Miss Gilman distributed two documents that were prepared with the .3ssistance of E P f . Brasfield of her staff.

a, "Summary of Building Valuations Medical Group, as of June 30, 1962," which includes a breakdown Eot 14 buildings since 1911 by Special State Appropriations, Federal Grants, Endowments and Gifts, University Services, Other, and Total,

b. A statement of "Statutory Requirements Affecting University Hospitals," June, 1965.

Miss Gilman emphasized thar both were preliminary reports and required further preparation. Some of the questions asked were: What does the word connection mean in the statement that all hospitals connected with the Medical School should be part of Minnesota General Hospital? Was there any elaboration on the statement that the hospital is for the treatment of the sick poor? Is there a law or adminietrative ruling inwriting governing the requirement of referral? 1s %here a law or administrative ruling governing the system of finaricial classification of patients?

1

Some of the preliminary findings are:

* In 1907 the State Legislature stated the legal basis at University Hospital for the clinical teaching of medicine and for service to indigent patients,

** In 1921 the Legislature passed a statute stating that all hospitals connected with the Medical School are a part of the Minnesota General Hospital. The statute also reaffirmed the principle of Hospital servic and treatment of persons unable to secure care. The statute also legally sanctioned research at the Hospital..

*** In 1923, beginning with the use of the George Chase Christian Memorial Cancer Hospital, University Hospitals were authorized to accept privalte patients.

In summary, the teaching, research, and service roles were fairly well documented. The committee then asked Miss Gilman and Mr. Brasfield if they could pursue their investigation with regard to the origin of the referral system and the basis for financial classification of patients,

The question was raised, what is the group looking for? isn't it a documentation of some basic assumptions about the role and objectives of the Hospital? It was also pointed out that to the extent we can recover information about the role that is in writing, we can distinguish administrative judgments from legal requirements. For example, we are moving away from the concept of special treatment and classification of tndigent patients. Increasingly, third parties are paying for the indigents and demanding they be treated as private patients. It is important for the committee to know of any restrictions or regulations covering groups that the Medical School may want to serve. It was suggested that the terms covering the creation of the Cancer Hospital imply an obligation on the part of the Hospital to make the latest medical advances available to the State and also connote a community role for the Hospital,

A question was raised about rules covering the creation of the Out-Patient Department, Do the items that have been discussed also cover the Out-Patient Department? Miss Gilman noted that when the Out-Patient Department moved from Millard Hall, one of the reasons was to serve more people and to aet as a screening device for the crowded In-Patient Services, Miss Gilman and Mr. Brasfield will check further on the documentation covering the creation of the Out-Patient Depargment.

Several comments and questions were made about the Bufldfng Valuations statement. However, the committee reserved any conclusions about the document until it has been completed.

4. Mr. Westerman distributed a table indicating the number of faculty and students, by classification, in the Basic Science Departments. He also handed out a fact sheet about Nursing Education in Minnesota and the number of students who have graduated from miversity Programs for Graduate Nurse Students.

The point was made that what would really be helpful would be a figure showing how many students are in class, in laboratory, in the library, on rounds, etc, at any one time and then one could develop a range of space needs.

Is there a Teaching Aids section in the University to help develop and coordinate programs of teaching utilizing electronic and visual aids? Yes,

there is such a center within the University, but there is no coordinated program in the Health Sciences. This subject is of great interest to this committee, because the.developm~nts~-Lnthis area have a real effect on'building plans. Apart from the merits of what applications the electronic aids are most helpful for, the mere presence of these aids has an impact on the kind of facilities required.

These aids also suggest a new role for the Hospital in developing extensi-x. in-service training programs.

What are the plans for a continuation education center? Mr. Westerman ,reported that the revisions in the existing structure have made it less useful for Health Science purposes. Most of the 'sub-cornittees have discussed the need for expanded post-graduate education facilities to meet the needs of more ambitious programs in this area. Perhaps one sub-committee should coordinate the requirements for a Health Sciences post-graduate or continuation 4 center. It is likely that this increased emphasis on post-graduate programs will place a greater demand on Hospital facilities.

Mr. Stephan observed that we seemed to be collecting the pieces needed for the draft of our report, which is due by the end of the summer. We are l.acking some things, and need more accurate information on what we do have. We don't have any information about the size of the Hospital or the assignment of space, except as the Medical School space study outlines Hospital areas used for Medical School edcuational activities.

Dr. Cowan wondersd if the Environmental Health people might have an up to date listing of Hospital space assignment, because they review all of the construction plans for the Unjversity. Mr. Frawley indicated that the Environ- mental Health Section did not tabulate square footage assignments. Mr. Frataiey wondered what measurement would be most useful for our purposes. He noted that many studies had been done, but each with a slightly different formula of measurement. Mr. Stepha.n thought the figure we wanted was usable square footage. We are interested in the net area of usable space, and it would be most helpful if we could put this information on IBM cards. ThOs doesn't have to be done this summer, but it would be useful for the Hospital to con side:^ how this might best be accomplished and in particular for Mr. Frawley to worry about this task. Tf the study was done right, it would serve many purposes over R long period of time.

Mr. Stephan asked Mr. Westerman to pull together some of the inforinatLon we F.OW have and draft a role, objective, and program paper for the July 26th raeating. Dr. Carey suggested we make a clear distinction between the Hospital and Nedical School roles. For instance, we ought not to use hospital care and medical care interchangeably. This Hospital has never had an organized Medical Scaff because of the organization of the Medical School. It will only cause confusion if we continue to blur the distinction between Hospital Staff objectives and Medical Staff objectives.


John He &&terman ~xec:?tivc Secretary

, ,

C ~ 1 ' I T E E FOR THE SlMJm UE' PHYSICAL FACILITIES FOR TIE HEALTH SC~ENCES

CLINICAL, MEDICINE AND HOSPITAI, PLANNING SUB-COMMITTEE

Hospital Task Force

Minutes of acting July 26, 1965 (#5)

Present: James Stephan, Chairman* James Carey, Gerard Frawley, Gertrude Gilman, Norman Holte, Florence Julian, Phillip Kernan (for Donald Cowan), Robert Laur, John Westerman

Absent: None

Guest: Sister Mary Eleanora

NEXT MEETING THURSDAY, JULY 29, 1965, 11 :45 A.M. . HOSPITAL DINING ROOM Jj3

Chairman Stephan announced that the committee was now ready to undertake its first written assignment for the Laelen Committee. Mr. Westerman, with the assistance of Miss Gilman, Dr. Carey, and &,,bur, has passed out a draft statement of "Roles and Objectives of University Hospitals" for our considerstion.

The lead sentence of each paragraph about a role will be listed, with a summary of the discussion,

A. THE PRIMARY ROLE OF UNIVERSITY HOSPITALS IS TO PROVIDE AN OPPORTUNXTY I . .

FOR THE EDUCATION OF HEALTH SCIENCE WORKERS IN MXNNESOTA.

It was decided that we did not want to specify the kind of health science workers ae thl.8 point, but keep the broad statement. The question was raised if we wanted to say we were training people from Minnesota or for Minnesota. Xt was suggested that we keep in mind what other committees are doing, in order that our role statement really does reflect what the responsibility of the Hospital is. A Hospital is more than four walls and a roof and a Hospital Administrator is more than a caretaker. Yet the word oppartunity may lead to confusian in that the Er_B~pitals' educational r o l e could be interpreted to be that of the other educational units, e.g. Medical School, Nursing School, Dental School.

The above lead sentence was then changed to: THE PRIMARY ROLE OF UNIVERSITY

HBSPITALS IS TO PROVIDE AN ENVIRONMENT IN MLNNESOTA FOR THE CLINICAL EDUCATION IN

0, THE SERVICE ROLE OF UNIVERSITY HOSPITALS LS TO PROVIDE HEALTH CARE

FACTLTTIES, EQUIPMENT AND PERSONNEL TO ASSIST THE HEALTH SCIENCE PROFESSIONS

IN PATIENT CARE, EDUCATXON AND RESEARCH PROGRAMS.

The statement was acceptable to the group, but aeveral suggestions were made to improve the supporting paragraph.

1. Somewhere in thie seetion, we must get aeross the idea of EXEMPLARY FACILITIES.

- 2 -

2. The dimension of QUALITY OF HOSPITAL SERVICE should be included, particularly in view of our role as a base hospital.

3. Do we have to answer the question of whether our obligat%on is just to have facilities and patients for the teaching programs, or do we have obligations that extend beyond the minimum number needed for teaching?

It was pointed out that the paragraph under B, includes a statement about obligations to categories of patients that goes beyond the minimum number needed for teaching. Bowaver, in designating these categories for care, the legislation states "care provided by members of the Department of Medicine (this was intended to mean Medical School faculty)." The point I s that the faculty gives care and there is a limit to the service obligations the faculty members can undertake.

The obligations to groups of patients that may exceed the minimum number required for teaching and a recognition of the limitations of service rendered by the faculty could be reconciled by a statement indicating the obligation is "consistent with the overall Medical Center mission." This is an important point because it is likely that the expansion of the patient care role in the next 10 years will exceed that of the last 5 0 years. The demand for more patient care will come from such measures as Medicare and the De Bakey report. There- fore a consideration of the parameters of service obligation is crucial f f we are to face the future with an organized plan.

QUESTIOLV: Is the role of the Emergency Department to provide care for the University population?

Dr. Kernan outlined the University Health Service policy with regard to rendering emergency care. In summary, the Hospital Emergency Room acto as a back-up for the 16 hour a day University Health Service program. The fact that the Emergency Department here is not a typical urban all comers operation fs largely because of the faculty stance, not because of a Hospital policy. The two large government hospitals in Minneapolis and St. Paul take pressure off this department and provide an excellent educational resource. A large Emergency Department is not essential for the teaching program at Minnesota.

The items under C, in the draft were gut under item B.

C. BESIDES TWF, SUPPORTIVE SERVICE RESEARCH ROLE MENTIONED IN B., UEJIVERSTTY

I!OSPXTALS, HAVE A FUTURE ROLE OF INVESTIGATING THE ORGANIZATION AND DISTRIBU-

TION OF HEALTH CARE SERVICES AND TPE CONDUCT OF RESEARCH RELATeD TO HOSPITAL

MANAGEMENT.

D. AS A PRODUCT OR TOTAL OF THE ABOVE BOLES, THE UNLVERSIT?S HOSPITALS MUST

HAVE AN AWARENESS OF THE FURTHER ROLE OF SERVING AS AN INFLUENTIAL SOURCE OF

LEADERSHIP FOR THE ADVANCEMENT OF HOSPITAL CARE FOR THE CITIZENS OF MINNESOTA, THE

REGION, AND THE NATION. It was decided to add example after the word influential.


John H, Westerman Executive Secretary

STATEMENT OF ROLES OF UNIVERSITY HOSPITALS AS APPROVED BY HOSPITAL TASK FORCE ON JULY 26, 1965

1. ROLES

A. The primary role of University Hospitals is to PROVIDE AN ENVIRONMENT IN MfNNESOTA FOR CLXNICAL EDUCATION IN THE HEALTH SCIENCES, This role includes the provision of staff and facilitiee, for students from Minnesota, and secondarily for students in the region and the country. Xn making Hospital reeources available to students of health sciences, most departments assume a teaching role for full time students, and also carry on in-service training programs for hospital personnel or for other persons coming to the Hospitals for continuing education.

B. The service role of University Hospitals is to PROVIDE HEALTH CARE FACILITIES, EQUIPMENT AND PERSONNEL TO ASSIST THE HEALm SCZENCE PROFESSIONS in the patient care, education and research programs. Because of many highly qualified health science professionals in the College of Medical Sciences and the Dental School, the University has the unique capability of providing the most advanced health care services, rzepecially advantageous for patients with complex health problems. The, University Hospitals there0.9 fore have the role of providing those hospital services necessary for the most advanced preventive measures, diagnosis, treatment and rehabilitation of illness on both an in-patient and out-patient basis. This role is further influenced by the fact that University Hospitals are designed aa the only Base Hospital in the "Minnesota Stare Plan for Hospitals, Public Centers and Related Medical Facilities" as developed by the Minnesota Department of Health,

Through State Legislation and University Administrative rulings, University Hospitals have a role of PROVIDING HOSPITAL CARE FOR SPECIFIED GROUPS. At present, these groups include:

1) Indigent patients residing in the State of Minnesota, whose care is authorized and supported by the counties and referred by a physician.

2) Patients who are referred by their attending physician to a faculty staff man or the Hospitals for diagnosis and care, These patients may be full pay or part pay.

3) Students enrolled in the University who ate referred by the Universit: Health Service Staff.

C. Besides the supportive service research role mentioned in B., University Hospitals may have a future role of INVESTIGATIt4G THE ORGANIZATION AND DZSTRIBllTION OF HEALTH CARE SERVICES and the CONDUCT OF RESEARCH RELATED TO HOSPITAL MANAGEMENT,

D, As a product or total of the above roles, the University Hospitals must have an awareness of the further role of SERVING AS AN INFLUENTIAL EXAMPLE AND SOURCE OF LEADERSHIP FOR THE ADVANCEMENT OF HOSPITAL CARE for citizens of Minnesota, the region, and the nation.

CaMMITTEe FOR m d STUDY OF PHYSICAL FACILITIES FOR THE HEALTH SCIJZNCES

CLINICAL MEDICINE AND HOSPITAL PLANNING SUB-COMMITTEE;

Hospital Taak Force

Minutea of Meeting July 29, 1965 (116)

Present: Bob Laur (chairman for Jmes Stephan),-James Carey, Gerard Frawley, Gertrude Gilman, Norman Holte, Florence Julian, Phillip Kernan (for Donald Cowan), John Westerman

Absant: None

Guest: Sister Mary EXeanora

M3XT MEETING AT TIE CALL OF THE CHAIRMAN

Acting chairman Laur suggested the group continue the consideration of the draft statement of July 26, 1965, turning our attention to fhe teaching, research and sewice objectlves. Mr, Westerman will work with Miss Gilman and the Hospital Administration Staff on an outline statement of present: and future programs,

The following , t e a e m objectives reflect the changes suggested in the July 29th meetlag, The servPce and research objectives were not considered by the group, but do include the changes suggested by Mr. Stephan prior to the July 29th meetdng,


John H. Westerman Executive Secretary

rm. O B J E ~ T T S ~l l -m HQISP~TALS

A* T W r n W M T V E S

1. TO PRW15)B EXEMPLARY FACILITfES AND SERVYCES THAT MEET THE 8EEDS

OF THE EDUCATfQE3AL PRQGRAMS of the College of Medical Seisnaea and the School

of Dentistry, ians administer these rservicer in an effecttve mamar.

2, To 83eRENGTHEN AND EXPAND IN-SERVICE TRAINING PROCRAMS fox Hospieal

personnel and CONTTNUATT.ON EDEATfON PRQC#AMS for appropriate health science

personnel On the aacea, The Norpitafa w i l l develop and participate $n these

yrogrmo. XE is intended that the I.Iospitsla play an active role in the ed-

ucation of health science psrronnel by providfn8 and Bevelop&ng competent

personnel to assfae fn the teaching. Xn thir aapaeity, the He6pitals may be

identifying new areas fox: participanthon sunB cooperafcion in educational pragrama.

3. TO STIMULATE AND PARTXCXPATE XM THE DBVELOPMENT OF A COORDINATED

I ~ G R A ~ PLANNING BFFORT among the health science educational programs at the

Universi tp . 6, To Improve and develop cooperative ]PROGRAMS (9F COMPRleHEEJS'ILWE PATIENT

CARE, whXch would include a ltealth plan for: the patient and reflect i t1 hospital

pract8ce what has been taught in the educational program, where such an objective

f s consi8te~t with the miseion o f the Hoapitalr.

B e SI'XVJCE OBJECXTWES

I. To CREATE AN EbSIIXROMMT bJW%C'M W I L L E M C E 'I= WT,1CH CARE OF the

patient. Th%e rrervice w t l t reqraire a recognition of the dtgnfty of the patient

and ca l l for pewasnalizerd hospital care by rr skilled staff.

2. TO PROVIDE A HIGH QUAEXrSY OF HQSPSTAL CARE XN A DEMONSTRATIVELY

EFFICXENT MANNER. This must be done i n a way t o meet the objectives of the

healrh aciences educatfonal progrimas and axso be capable of seotvfslg are a model,

for service programs that could b@ adapted by other hospitals in the state.

3. To BETTER ORGANIZE AVAILABLE PATIENT DATA so tha t the data may be

readi ly available. t o approprfate members of the heal th eciencea profession.

4. TO INTEGRATE UNIVERSITY HOSPITALS SERVXCES WITH OTHER STATE

HOSPITAL AM) HEALTH RESOURCES t o the end tha t the r e f e r r a l system and continuity

of care objective are enhanced and the t o t a l health plan fo r the pat ient may

be made operative. v

5. To PROVXDG W E R S H T P TO THE HOSPITAL FIELD i n developing the

f u l l potent ia l of hospi ta l based services and Sntegration of a l l other comsnunity

services. It i s hoped tha t t h i s action would elevate atandarda of hospital

services throughout the state.

6. To ATTRACT AND RECRUIT THE BEST QUALIFIED PERSONNEL t o the seaf f

of University Hospitals and thereby serve ae a aource fo r hoapital leadership

fa the region.

C . RESEARCH 0BJF:CTIVES

Lo TO INWESTZGATE THE IMPLZCATIONS OF BEING A BASE HOSPITAL. For

tnetarrce, what a re the elements of the relationship, what are the dutfea, what

are the c r i t e r i a fo r successful fulE11lment of t h i s role?

2. TO DEFINE WHAT HOSPXTAL SERVICE I S AND WHAT ARE TlU3 DETERMINANTS

OF HIGH QUALITY HOSPZTAL CARE.

3. TO CONTRIBUTE NEW KNOWLEDGE: AND UNDERSTANDING ABOUT PATTERNS OF

HlOSPlTAL CARE and the ro le to be played by Untvarsity btospitals i n a rapidly

changing emrSranmentr

4. To Snvestigate the Hospital sexvices tha t a r e provided t o deter-

mine optimum OPOANXZATXON OF HOSPITAL SERVTCES AND TEST HYPOTHESES ABOUT THE

ECONOMICS OF HOS PLTAL SERV I CES

COMMITTEE FOR THE STUDY OF THE PHYSICAL FACILITIES FOR THE HEALTH SCIENCES

Hospital Task Force Sub-Committee

M%ntrtes of Meeting September 15, 1965

Fresent: James Stephan, Chairman, James Carey, Phillip Kernan for Donald Cowan, Gerard Frawley, N. L. Gault, Jr., Gertrude M. Gilman, Norman Holte, Robert Laur, Kathryn Rirzen, John Westerman

Absent : Florence Julian

NEXT MEETING MONDAY, SEPTEMBER 20, 1965, 11:45 A.M.

Mwbss Gilman briefly reviewed the programs in which the Hospital anticipates involvement in the next ten to twenty years, and distributed to the committee copies of the Department programs except for Rehabilitation, Medical Records and Maintenance, It was auggested that the Departmental programs be summarized and Sncluded in the overall sub-committee statement.

QUESTZON: Was physical space included in the programs? NO, the Hospital. still needs parameters on space from other Departments and connuittees to decide on its space requirements.

QUESTION: Can the reports as they now stand be highlighted in the committee report? The elements which the Departments have in common with the whole Hospital program have been extracted in a list of ten statements included in the material distributed here.

QUI3STfON: Have the elements which are not in common with the entire program, for example, the unique research and teaching needs of each Department, been extracted for inclusion in the committee report? To some extent, Food Service, for instance, favors centralization o f itself, and Pharmacy does alao, The development of services remote from the core fac&ffty, such as storage, has been discussed.

QmSTION: Do you envision a continuing need for housing nursing personnel and studentn? Students will not be houaed, but personnel will have to be housed as a necessary fringe benefit, On-call rooms will c~atinue t o be needed for interns and residents. Powell Hall is not a dormitory responsibility of the Hospital unless it is directly related to the Hospital.

QUESTTON: What about housing for vieitors of patients? This is done only occasionally, Is there a demand for this? Yes, the Hospital is often called upon t o male accommodations arrangements for visitors,

QUESTION: What has happened to the discussion of a Continuation Center for Health Sciences? NothCng yet. It would appear that the Health Sciences should consider a joint effort in planning a center in this complex, Powell Hall is a possible site. Dr. Howard would like this . committee t o consider alternative uses for Powell Hall.

Dr. Carey: Althottgh what 1 am going to bring up Is a topic which might more properly be included in the Clinical Medicine Committee Report, 3 want

t o c a l l the committee's a t t en t ion t o the v i t a l need f o r facul ty organization i n pat ient care. This i s a problem which i s worsening daily; r igh t now it i s dea l t with a s medical coverage and the pat ient sees a d i f fe ren t doctor each time. When the facul ty does organize i t s e l f fo r pat ient care coverage, $6 w i l l have t o turn t o the Hospital for help, especial ly i n regard t o a centra l appointment system and ambulatory pat ient care. I am disturbed about the omission of t h i s problem from tho Cl inical Medicine report and f k s m the Faculty Constitut%on revision. OnLy the Medical School Faculty i s charged w%th giving medical care. This is wri t ten i n t o the law books, but eha Snstruceions which the individual professor receivee when he i s hired do not charge hirn with t h i s responsibil i ty.

Mr, Beasfield had a l so brought up t h i s point. A t present the c l i n i c has no respons5bility f o r t h i s . It was suggested t ha t same statement be mads i n the report that: the Hospital AdmPnistaation i s a m r e ellat concern fo r pa t ien t care responsibility Is developing, The physicians receive wonderful nursicg eupgort: Erom the Hospital, but: there w i l l be no solut ion t o the pat ient care ps~hlem ulztil the facul ty organizes i t s e l f f o r t h i s responsibil i ty. So the question remains t o be faced; how does the Hospital help tho facul ty t o organize t o give pat ient care?

QUESTION: What about the number of in te rns and res idents i n the future? Does the Hospital have a greater voice i n decidEng on in te rns than residents? Yes, the Hospital does have a grea te r par t i n the decision of interns. The number of in te rns and res idents changes each year on the bas i s of increased pat ient load. Residents are chosen by the Departments atld paid by them, although most othax Hospitals do pay t h e i r res idents i n recognition of t h e i r serv$.ces,

QUESTTOE: W L l l there be a difference i n handling res idents i n t h e future? I f the Departments indicate the number of in te rns and resldenrs they want, can i t be re la ted t o number of beds? F i r s t the nmber of beds and programs have t o be known t o determine the number of Interns. The problem rea l l y only concerns the r a t i o of beds Co i n t e ~ d s , ra ther than residents. The need for res idents i s increasing, since they a r e primasily involved i n research; beds and the consequent need f o r Sneeras a r e not increasing i n che same ra t io .

COMM3NT: Some Olinical Medicine staff don't envision any expansion of the present number: of beds a t the TJniversicy, because they prefer that: beds be increased i n the cormnlinity hospitnla. However, it i s doubted whether the Cl inical IiIedicfne Sub-earnittee will auppart the Department ekairzaen on tho estimated calculatfons of bed needs.

QUESTION: So far the number of beds has been re la ted t o the teachlng and research programs. What does our responsibil2tg fo r SERVICE spec i f ica l ly imply I n te rns of expansion? I f Ilennepin County didn ' t operate a hospi ta l , servtce would loom much larger i n our pernpeckive than i t ac tua l ly does, The University s t i l l handles a large number of r e f e r r a l s , much of which is unnecessary f o r teaching and research, but necessary a s par t of our ro l e as M-Lnnesotaqs Seate Hospitc.1, Perhaps service needs t o be handled completely apar t from our taaching function. Tor example, thn, valuae of the e n t i r e r ehab i l i t a t i on program has l i t t l e r e l a t i o n t o t ra ining needs. In any case, the servlce responsiblllity of tlilis Bospital i n terms of elements of the Mlnnessta population i s not adequately spelled out, and our service function a f f ec t s the number of beds required.

QUESTION: How many beds are needed to train residents, say in Orthopedic Surgery? It hasn't been possible to gat this information from the divislon chiefs . QUESTION: Wfth federally financed medical care increasing, doesn't it hold true that the Un&versicySa obligations to case for special county patients are changing? Mhether these patients are indigent or private by means of federal health insurance, the University wifl'still have to take care of them. This Hospital's obligation has nor changed; rather, the patLents now have the opportunity to choose their source of medical care.

At this point the factors we still have to consider in deciding on the number of beds are the ability to measure need, determine the location of the Medical Center,'and whether the Center can be expanded on this site.

QUESTION: What other elements figure in service? Referral patients must be served by the University - possibly the Mayo Clinic could handle this, but it's not probable.

The committee wa8 reminded that the major obligation of the Medical Center is to train the physicians in Minnesota, through in-patient and out-patient care.

Service requires not only bed and staff, but also auxiliary staff to trans- mit information and service back to the community. There is a whole set of relations for dealing with referral patients.

QUESTION: Should we enter the non-intensive, motel-type care facility? The Mospital report, while nor explicit on this point, provfdes the frame- work for the development of a motel-type facility.

Another area the Hospital is involved in is the nursing home field, and the Hospital must determine its obligation in this area. The Masonic Rospital approaches this function somewhat. Of course the picture is somewhat complicated by the fact that many nursing home patients are also heart, stroke, etc. patients. This Hospital w i l l have to move patients on to nursing homes, howwer, in order for them to be able to collect Medicare benefits. If the Hospital needs to add nursing home care to its services, it need not necessarily be i t s a m nursing home.

QUBSTION: How can you control a nursing home for the Hospital's patients unless the Hospital itself tuns the home? The quality and needs of the Medical Center prohibit dodging this responsibility. However, none of the University faculty at present is concerned with caring for long-term patients. In Canada there is a great development of physicians primarily concerned with chronic and long-term patients; in fact, there is even a Chair in Chronic Disease in university medical centers there.

QUESTION: Do we have a comfteee studyfng the DeBakey Program? 3Che committee has made a statement: regarding the DeBakey Report. The Un5versity now acts as a disease research center, but for full implementation of the DeBakey Report, planning and enlargement are necessary. The first grants are expected to be for planning purposes, with the State Medical AssociatPan Mayo Clinic and Dr. Barr comprising the nr~cleus for planning in Minnesota. The results of this planning obviously will have an impact on the size, number of beds, etc., of the University Medical Center projected for the future. The Learn Committee report must ultgmately tell the President of

the University what physical facilities are needed in the next twenty-five years.

COMMENT: There appears to be a basic conflict between the attitude of the lledical School concerning beds and that of the Hospital Administration. The Departments have to aupply the background information necessary for the Hospital to determine the number of beds needed,

QUESTION: Wouldn't it be a good idea ta have Dr. Barr address the committee about comprehensive, complex medical care? It is routine to inform people on the community level and in regional centers about the meaning of such care, The public's view of a medical center makes a gap between the center and the community hospital. A patient can only be referred to the University Center if he's indigent, has a complex problem or simply asks his physician to refer him, and few doctors refuse such requests . It was pointed out that in the future, with more coinprehensive health

insurance coverage, doctors will try harder to hold sn to their own patients, who w211 then be in a position to pay for medical care. Nevertheless, the only places in Minnesota where comprehensive, complex medical care is available are the Mayo Clinic and the University. Thus, in a sense, the University can be required to care for anyone who i s determined enough to come here.

QUESTION: What effect will private group clinics of 30-35 physicians, such as the one in S t , Louis Park, where patiants can also receive com* prehensive care, have on the University's patient load? It seems that Medicare will enable many more patients to choose a private group clinic instead of the University. The University will continue to lose patients until the doctors become more concerned with patient care?

QUESTION: Is it true that the University now has more cases than it needs for tratning? No, not necessarily; the University does seem to have enough cases, however,

CONbIEMT: It: is naZve to assume that training needs can be met by cotnmunity hospitals unless we have control of appointments. In Rochester, for exampl.e, the Gznesee Hospital Chiefs are appointed by the University, and there Es tight concrol of voluntary, non-profit hospitals. Although at first the hospitals balked at this control, by 1962 all Rochester hospitals had petitioned for the BaGle arrangement.

One factor which inevitably must be related to the University's growth 5s tho projected increase of twa million in the State's population. A proportionate increase of hospital beds will be necessary, if not at the University, then elsewhere. The Department Chairmen cannot thdxik in terms of more beds with the present level of staff and University support, This committee, however, needs to visualize growth in all dimensions. An increase of staff will result in more patients.

It was noted that the amount of medical knowledge practically doubles every seven years, and this, too, needs to be considered a factor in planning growth,

fn psychiatry-here, there is no plan or desire for expansion. Psychiatry students are. being farmed out now.

QUESTION: Should there be a medical staff entirely distinct from the medical faculty? The State Legislature says that the staff of the Unlt- versity Hospital shall be the medical faculty. Possibly this shows a misunderstanding of how medicine is developing. If service is considered apart from the University's teaching needs, then thought must be given to establishing a Flospital Service Staff separate from the medical teaching and research staff.

Of course, even now there are some specifically designated research prom fessors - in metabolism, for example, The State is pressuring the Hospital do admit metabolic patients who need care, but the researcher is uninterested in giving patient care. One unfortunate case of the conflict between the research and service responsibilities of this institution concerned a patient who was referred here for dialysis, The patient was refused treatment by a physician who was, nevertheless, doing research in this field.

COMMENT: Then this Center is not living up to it8 responsibility as a referral hospital.

COMMENT: Whether that charge ia true depends on which responsibility is being considered, It has not been our responsibility to provide any dialysis service for the Midwest. More problems like these can be expected, however.

QUESTION: Xf there wars two separate staffs - service and teaching - wouldn't: there be a s~nflicr over the use of patients? Dr. Cowan: "I don't see how service can really be separated from a physician's responsibilitymn

It's unusual today for anyone to practice, teach and do research as well. This is true of the faculty throughout the Uk&.rersity.

Three criteria for service were agreed upon:

1) The increase in populatfan will require an increase of beds at: the Center,

2) The greater availability of medical care financially will result in greater Bermids for serv$@e,

3) Advances in medicine will mean a greater work load and will require expansion, Cardiac surgery, for example, brought about much of the present Uni.ver82ty work load, Transplantation is likely to increase; work in Reproduction and Genetics will require expansion of Obstetrics and GynecoXogy,

If the teaching staff still refusee to render patient care, increased f scilities won' t make much difference .

Thisl problem fa involved with increasing the staff with primary responsibility for patient care in each area.

QUESTSON: Shouldn't the staff be increased before the number of beds? It will be impossible to get more staff without more beds.

It was felt that an educated guess about likely expansion of the Medical Center fn terms .of nwber oS interns and residents, the teaching program and even ~esponsibPlity to the State, would not be forthcoming from the staff.

It's possible that this could be determined through the creation Of research beds, auch as the expansion of 100 beds in discrete units. It was objected that research beds will detract from service beds,

QUESTION: !&ere is evidence that thexe is no way to escape,gxowth and more beds, but will growth necessariily take place at the ~niverkiit?? The Medical School will allays be a balance against unlimited egpansion.

When Departments ~ p l i t and expand, such as Eye Service from Emt Radiation Therapy. Dermatologys new beds will be needed apart from p~p~rtiti~d growth,

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The possibility of the St, Paul Campus having a medical schabl,uailxa$ hcker patients, was discussed.

It was agreed that the final report probably would not have cbnsenstrs support, but it would be enough to stimulate the University to takd an ed;xated look at planning for the Medical Center. If that much can be achieved, then the Committee will have made significant accomplishment. From ghat point, a professional planner can be secured to actualize p1an.s. And for further expansion, the Medical Center is the most fortunate branch of the University, since it can obtain Federal matching funds.


Kathryn Ritzen Research Assistant

COMNXTTEE FOR T'HE STUDY OF THE PHYSICAL FACILITIEB POR THE HEALTH SCIENCES

Kospital Task Force

Minutes of Meeting September 20, 1965 (#8)

Present: James Stepban, Chairman, James Carey, Donald Cowan, Gerard Frawley, Gertrude Gilman, Norman Holte, Florence Julian, Robert Laur, Kathryn Ritzen, John Westerman

NEXT UETXNG AT THE CALL OF THE CMXRMAN

The committee was reminded tha t the Cl inical Medicine and Hospital Sub- Comtt tee Report w i l l be given t o the Learn Committee on Monday, September 27, a t 3t30 p.m. i n 510 Diehl Hall r Everyone on the C12nical Medicine and Hospital Sub-Committee is invited t o t ha t meeting when Mr. Stephan and Dr. French w i l l present the Report. The general formst of the report Lncludes: I Introduction; ZZ Roles and Objectives; and 111 Program. A t t h i s point the Hospital Task Force was ready t o deal with the Program sect ion of the report and copies of STATEMENT FOR HOSPfTAL TASK FORCE <9/20/65) were dis t r ibuted by Miss Gilman.

X t was agreed that: infomation from other committees concerning the Medical School's re la t ionship t o c l i n i ca l teaching was needed for any comprehensive report on the Hospital. Therefore, the Hospital Task Force Report must be of a ten ta t ive nature, c lear ly mentioning i n the Introduction what material i s omitted and what bearing other committee report8 have on the Hospital Report.

It was noted tha t i n the Cl inical Medicine Report the Hospital would need 200 more beds i n the next f i ve t o ten years, In other areas of need, Dr. French's report doesn't glve complete f igures t o guide the Hospital Task Force, There are, however, some space-need Impl.ications i n the report , such a s increased special i - zation, the i n s t i t u t i ona l concept of medicine, a cloael: t ie with dentistry, ambulatory care, etc.

rhe optfmum fntrahospttal, diseribuefon of beds was dfeeueaad and it. was suggested tha t the estimated increase La number of beds for the immediate future should be based on service and research needa, This could overlap with the demand fo r teaching beds. The 200 beds c i t ed i n the report include 50 for Health Service and Dentistry. The HoeprPtal Task Force Statement should linclude the exact number o t beds we have now by services and an in t e l l i gen t guess a t the number needed by services.

The eatimated increase of 25% i n beds mentioned i n Dr. French's report: depends on teaching bed needs. It was objected, however, t h a t more than 25% expansion w i l l be needed i n ambulatory care, cost centers, and other space needs. It i s dangerous to speak of expanding the Center by 25% when the t o t a l number of square f ee t a t present is unknown, For example, 100% more laboratory space i s needed, pkrrmaey reqonf ree 100% more space, etc, Z t i s quite! possible t ha t the Administration would misinterpret the 25% c i t ed fo r bad needs t o mean sn over-all expansion of 25%. This would qu i te probably be inadequate i f Wisconsin, which had t o increase its square footage from 674,000 t o 1,400,000, i s any example, Further, one has to question whether the present site is adequate f o r the future needs of the Medical Center, While one answer would be t rue for 25% expansion, pulre another would obtain i f 100% expansion is planned,

QUESTION: Should we say there appears a need for 100% axpansion? No, because we don't know yet for sure, so we shouldn't fix that idea in anyone's mind. We could say anywhere from 25% to 150%.

Mr. Westerman suggested that it might be a good idea to raise the idea of moving to another site. Mr. Stephan agreed that although the commf.ttee can't give exact expansion figures because of the complexities and lack o f parameters, it is altogether possible that a sire change may be necessary, This underscores the need to obtain exact figures from other committees; 'for's~mgts, the numbers involved in Continuing Education,

QUESTION: How did Wisconsin expand? On the basis of department figures* The departments were made to project figures in order to get the expanston plan through the legislature, For us to talk to the legislature, it might be well to regard Wdisa$=tEd%%ow~-as students. If the number of students Is not expanded by 25 - 50%, our capacity for graduates and residents can be expanded, Insofar as the health care needs of the State of Minnesota are concerned, it is far better to retain residents that graduates of the Medical School,

The Hospital Task Force Statement now includes Dx, careyts concern for organized patient care and an efficient appointment and scheduling systern, Sociel Service roles have now been added to the HospStal Task Force information. The rest of the Hospital Task Force Report was reviewed by category.

NURS f NG SERW ICE

To carry out research and an evaluation of the quality of nursing care and implements improvement, the idea of an Experimental Nursing Program has been discussed frequently. However, the North Carolina experiment has shown that a three story building i s necessary to observe the work on one story. On the other hand, remote control television could actually do much of the monitoring for quality control observation.

QUESTION: Are them any research programs in the Nursing School in conjunction wlth the nursing staff? There are no joint programs now.

The committee mentioned the need to expand program space to carry out the in-service training program on rt hospital wide basis, The cornittee agreed that the Nursing section o f the STATEMENT had good material for iaclusion in the Carnietee report.

This program can't be included in the committee report wirhout studying the question of whether the Hospitals should be in the food businelss for patients and personnel, or whether this service should be contracted. There is enough on the market, including diets, to use pre-packaged, frozen foods to assemble on the wards.

Although P t would be pearfbla to contract the nutrition program as far ae service Ls concerned, there i a another conaideration in regard to the educattonal aspects of the program: the Universfty runs the only dietitian program in the etate.

If &e HospiCals w e d a decentralfzed food service, joba would be provided to University students, which would be the main reason for choosing decentralization, It was objected that Ot might be better to pay full tlme food personnel;

on the other hacd, the ratio of students to full time personnel in the dietary department is small.

QUESTION: If the Hospitals contract food services, doesn't that put the Dietary Intern Program out of business? Not necessarily, because at present the dietitian8 are not primarily in food service, The question still needs to be asked, however; how many dietary etaff have to be trained and what facilities are necessary.

Decentralization of the pharmacy should be consfdered in our long-range planning. Perhaps the manufacturin~ should be done away from the Hospitals.

QUESTION: Was the pharmacy mentioned in the Outpatient Department: report? Yea.

QUESTION: Why is there a separate pharmacy in the Student Health Service? For faster aewice, which is important to the student who is between cEassesr Besides, the Hospitals pharmacy was inadequate in siee when the Student Health Service phamacy was established, there was enough business to make it self-supporting, and it was sanctioned by the Hospitals. For example, nose and throat cultures formerly done in the hospital lab, which was swamped, are now done in the Student Health Service. The logic of shifting services such as pharmacy to the Student Health Service applies to the entire hospital program, especially to ambulatory care services.

QUESTION: How is pharmacy going to be handled for the clinic ambulatory patients? At present, getting prescriptions filled in the Hospitals phamacy is difficult for the clinic patient, especially the newcomer. Priority is given to inpatient prescriptions.

It would be advantageous to both Student Health Service and the Hospitals Ijharnnacy (including the Outpatient Department) to centralize the manufacture of their drugs, with the righe storage facilities, before the new Outpatient Depart- ment building is even begun.

QUESTXON: ShouPdn8t thfs auggesfion be added to the committee report? 90% of the preecriptions could be dispensed easily. The original reason for the patient going to the pharmacy was to meet the pharmacist; now that there are clerical intermediaries, there is no reason to send the patient to the pharmacy.

QUESTION: Can North Clinic patients go to the Hospitals pharmacy? Yes, in hoderata numbers.

With the appropriate physical design and volume, the pharmacy can serve outpatients* Iowa had a study done on optimum pharmacy arrangements and the University of GaineeviZZe is moving in this direction, Dr, Cowan urged that the new Outpatient Department building have a pharmacy easily accessible to

, patients8 on the first floor for example, as most: hospitals, such as North- western, do.

CEN'L'RAL SUPPLY

This is another area h t t by tqchnolagical change. The reference in the Hospi- tal Task Force Statement to using profeeeional nursing services in central supplies

was objected to, Professional nursing services were separated from central supplies a long time ago. It was Eelt that, conearley to a statement in the information Miss Gilman had distributed, excepttag operating rooms, the Hospitals should aspire to centralize all ster%lization procedures.

QUESTION: Has any thought ever been given to the possibility of the , University operating a sterilizing un26 for its own purposes and for other

hospitals as well? There is some question as to what is sterile. The stsrilfzation of prosthetic devices is complicated; nuclear sterilization is best, bur not many hospitals can do that, The University now has its own gas sterilizer in the operating room.

Sterilization and central supply and disposal are areas where it might be advantageous for Student Health Service and the Hospitals-So operate as one unit.

Mr. Stephan pointed out tbat in metropolitan areas, hospitals don't need more than one week's supplies on site, since suppliers already charge the hospitals for stockpiling, and therefore, a great deal of space is not required for supplies.

QUESTION: What about equipment? At present: much equipment, pluglh as respirators and croupettes, is rented, mostly from ABC, but protection and transportation are inadequate. This equipment seeme to need repairs after coming from the service centers because of poor haridling. Demands for this equipment, however, are likely to grow, and it would be a good arrangement if all hospitals in the community used a common pool of equipment from ABC. The point is, finally, that space for storage of service equipment is Eerribly inadequate, even if ib is contracted. For servicing its disposal problem, the Hospitals use a chemical storehouse.

MAINTENANCE AND OPERATION

The information Miss Gilman provided on this topic will make a good statement in the sub+cgmim$ttw~~rt, Automatic equipment is invaluable in this sewice, There is a tremendous educational need in this area to acquaint people with the importance of maintenance and operation and the consequent need for a highly trained, highly skilled planner in this ffefd. In the future it will be necessary to give a degree in Hospital Engineering and Maintenance, although there is much opposition to this concept at present, Right now there ds a Master's program in this field, but the participants are few, This program could possiblg be tied in to the University Engineering program,

HOUSEKEEPING

The information on this item appear8 to be thin, Perhaps mote of a point could be made concerning environmental health.

NJ3DfCAL ART AND PHOTOGRAPHY

There is a tremendous respect in this field for utilizing what is already at hand, such as teaching machines. Z t would seem that the Education faculty should show some initiative in the planning and adoption of programmed learning in this area, The University has an agency for programed learning, but perhaps there should be a special programmed learning branch in physical proximity to the Medical Center for its special needs, especially since the demands on the University facdlbay are heavy. Some mention of this should be made in the report.

QIIESTION: If Medical Art and Photography beconies accredited, will it be out of the Hospitals? No, But is the Medical Art and Photography budget $n the Medical School?

QUESTION: What about the Scientific Apparatus Shop in Diehl Hall? A committee is studying this and it is felt that the Shop ought to be a part of the Medical Center. This should be mentioned in the Hospital Committee report - at the end, in future business, QUESTION: Are there space implications for a possible Personnel Director in the future, or will this position be absorbed in Administration?

QUESTION: In the future, will the Medical Center be more integrated Pit the University or more autonomous? It seems inevitable that it wf-11 be more autonomous, though it would be a loss to pull it away from the University. Maintenance is split right now. Purchasing is another question. If the Center had its own purchasing office, it would dupli- cate the functions of the University purchasing somewhat. The University is against the Center's becoming more autonomous because the University gets its importance from the Medical Center, At the University of Indiana, greater integration of the ,Med$cal Cen&etj?w%eilb %Be Ootal university is foreseen. Of course, the integration of faculty and the integration of services, such as printing, are two different questtons.

VOLUNTEER SERVICE &nB SOCIAL SERVICE were read without comment.

Dr. Carey thought the Hospital Report was fine, but expressed concern about Nursing and Pharmacy; aarm&ly, that there is no mention in these sections recognizing the existence of the physician with which each service works. The Clinical Medicine Report does the same thing and although the Nursing section in the Hospital Report does mention coordinating acitivites with those in medicine, it is a weak statement in this respect. The essence of nursing and doctoring i s to work together in patient care. This comunication should be formalized and recognized, and the same applies to pharmacy.

QUESTION: Is the Outpatient Department a real department of the Hospitals? The budget is set up for a separate Outpatient Department, but it is not a formally organized department. As a matter of fact, this is under consideration in the Constftutfon as a Department of Community Medicine in connection with the Comprehensive Clinic, The Outpatient Department should be recognized in the report; Dr. Carey would like to have a Clinic Manager and see the Clinic as a real unit in Administration thinking. Mr. Staphan agreed that this could certainly be recommended in the report, However, there should be coordination among the Clinical Medicine Task Force, the Hospital Task Force, and the Outpatient Depart- ment on what the nature of the recommendation should be.

QUESTION: Does this put the committee on record supporting the Outpatient Department Building? It would if this committee accepts the Outpatient Department Report.

QUESTION: Did the report say that the structure bad to be separate? That point isn't really decided yet. The general feeling is that it sBould be fairly close to the main center. If Outpatient Department is headed for a separate unit, wetre headed for trouble in duplicating staff and hesdi.ng away from integration.

Thia committee should include a statement supporting Outpatiene Depart- ment as a department within the hospital structure and support the Outpatient Department report for a new facility as part of an integrated unit.

QmSTION: If disease category centers are established, what mfght be the implications for the Outpatient Department in thoee area@% There need not be a conflict. The Child Development Study is an example*

QUESTION: Xsn't there ample evidence that the Outpatient Department is not given enough attention because it is not a separate department? Mss Gilman would hesitate to make a statement supporting the Outpatient Department as a department within the Hospitals.

The problem of handling ambulatory care patients muet sttll be given attention, but it might be enhanced Sf the Outpatient Department were an integral part of the Hospitals,



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( STATEMENT OF HOSPITAL TASK FORCE FOR PRELIMINARY REPORT TO THE LEARN COhfMITTEE

SEPTEMBER 27, 1965

A. INTRODUCTION TO TIE REPORT 1

I We would l i k e t o emphasize t h a t a major conclusion t o be drawn from t h i s pre-

l iminary repor t i s t h e f a c t t h a t we a r e concerned with a l a r g e s c a l e space expan- ! s ion program t h a t has s i g n i f i c a n t impl icat ions i n ca r ry ing ou t tho changing r o l e I and ob jec t ives o f t h e h o s p i t a l s , This repor t , i n combination with tho c l i n i c a l medicine and o t h e r sub-committee r e p o r t s , c l e a r l y p o i n t s ou t t h e need f o r an o v e r a l l space s tudy and t h e formulation of a long-range plan which i s based on coordinat ion among t h e respec t ive u n i t s , I t appears t h a t t h e immediate require- 1 ments can be quickly and f a i r l y adequately asce r ta ined , but t h e long-range needs 1 can only be an educated guess, This means t h a t land on which t o grow i s one of I t h e most important f a c t o r s and could be of such over r id ing importance t h a t conceivably an e n t i r e l y new s i t e could be required, The c lose r e l a t i o n s h i p between h o s p i t a l beds, ambulatory ca re f a c i l i t i e s (out-pat ient and emergency department) and c l i n i c a l o f f i c e f a c i l i t i e s and c l i n i c a l research f a c i l i t i e s could very well

i p r e d i c a t e an e n t i r e l y new approach t o t h e physical f a c i l i t i e s required,

I I I t

We should a l s o l i k e t o p o i n t out t h e l i m i t a t i o n s o f t h i s r epor t . Many param- 1 I e t e r s r e l a t i n g t o t h e expansion needed a r e missing. While i t can be concluded t h a t t h i s i s a major expansion program, we don' t know how many graduate s tudents , i

.( pre- and post -doctoral , t h e r e w i l l be i n t h e next 10 - 20 years , how many undergraduate s tuden t s t h e r e w i l l be, how many continuing education courses w i l l be i o f f e r e d f o r h e a l t h sc ience workers, how many f a c u l t y members, how many beds a r e needed, how much research space is needed, what t h e r e l a t i o n s h i p between t h e c l i n i c s and d e n t i s t r y w i l l be, what t h e e f f e c t of h e a l t h l e g i s l a t i o n w i l l be , and

I i n general , what demands the f a c u l t y and t h e community w i l l p l ace on t h e hosp i ta l .

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The t losp i t a l s w i l l have t o be s e n s i t i v e t o t h e space impl icat ions as a l l t h e o t h e r ! u n i t s develop t h e i r programs and requirements, We do be l i eve t h a t t h i s informa- i t i o n which is now lacking can be made ava i l ab le i n a r e l a t i v e l y s h o r t per iod of t ime, Future e f f o r t s w i l l be aimed a t r e f i n i n g t h i s document by f i l l i n g i n t h e i

gaps and by conducting a s tudy of t h e e x i s t i n g f a c i l i t i e s and an evaluat ion of i

Eurure needs and uses fo r a l l e x i s t i n g bui ldings ,

For t h e convenience of t h e reader , c e r t a i n programs which a f f e c t a number o f h o s p i t a l departments have been summarized and l i s t e d under t h e headings of teaching, o f f u t u r e needs and uses f o r a l l e x i s t i n g bui ldings . i

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B. ROLES OF UNIVERSITY HOSPITALS

1. The primary r o l e of Univers i ty l losp i t a l s is t o PROVIDE AN ENVIRONEENT IN EVIINNESOTA FOR CLINICAL EDUCATION IN THE IIEALTkI SCIENCES. This r o l e includes t h e provis ion o f s t a f f and f a c i l i t i e s , f o r s tuden t s from Minncsota, and secondar i ly f o r s tuden t s i n t h e region and t h e country, I n making Hospi ta l resources a v a i l - a b l e t o s tuden t s o f h e a l t h sc iences , most departments assume a teaching r o l e f o r fu l l - t ime s tuden t s , and a l s o ca r ry on in-service t r a i n i n g programs f o r h o s p i t a l personnel o r f o r o t h e r persons coming t o t h e Hosp i ta l s f o r continuing education,

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2 , The s e r v i c e ' r o l e o f Univers i ty Hospi ta ls i s t o PROVIDE HEALTH CARE FACILITIES, EQUIPMENT AND PERSONNEL TO ASSIST THE HEALTH SCIENCE PROFESSIONS i n I

t h e p a t i e n t care , education and research programs, Because of many highly q u a l i - I

f i e d h e a l t h sc ience p rofess iona l s i n t h e College of Medical Sciences and t h e I

Dental School, t h e Univers i ty has t h e unique c a p a b i l i t y of providing t h e most / / i

advanced h e a l t h c a r e s e r v i c e s , e s p e c i a l l y advantageous f o r p a t i e n t s with complex h e a l t h problems. The Univers i ty Hospi ta ls t h e r e f o r e have t h e r o l e of providing those h o s p i t a l s e r v i c e s necessary f o r t h e most advanced prevent ive measures, d iagnosis , t rea tment and r e h a b i l i t a t i o n of i l l n e s s on both an in -pa t i en t and out-

I ! p a t i e n t bas i s . This r o l e i s ~ f u r t h e r inf luenced by t h e f a c t t h a t Univers i ty Hospi ta ls a r e designed a s t h e only Base Hospi ta l i n t k e "Minnesota S t a t e Plan f o r I

i Hospi ta ls , Publ ic Centers and Related Medical F a c i l i t i e s " a s developed by t h e 1 Minnesota Department of Health, 1

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Through S t a t e Leg is la t ion and Univers i ty Administrat ive ru l ings , I I Univers i ty Hospi ta ls have a r o l e o f PROVIDING 11OSPITAL CARE FOR SPECIFIED GROUPS. I

A t present , these groups include: I I

.( a. Indigent p a t i e n t s r e s i d i n g i n t h e S t a t e o f Minnesota, whose ca re i s author ized and supported by t h e count ies and r e f e r r e d by a physician.

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b, P a t i e n t s who a r e r e f e r r e d by t h e i r a t t e n d i n g physic ian t o a f a c u l t y I i s t a f f man o r t h e Hospi ta ls f o r d iagnosis and care , These p a t i e n t s I

may be f u l l pay o r p a r t pay. i

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c, Students e n r o l l e d i n t h e Univers i ty and members o f t h e f a c u l t y and 1 1 s t a f f who a r e r e f e r r e d by t h e Universi ty Health Serv ice S t a f f . I

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3. Besides t h e support ive s e r v i c e research r o l e mentioned i n B., Univers i ty Hospi ta ls may have a f u t u r e r o l e of INVESTIGATING THE ORGANIZATION AND DISTRIBUTION OF HEALTH CARE SERVICES and t h e CONDUCT OF RESEARCH RELATED TO HOSPITAL MANAGEbIENT.

4. A s a product o r t o t a l o f t h e above r o l e s , t h e Univers i ty Hospi ta ls must have an awareness o f t h e f u r t h e r r o l e o f SERVING AS AN INFLUENTIAL EXAMPLE AND SOURCE OF LEADERSHIP FOR THE ADVANCEMENT OF HOSPITAL CARE f o r c i t i z e n s of Minnesota, t h e region, and t h e nat ion.

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C. OMECTIVES OF UNIVERSITY HOSPITALS

1, TEACHING OBJECTIVES

a. To PROVIDE EXEMPLARY FACILITIES AND SERVICES THAT MEET THE NEEDS OF I

THE EDUCATIONAL PROGRAMS of t h e College of Medical Sciences and t h e School of Dent is t ry , and adminis ter t h e s e se rv ices i n an e f f e c t i v e manner, I

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b. To STRENGTHEN AND EXPAND IN-SERVICE TRAINING PROGRAI\B for Hospi ta l ,

personnel and CONTINUATION EDUCATION PROGRAMS f o r appropr ia te h c a l t h sc ience personnel i n t h e area . The i losp i t a l s w i l l develop and p a r t i c i p a t e i n these

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programs, I t i s in tended t h a t the Hospi ta ls p lay an a c t i v e r o l e i n t h e education of h e a l t h sc ience personnel by providing and developing competent personnel t o I , a s s i s t i n t h e teaching. I n t h i s capacity, t h e Hosp i ta l s may be iden t i fy ing new 1 areas f o r p a r t i c i p a t i o n and cooperation i n educat ional programs. I

I c, To STIMJLATE AND PARTICIPATE I N THE DEVELOPbENT OF A COORDINATED I

INTEGRATED PLANNING EFFORT among t h e h e a l t h sc ionce educat ional programs a t t h e 1 University.

d, To IMPROVE AND DEVELOP COOPERATIVE PROGRAb1S OF COMPREI-IENSIVE PATIENT 1

C A N , which would include a h e a l t h plan f o r t h e p a t i e n t and r e f l e c t i n h o s p i t a l p r a c t i c e what has been taught i n t h e educat ional programs where such an o b j e c t i v e

I i s cons i s ten t with t h e mission o f t h e Hospi ta ls ,

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2. SERVICE OBJECT1 VES 1 I

a. To CREATE AN ENVIRONMENT WHICH WILL ENHANCE THE HEALTH CARE of t h e I I

p a t i e n t , This s e r v i c e w i l l r equ i re a recogni t ion of ( the d i g n i t y of t h e p a t i e n t and c a l l f o r personal ized h o s p i t a l ca re by a s k i l l e d s t a f f , 1

.( b. To PROVIDE A HIGH QUALITY OF HOSPITAL CARE I N A DEMONSTRATIVELY EFFICIENT

MANNER. This must be done i n a way t o meet t h e o b j e c t i v e s of t h e h e a l t h sc iences educat ional programs and a l s o be capable o f s e r v i n g as a model f o r s e r v i c e programs t h a t could be adopted by o t h e r h o s p i t a l s i n t h e s t a t e .

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C r To BETTER ORGANIZE AVAILABLE PATIENT DATA s o t h a t t h e da ta may be r e a d i l y a v a i l a b l e t o appropr ia te members of t h e h e a l t h sc iences profess ion. //

I

d. To INTEGRATE UNIVERSITY flOSPITALS SEI<VICES WITH OTHER STATE IIOSPITAL I AND HEALTH RESOUIlCES t o t h e end t h a t ' t h e r e f e r r a l system 2nd con t inu i ty o f care ob-

I

j e c t i v e a r e enhanced and t h e t o t a l h e a l t h plan f o r t h o p a t i e n t may be made opera t ive .

e. To PROVIDE LEADERSI-LIP TO THE IIOSPITAL FIELD i n developing t h e f u l l '

p o t e n t i a l of h o s p i t a l based s e r v i c e s and i n t e g r a t i o n of a l l o t h e r community s e r v i c e s . I t i s hoped t h a t t h i s a c t i o n would e l e v a t e s tandards of h o s p i t a l s e r v i c e s throughout t h e s t a t e .

f . To ATTRACT AND RECRUIT THE BEST QUALIFIED PERSONNEL t o t h e s t a f f of Univers i ty Hospi ta ls and thereby se rve a s a source f o r h o s p i t a l l eadersh ip i n t h e region.

3. RESEARCkl OBJECTIVES I

a, To CONTRIBUTE NEW KNOWLEDGE AND UNDERSTANDING ABOUT PATTERNS OF HOSPITAL ,

CARE and t h e r o l e t o be played by Univers i ty Hospi ta ls i n a r a p i d l y changing en-

( v i ronment .

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b. To , invest igate the Hospital services t h a t are provided t o determine optimum ORGANIZATION OF HOSPITAL SERVICES AND TEST HYPOTHESES ABOUT THE ECONOMICS OF HOSPITAL SERVICES.

C, TO DEFINE HOSPITAL SERVICE m n TO INVESTIGATE THE DETERMINANTS OF HIGH QUALITY HOSPITAL CARE.

d, To conduct research i n coordination with members of the c l i n i c a l s t a f f i n high qua l i t y pa t i en t care.

1

I

e. To conduct research i n Hospital administrative services. I

D, PROGRAMS OF UNIVERSIm llOSPITALS I ,

I 1. Service 1

I

a. Determination of the need f o r expansion of hospi ta l beds, services and supportive f a c i l i t i e s , consis tent with the needs of educational and research programs and consis tent with the legal obl igat ions t o serve as a prime r e f e r r a l center.

i 1 !

This includes giving recognition t o such f ac to r s as the constantly changing educational and re'search needs, the demographic cha rac t e r i s t i c s of the service

i area, the a v a i l a b i l i t y of a l t e rna t ive resources f o r medical and hospi ta l care, and

I

thej-onstantly changing s t a t e of medicak knowledge and techniques. I I i

b, Definition of the optimum in t rahospi ta l d i s t r ibu t ion of beds, se rv ices , I I

and supportive f a c i l i t i e s t o provide a spectrum of properly s ized, supported and . coordinated un i t s ranging from intensive care through nursing home leve ls with I

extension on t o ambulatory and home care services . A preliminary estimate of shor t term bed needs f o r the immediate future, based on the current need and demand f o r beds by c l i n i c a l services , i s approximately 200 i n addition t o those current ly

I I

under construction i n Mas,onic Memorial, I 1 I

c, Recognition must be given t o t he necessi ty of reinforcing exemplary medical care with exemplary hospi tal care, recognizing the digni ty of t he individual and the soc ia l and economic needs of the pa t ien t . I I

i

emands, such as:

ons is ten t with educational needs dequate parking, t ransportat ion and t r a f f i c p a t t e ecessary housing and dining f a c i l i t i e s

This concept w i l l requi te a well organized, well s t a f f ed dep

3

..'

COMMITTEE FOR THE STUDY OF PHYSICAL FACILITIES FOR THE HEALTH SCIENCES

Hospital Task Force

Minutes of Meeting November 30, 1965 (#9)

Present: James Stephan, Chairman; James Carey, Donald Cowan, Gerard Frawley, Gertrude Gilman, Norman Holte, Florence Julian, Robert Laur, Kathryn Ritzen, John Westerman

Guest: Mr. Edward Nelson of Hamilton Associates

NEXT MEETING - MONDAY, DECEMBER 6, 1965, at 11:45 A.M. IN HOSPITAL DINING ROOM #3 A Joint Meeting with the Clinical Medicine Task Force

Mr. Stephan announced that the meeting was called to consider the Draft of the Learn Committee Preliminary Report , particularly the General Conclusions and the Hospital section of the Report. He felt these Conclusions contained a sound general point of view and incorporated same Of the Hospital Task Force Report.

Attention was called to the Conclusions, beginning on $age 5 , regarding the inadequacy of facilities for present teaching and research programs. There was some discussion of the question whether the adequacy of the facilities ought to be clarified in regard to the service role of the Hospitals, It was felt that the report should emphasize the general agreement on the long-standing deficiencies of the present facilities, especially in regard to outpatient services.

Paragraph d. on page 6 also concerned the Committee. The Hospital is vitally interested in knowing the extent af the graduate student programs it will have to serve in the future, as well as the paramedical and ancillary programs. Greater effort should be made to speal this out.

There was considerable discussion of the service role of the Hospital. "Patient-care" references in the Report were thought by some to include the various aspects of service. One opinion is that a12 patient-care roles are determined by the Hedical Center's teaching obligations and research interests. However, there was some feeling that the patient-care concern was not expressed strongly enough in the overall Conclusions, and consequently needs revision.

It was assumed that the Hospital Task Force had originally agreed there would be an increase in the number of hospttal beds, but it doesn't seem that: the Learn Committee reached a consensus on this as a major conclusion. Perhaps that was because of the very preliminary nature of the Hospital Report and the fact that there are no firm estimates on the precise number of beds needed. The Teak Force felt , however, that there should be some statement in the Report warning the President that an increase of hospital beds can be expected, as a response to factors such as upgrading the ambulatory services, hiring new staff in the future who are likely to call for an increase in beds to support their teaching and research activities, an increase in the number of medical students, and the increased speckalization of medicine itself which requires teaching of that specialization, using distinct facilities, It might: be well to make that statement even more inclusive by stating that the expansion of in-patient care will require more beds and more ancillary services as well.

Several recommendations were made for changes in the Draft Report. The important potnts made by the X o s p i t a l Taak Borce d l 1 be %nearparated in a new

paragraph, i,e., under the Conclusions. Tho Report will also state what has been excluded from its consideration, for example, School of Pharmacy and Uni- versity Health Service,

The Committee then turned to the Clinical Medicine section of the Report, page 14, it- d. The question was whether some additional responsibility will devolve on the Hospital if affiliations are strengthened and expanded, since University control of faculty appointments in affiliations carries with it some sort of reciprocal responsibility. Although there was some disagreement on the extent to which the Hospital would be influenced by this, it was acknowledged that the issue is mitigated by the fact that the primary responsibility of the faculty is to the University Hospitals. Tt doesnf t seem that affiliations, as they presently stand, will have much of an effect on the Hospitals' However, additional burdens and expectations could be placed on University Hospitals if future affiliations led to an overall tightly knit complex.

Turning to page 16 of the Report, "VFW" should be omitted from the first sentence, since their financial assistance has been for a laboratory, not strictly, a Hospital facility.

It was agreed to reword the second paragraph on page 16, in reference to a llcritical look at what is being taught and how it is being taught." so that it doesn't appear that the Hospital is judging what the Medical School is teaching.

Finally, the Committee expressed concern for the implications of the Nursing Section of the Report which states that the nursing program should not serve as a primary supplier of nurses for the state or region, but rather as a model program. Although this statement is in accord wlth the philosophy of the Ancillary Report and the Administration's belief that the University's responsibility is to provide unique educational programs, the Committee thought it ought to point out that there are pzoblems involved in taking the School of ~ursing~s position. Minnesota may be a supplier state of nurses, but this does not necessarily mean that the state has enough nurses for its own needs.

The next Committee meeting will be a joint one with the Clinical Medicine Task Force, to consider the progress and inplications of the proposed new medical research building project and related concerns. The meeting will be in Hospital Dining Room $3, on Monday, December 6, 5965 at 11 :45 A, M.



COMMITTEE FOR THE STUDY O F PHYSICAL FACILITIES

FOR THE HEALTH SCIENCES

CLINICAL MEDICINE AND HOSPITAL SUBCOMMITTEE

Hospital Task F o r c e

January 1, 1966

TO: THE LEARN COMMITTEE

FROM: THE HOSPITAL TASK FORCE

SUBJECT: THE HOSPITAL PROGRAM REPORT

Enclosed i s a copy of the hospital p r o g r a m repor t , This r epo r t was p r e -

pa red by the hospital adminis t ra t ion staff and forwarded to the hospital t a sk

fo rce commit tee .

The f i r s t hospital r epo r t i s in the L e a r n Committee minutes of September

27, 1965 (#12) . On page 5 , a t the end of the hospital r epo r t i s the notation,

"Appendix. Repor t s f r o m individual Hospital Departments . (This information

will follow)" The enclosed r epo r t should be considered a s the above r e f e r r e d

to appendix.

ROLES, OBJECTIVES AND FUTURE PROGRAMS O F HOSPITAL DEPARTMENTS

ADMINISTRATION

Service

(1) Determination of the need for expansion of hospital beds, se rv ices and supportive facil i t ies, consistent with the needs of educational and r e sea rch p rograms and consistent with the legal obligations to serve a s a pr ime re fe r - r a l center . This includes giving recognition to such fac tors a s the constantly changing educational and r e sea rch needs, the demographic charac ter i s t ics of the service a r e a , the availability of alternative resources for medical and hospital ca re , and the constantly changing state of medical knowledge and techniques.

(2) Definition of the optimum intrahospital distribution of beds, s e r - vices , and supportive facil i t ies to provide a spectrum of properly sized, supported and coordinated units ranging f r o m intensive ca re through nursing home levels with extension on to ambulatory and home ca re se rv ices . A prel iminary est imate of shor t - t e rm bed needs for the immediate future, based on the cur rent need and demand f o r beds by clinical serv ices , i s approximately 200 in addition to those currently under construction in Masonic Memorial Hospital.

( 3 ) Recognition must be given to the necessity of reinforcing exemplary medical care with exemplary hospital care , recognizing the dignity of the individual and the social and economic needs of the patient.

(4) Development of ambulatory ca re facil i t ies and serv ices in a comprehensive manner which will give proper consideration to the emerg- ing medical, organizational and educational environment. This development must also give recognition to the necessi ty of reinforcing good medical ca re with thoughtful attention to other patient needs and demands, such a s :

( a ) Efficient appointment and scheduling sys tems

(b ) Provision of necessary ca re in the shortest possible t ime consistent with educational needs

( c ) Adequate parking, transportation and traffic pat terns

(d ) Necessary housing and dining facil i t ies

This concept will require a well organized, well staffed department, combining the resources of the ent i re medical school and hospitals. We a r e grateful f o r the excellent repor t by the Clinic Direc tors Committee and a r e wholehearted- ly in favor of their conclusions and recommendations.

ADMINISTRATION (cont'd. )

(5) Maximization of individualized patient care , giving recognition to the increasing sophistication and articulation of service demands by the public, g rea ter f reedom of choice of vendor for medical care by a l a rge r segment of the population, and the des i re to offset any possible tendency toward the de-

c humanization of hospital service a s the technology of patient ca re becomes increasingly "machine" oriented.

( 6 ) Identification of cost centers for hospital se rv ices including a de - lineation of costs f o r formal and informal educational efforts, acquisition of support and t ransfer of costs to other appropriate sources .

( 7 ) Utilization of automatic data processing capabilities in compre - hensive application to the Hospitals operation.

(8) Revision of accounting sys tems to provide improved efficiency in a l l phases of the f iscal operation of the Hospitals.

( 9 ) Development of equipment and supply distribution sys tems, methods and facil i t ies to incorporate a more closely coordinated approach to purchasing, warehousing, inventory control, distribution, efficiency and cost control.

( 10) Encouragement of cooperative associations with allied academic fields related to the operation of hospitals, e , g . , Public Health, Dentistry, Social Work, Industrial Engineering, Sociology and others .

(1 1 ) To cooperate with the Dental School in improving the hospital ( dental serv ices for outpatients and inpatients.

(12) To continue to cooperate with the Univercity Health Service in a s su r ing adequate hospital facil i t ies for University students requiring bed ca re , and in making available to University students those specialized s e r - vices not provided in the University Health Service i tself .

Teaching

(1 ) Cooperation with the various units of the College of Medical Sci- ences and associated Hospital and Health Care P rograms to strengthen the contribution of University Hospitals in the total educational endeavors of the University of Minnesota.

(2 ) Expansion of the in-service training program on a Hospitals- wide basis to provide adequately t ra ined personnel for non-professional hospital functions, including r e cognition of the possible support such efforts could lend to improving non-professional hospital skills on a statewide bas i s .

( 3 ) Interpretation of the Hospitals' multiple roles in teaching, r e - s ea rch and service to interested individuals and organizations including medical staff and employees, citizens of the state of Minnesota, state and national legislative bodies, s ta te and national administrative agencies, local,

state and national hospital organizations and all ied groups.

Research

(1) Establishment of a formally organized, supported and coordinated effort to conduct r e sea rch in hospital administrative serv ices .

( 2 ) Assistance by every means possible to the members of the Clini- cal and Basic Science faculty in the conduct of their r e sea rch .

( 3 ) Establishment s f specific r e sea rch into methods analysis (operations r e sea rch . ) ' i I

NURSING SERVICES

Service

Nursing ca re to patients i s now and will continue to be the p r imary purpose of the Department of Nursing Services . This c a r e will be individualized to meet the needs of patients. Nursing ca re will be given by p ro fes - sional and technical nurses who will be ass i s ted by auxiliary staff. An in- c reas ing number of par t- t ime nurses will be utilized.

Nursing service will be more diversified, encompassing care for acutely ill, convalescent and ambulatory patients within the Hospitals a s well a s extending to care in the patient 's home environment. There will be a grea ter emphasis on patient teaching, both individually and in groups.

With rapid changes in the health serv ices and changes in the educational programs for nu r ses , there will be an increased need for more intensive orientation and continuing educational p rograms . This will necessitate a n increase in nursing staff to teach and a s s i s t new employees. There will

a l so be a need for expanded teaching facil i t ies for both smal l and la rge groups of employees. New techniques, such a s programmed learning and television, will be used to facilitate learning of employed staff. Continuing educational p rograms will a lso be geared to meet the needs of nu r ses reentering the nursing field.

Changes a r e anticipated which will make i t possible for nu r ses to give m o r e d i rec t care to patients. Some of these anticipated changes a r e :

( 1 ) Nursing units will be managed by non-nurses.

( 2 ) Functions of a l l departments in the Hospitals will be clear ly defined and coordinated.

NURSING SERVICES I cont'd. )

(3) Monitors, computers and other information systems will be used increasingly and will be operated by technicians o r technologists. c

(4) Intercom sys tems will be used to facilitate communications with patients .

(5) Intercommunication and delivery sys tems will be instituted, en- abling nursing service personnel to spend more t ime with patients.

(6 ) Disposable supplies and equipment will be utilized, reducing o r eliminating cleaning now performed by nursing service personnel.

Teaching

The future role of the Department of Nursing Services in teaching will be an increased emphasis on teaching employed staff a s mentioned in the s e r - vice ro le . This will necessitate a substantial increase in the numbers of in- serv ice educational staff and teaching facil i t ies.

Although the pr imary role of the Department i s service, the staff i s involved, and will continue to be involved, in teaching in various ways:

(1 ) Demonstrating exemplary nursing ca re

( 2 ) Orienting students and/or faculty members to the physical environment and to patients

(3) Assisting employees f r o m other Departments in relation to needs of patients

(4) Teaching in specialized a r e a s such a s ca re of patients with kidney dialysis, hear t surgery, etc.

(5 ) Conducting continuing educational programs fo r nu r ses in the community (local, national and international)

The Department will initiate and conduct r e sea rch in nursing and nursing se rv ices . Research will a lso be conducted jointly with the School of Nursing and Public Health Nursing. There i s potential for expansion of interdisciplin- a r y r e s e a r c h including other Departments in the Hospitals, medical staff and Hospital Administration staff. An increase in r e sea rch activit ies will neces- s i ta te additional prepared staff.

Nursing service staff will continue to a s s i s t with medical r e sea rch . Hopefully, however, some of the t ime consuming technical ass i s tance in medical r e s e a r c h can be assumed by technicians, freeing nur ses for nursing c a r e . (.

HOSPITALS L A BORATORIES

A summary of requirements and policies with respect to space for the Hospitals laboratory serv ices may be made a s follows:

(1) Even with the new Southwest Court Development, which will bring the total space assigned to the Department of Labora- tory Medicine to about 25, 000 square feet, space limitations will become cr i t ical within the next five y e a r s . A number of developments make this likely, including;

( a ) Continued growth of volume of requests for laboratory serv ices

(b ) P r e s s u r e s to add new serv ices

( c ) Growth of teaching responsibil i t ies, especially in the a r e a of Medical Technology

( 2 ) The ra te of increase in laboratory work volume over the past few y e a r s i s expected to continue for many more y e a r s , Fur the rmore , the requirements of special clinical r e sea rch projects , such a s the transplantation studies, child development studies, and can- c e r and leukemia studies a r e adding both to overall volume and to requirements fo r new serv ices . We plan to respond to demands f r o m the clinical serv ices by initiating new serv ices in the a r e a s of immunology, hormone analyses , enzyme analyses , acid-base analyses , radio-isotopes and biochemical genetics. Electron microscopy i s likely to become both a training and serv ice facility within our sphere. Areas which a r e likely to expand a r e clinical chemistry, microbiology and virology, blood coagulation laboratory and the genetics laborator ies .

( 3 ) If the laboratory i s to continue to meet the obligations placed upon i t a s a constituent unit of the s tate university, i t will have to continue to t r a in medical technologists. The c lasses a r e instantly increasing in s ize, and since there a r e many urnsatis- fied needs for personnel in this field, the c l a s s s izes can be expected to grow fur ther , to perhaps 100 in 1970 and 150 in 1975,

In o rde r that the Hospitals Laborator ies fulfill their multiple ro les in the y e a r s ahead and rea l ize in some measure their t rue potential f o r growth, it i s real is t ic to s ta te that 50, 000 square feet should be planned f o r the ent i re department by 1970 and 75, 000 by 1975. These figures include departmental teaching and r e s e a r c h space and include space for per ipheral s e rv ices such a s EEG, ECG and heart catheterization labora tor ies .

Finally, because a t present our faci l i t ies a r e s t rained to the l imit to provide the laboratory serv ices now required, - any new clinical - facil i t ies planned must include plans fo r new laboratory facil i t ies to service them.

RADIOLOGY DEPARTMENT

Service P r o g r a m

A definite t rend in the Department i s that a s new procedures a r e de-

c veloped in Radiology, which increases the work load of the Department, r e l - atively few of these new procedures become obsolete. The utilization of these new procedures , together with the increasing utilization of the older procedures , amounts to an increase in o v e ~ a l l service work in the Depart- ment of Radiology of f r o m 10 to 15 per cent a yea r .

Another long-range t rend i s that the future of the Department of Radiology i s extremely closely allied to the number of patients in the Univer- si ty Hospitals and the number of patients seen in the Outpatient Clinics. Con- sequently, our work load will be proportionate to the number of patients which will be seen in these two a r e a s over the next 15 y e a r s .

The Radiology .Department sees no suggestion that any type of procedure will minimize o r lessen the utilization of radiologic procedures . New procedure s and equipment a r e constantly being developed which the Department wants to utilize, such a s the use of video type for recording fluoroscopic examinations.

Teaching P r o g r a m

The School of X-ray Technicians, a s i t expands, will need increased c lass room and seminar space. At the present time the School has no space

( for the 80 to 100 students who gather for a two and one-half month lecture p rogram. The 30 students who a r e in the Department full t ime do not have space for teaching and organizing.

Research P r o g r a m

To continue r e sea rch , equipment will be m o r e essent ial than increased space. The cost of furnishing a r e sea rch diagnostic room may be near $100, 000, and two diagnostic rooms could be used for the present space for quarter ing animals .

MEDICAL RECORD DEPARTMENT

The planning for the future of the Medical Record Department i s closely linked with the remarkable capabilities which automatic data processing and new concepts in information s torage and retr ieval s e e m to offer the medical profession. The state of this technology a t present , however, includes a l a rge number of var iables , the proportions of which can now be only est imated. F o r this reason the following statements a r e predicated upon projections of the traditional medical records sys tems. It i s expected, however, that data processing will significantly affect the development of the Medical Records i Department over the next 15-20 yea r s .

MEDICAL RECORD DEPARTMENT (cont 'd. )

Space projections for storage of medical records , based upon present patient load, predict a need to double the present 2, 400 square feet of space within the next 10- 15 yea r s , (This est imate a s s a m e s that the 260, 000 r ec - ords in storage in Rosemount remain constant and that the bulk of each r ec - o rd does not increase markedly. )

Anticipated developments during the next 15-20 years include:

(1 ) Increase in Medical Records staff of a t leas t s ix people and addition of a second shift of Stenographic Pool typists. Twenty -four hour coverage of Medical Records Depart- ment i s a l so expected to become necessary .

(2) Development of a means to determine and abs t rac t f r o m the medical record the most pertinent information.

( 3 ) Increased attention given by medical staff to completion of communications about patients to the physicians and agencies fo r whom we a r e a pr ime r e f e r r a l center . This will be r e - flected in staffing and space requirements .

(4) Transfer of disease and operation coding f rom the medical staff to medical record personnel, a s well a s other duties, e . g. , abstract ing medical information f r o m the record .

(5 ) Development of r e sea rch record reviewing a r e a s easily a c - cessible to Medical Records where physicians can work on study projects .

( 6 ) Installation of centralized dictation equipment to make possible transcription of medical record information and r e - por t s f r o m a number sf inpatient locations around the Hospi- ta l s .

( 7 ) Development of a rapid method of transporting the medical r eco rd by pneumatic tube o r other devices.

(8 ) Establishment of a formalized school for training medical s e c r e t a r i e s .

PERSONNEL DEPARTMENT

The p rograms for the Hospitals Personnel Department a r e expected to become wider in scope and perceptive to grea ter depths a s Hospitals p ro - fess ions become more specialized. Basic to the expansion of p rograms i s the realization that numbers of patients, numbers of employees and hospital costs continue to r i s e . The l a rges t single component of hospital costs i s payroll . Efficient management and maintaining and improving quality of

PERSONNEL DEPARTMENT (cont'd. )

patient ca re a r e therefore imperat ive.

It i s important to point out that the needs of the Hospitals a s an o r - ganization serving a unique purpose within the total scope of University

c activit ies, which demands the use of more highly specialized skills by an ever increasing variety of health ca re professions, will require the r e - sponsive development of health care oriented personnel capabilities i f this vital resource for patient care i s to receive the attention necessary for p rogress along many dimensions.

The personnel programs a r e expected to be organized along two l ines . The f i r s t i s to bring to the Hospitals the best of industrial pract ices and techniques. The second i s to t ranslate into personnel programs the unique and differing aspects of the Hospitals organization and activit ies so that achievement relevant to the efficient use of total resources and provision of high quality patient care may be accomplished.

The above statements imply an expansion of services which will need be reflected in space allocation and staff requirements . Fur ther statement of space needs etc . awaits more exact definition and development of pro- g rams . However, this important aspect of the hospital activit ies will definite- ly be a factor requiring consideration and expression in long- range planning.

EMPLOYEES HEALTH SERVICE

The present program of the Employees Health Service encompasses:

(1) Physical Examination of Employees

( a ) Pa r t i a l preemployment physical examination when there i s a question of job placement

(b) Pa r t i a l examination when needed for clearance evaluation, re turn to duty o r modification of duty

( c ) Pa r t i a l examination a s required for food handlers

( 2 ) Clinical Care of Employees

( a ) Brief observation for minor i l lnesses

(b) Evaluation and r e fe r ra l for definitive ca re in case of major i l lnesses

( c ) Evaluation of employee's condition a s it re la tes to potential contagion to patients and other employees

EMPLOYEES HEALTH SERVICE (cont 'd. )

( 3 ) Supervision of c a r e of employees who have had industr ia l accidents

( a ) Trea tment of hospital employees injured a t work o r general supervision while employee i s being t rea ted in another a r e a

(b ) Evaluation of condition of University employees injured a t work

( c ) Completion of Physicians Reports fo r Industrial Com- mission fo r employees of Hospitals and University a s a whole injured a t work

( d ) A r rangement for special examinations for employees who have had industr ia l accidents

(4) Tuberculosis control

Administration of p ro g r a m which includes mantoux testing and periodic chest x - r a y s

(5 ) Staff immunization

( 6 ) P r o g r a m of Health and Safety Education

The Health Officer a c t s a s l ia ison physician with State Board of Health i n report ing communicable d i seases . He checks r epo r t s of patients in i so la - t ion with the medical staff, par t icu la r attention being paid to health of e m - ployees car ing f o r patients. He surveys and t r e a t s staff who have been ex- posed to contagious d i sease .

P r e s e n t employee facil i t ies a r e inadequate. There i s immediate need fo r two examining rooms and m o r e space for r eco rds .

Fu tu re P r o g r a m

Additional and expanded fea tures :

(1 ) Physical examination of employees

( a ) Complete preemployment physical examination of employees

(b ) Annual physical examination of employees

( c ) Annual food handlers examinations

( 2 ) Continue with p re sen t p r o g r a m

EMPLOYEES HEALTH SERVICE (cont 'd. )

( 3 ) Care of a l l University employees injured a t work

( (4) Continue with present program

(5) Include Medical School

( 6 ) Greater participation in Education and Inspection programs

I t i s anticipated that a qualified epidemiologist would direct the pro- g ram. His support would improve control and reporting of communicable d iseases and se t standards for clearance of staff ill with communicable d isease .

Space needs of the future depend on growth of Hospitals, i. e . , increase in number of employees .

REHABILITATION CENTER

At the present t ime chronic disability incapacitates more than ten p e r cent of our population. This proportion will increase in future yea r s a s acute medical ca re becomes even more effective in saving lives and thereby inc reases the number of persons with chronic disabili t ies. Adequate attention to the medical needs of patients with chronic disability requires the development of comprehensive medical management both f rom the standpoint of optimal medical care and f r o m the standpoint of decreasing dependency.

(

Comprehensive medical management of patients with chronic disease and disability requi res a multi-disciplinary approach.

The Rehabilitation Center of the University of Minnesota Hospitals provides within a single a r e a of the Hospitals for the multi-disciplinary approach necessary to provide the comprehensive medical management which i s required for the care of patlents with chronic disease and disabili ty,

The major roles of the Rehabilitation Center in the University of Minnesota Hospitals a r e threefold:

(1) To provide the optimal ca re for patients with disability which will resul t in their obtaining the optimal level of function in society.

( 2 ) To develop within students in the health professions the concept of comprehensive ca re of the patient a s the minimal p ro - g r a m for the adequate ca re of patients by providing a model of multidisciplinary coordination in the assis t ing of patlents to achieve the optimal physiological, psychological, and social levels of function. (.

( 3 ) To develop new techniques and programs for the bet ter management of patients, and for the better education of m e m b e r s

REHA.BILITATION CENTER (cont 'd. )

of the health professions in comprehensive medical management of patients with chronic disease.

The goals and objectives of the Rehabilitation Center a r e :

(1) To provide within one a r e a an integrated team approach in the provision and teaching of rehabilitation methods for the chronically disabled. The Center operations a r e designed so that in the clinical teaching of students of the health professions, they can participate in a learning experience focused upon the patient through demonstration, precept, and tutorial methods.

(2 ) To provide for coordination with physicians and other health professionals in our state and region in the continuing management of patients with chronic disease and in educating them to meet the problems of the ever increasing number of these patients .

( 3 ) Providing exemplary rehabilitation programs for the disabled and chronically diseased in a coordinated manner both within the Center and the Hospitals.

(4) To provide for evaluation of our teaching programs to the health professions a s to their effectivenes s in furthering the concept of comprehensive medical management, and of our efforts to fur ther coordination with the community a t la rge of the procedures and methods used in providing comprehensive rehabilitation serv ices .

The programs of the Rehabilitation Center which a r e now involved in car ry ing out the goals and objectives a r e :

(1) Integral participation in the Comprehensive Clinic program in the training of medical students in the basic concepts and methodology of comprehensive rehabilitation and providing them experience in a multi-disciplinary program in o rde r that they may be prepared fo r s imi lar activit ies in their professional pract ice. At the present t ime and part icular ly i f there i s an expansion in the c lass s ize of medical students, there i s a need for bet ter facil i t ies in the Rehabilitation Center for providing the students instruction and demonstration in rehabilitation.

(2) The responsibility for providing students of health professions, other than medicine, clinical experience a s members of a multi- disciplinary t eam in the management of the chronically disabled. This involves providing the necessary clinical experiences and / training for physical therapis ts , occupational therapis ts , speech I therapis ts , clinical psychologists, vocational counselors, and public health n u r s e s . There i s a need for m o r e of these members

REHABILITATION CENTER (cont 'd. )

of the health professions and a s the number of students in each field i s increased, the present facilities and/or operations of the Center will have to be modified in order to provide for their training.

( 3 ) The provision of the clinical training of physicians specializing in the field of medical rehabilitation.

(4) Meeting the need for " ref resher" programs for therapis ts who have discontinued pract ice for various reasons but who wish to and a r e being encouraged to return to pract ice. At the present t ime the number of these professional persons in the rehabilitation field i s small but because of the increasing need, the Center will be assuming a grea ter responsibility for their retraining. Additional personnel and facil i t ies fo r the educational programs these people require will be necessary. Also, the Center i s now serving a s the p r imary training source for foreign trained therapis ts in the field of rehabilitation. It i s anticipated that the demands for these programs will a l so increase requiring the use of additional facil i t ies and educational techniques.

(5) To provide comprehensive serv ices to patients of the University of Minnesota Hospitals. At the present t ime the facil i t ies of the Rehabilitation Center can just provide f o r the present hospital population. If the hospital expands the number of patients cared for , whether in-patients o r out-patients, and also in light of the increasing number of chronically disabled, the present facil i t ies will need to be increased and/or the methods of operation changed in o rde r to provide the necessary rehabilitation s e r - vices for patients. Par t icu lar ly cr i t ical a t the present t ime, and cer tain to increase , i s the need for additional facil i t ies for the professional personnel providing psychological, social , and vocational rehabilitation serv ices .

) To develop better methods of assess ing the programs of the Center . There i s a t present a need to m o r e objectively evaluate the serv ices provided patients, the effectiveness of the clinical training programs, and the administrative operations. In the future a s the utilization of this comprehensive rehabilitation facility for teaching, r e sea rch , and service increases , it will be necessary to provide f o r and employ those pertinent technological advances in communication, automation, and computers to i m - prove the effectiveness of the service and educational programs a s well a s to provide for their evaluation.

NUTRITION DEPARTMENT

Nutrition Department submits the following p rograms a s having i m - portance for the future:

NUTRITION DEPARTMENT (cont'd. )

(1) Increasing efficiency of food service through expansion o r r e - organization of facil i t ies to provide adequate working space, accommodate new equipment to allow grea ter use of p re - packaged, preportioned, frozen foods and by controlling labor cos ts .

( 2 ) Careful study of the feasibility of inauguration of centralized food serv ice .

( 3 ) Extension of selective menus to al l patients on general and modified diets .

( 4 ) Provision of dining facil i t ies for ambulatory patients and outpatients.

( 5 ) Use of automatic data processing for a range of activit ies, including calculation of diet, recording food consumption, cost control, budgetary planning, menu planning, scheduling and employee records .

( 6 ) Development of physical facil i t ies on the nursing station f o r the dietitian.

(7 ) Increase of supervisory capabilities to allow the dietitian to make most effective use of he r ski l ls .

( 8 ) Develop dietary internship program a t the mas te r degree level in administrative dietetics o r therapeutic dietetics. It i s the department 's prediction that the internship program a s it i s present ly known will be incorporated a s pa r t of the University degree p rogram with a residency program leading to a m a s t e r ' s degree replacing the internship program.

PHARMACY DEPARTMENT

The Pharmacy statement i s comprised of the anticipated need for p ro - g rams which will:

(1 ) Expand service to include 24-hour pharmacy coverage.

( 2 ) Assume responsibility for preadministration additives to I . V . solutions.

( 3 ) Explore feasibility of improving drug distribution and adminis t ra - tion through utilization of some fo rm of unitdose dispensing.

(4) Expand manufacturing to nea re r 100% effectivene s s by providing space, equipment, and management necessary to undertake the

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PHA.RMACY DEPARTMENT (cont 'd. )

order ly and controlled production, storage, a s say, testing and distribution of a high proportion of solutions, ointments, t inctures , e tc . used within the Hospitals. (

( 5 ) Adapt automatic data processing techniques to a l l possible phases of pharmacy operation ranging f r o m inventory control to patients ' billings for drugs .

( 4 ) Upgrade personnel and professional capabilities by:

(a) Development of refined cr i te r ia for screening job applicants.

( b ) Utilization of non-profe s sional workers , under proper super - vision, wherever possible.

( c ) Definition of professional ve r sus non-profes sional duties

(d ) Cooperation with orientation programs to encourage hospital pharmacy a s a ca ree r choice for young people.

( e ) Participation in specialty training in hospital pharmacy a t a graduate student level .

(7) Cooperation in formulation of educational efforts to provide m a s t e r ' s and doctorate level training fo r hospital pharmacis t s . (

(8) P e r f o r m resea rch in product development and medication d is t r i - bution pat terns .

( 9 ) Encourage centralization within hospital pharmacy activities r e - lated to use of r e sea rch drugs.

CENTRAL STERILE SUPPLIES

The p rograms of the future for Central Ster i le Supplies will be shaped by pat terns of supply and equipment distribution worked out on a Hospitals - wide bas is . An expansion of serv ices i s anticipated a s programs to utilize the professional skil ls of nursing service a r e coordinated with the total scope of Hospitals activit ies .

In anticipation of such programs and in awareness of the need f o r c l ea re r definition of such programs the following a r e submitted by Central Ster i le Supply a s programs for the future:

(1 ) Centralization of a l l steri l izing procedures , with the possible exception of the operating room, for the ent i re Hospitals. (.

( 2 ) Centralization of bedside utensil processing.

CENTRA.L STERILE SUPPLLES Jcont 'd. ) _-- __________l__,_ '__ I_I__._,_ __._,->_I--

( 3 ) As si stance in development of central ized t ransporta t ion sys t em to include delivery and pickup of equipment and supplies.

(4 ) Improved inventory conlrol through g rea t e r coordination with a l l e lements ranging f r o m purchasing procedures to supply usage on nurs ing stations and cl inics .

MA.INTENANCE A.ND OPERATION

The p r o g r a m s for the future in this depar tment anticipate expansion of s e rv i ces along seve ra l dimensions, The increased awareness of the need to control not only the pat ients ' environme11.l with respec t to tempera ture , hu- midity, bacter ia l control e t c . , but specialized technical facil i t ies a s well, e. g . , computer rooms , hyberbar ic uni ts , e t c . would imply needs fo r a higher volume of m o r e special ized se rv i ces .

The advent of e lectronic monitoring equipment and other devices which appear to be just over the horizon will demand specialized, highly skil led technicians for maintenance.

Developmeni along both l ines will i nc rease the need to provide the se rv ice and the t ra ining neces sa ry to develop the ski l ls . A g rea t e r role in teaching and t ra ining of personnel with respec t to both the Hospitals, and, possibly the State, i s anticipated,

Future space requi rements should take into consideration de te rmina- tion of this expansion f ac to r ,

HOUSEKEEPING DEPARTMENT -------.-

This depar tment a l so anticipates increased specialization a s environmental demands and technical capabil i t ies i nc rease . A need i s seen to p ro - vide a degree p r o g r a m for Hospitals Housekeeping, with s t rong basic science emphas is .

A r e s e a r c h p r o g r a m i s a l so envisioned which should provide the r e - sou rces to explore new procedures and management methods.

VOLUNTEER SERVICES --- - -

Severa l f a c t o r s , including a t r end to shortened work weeks by some segments of society along with a possible growing "civic-mindednes s , I ' a r e predicted to produce a n inc rease in the supply for hospital volunteers, pa r t i c - u l a r ly among m e n and teenagers .

The demand for volunteer s e rv i ces i s expected to continue and, i n some ins tances- - e . g. , rehabil i tat ion se rv ice , chronic o r nurs ing home c a r e and

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VOLUNTEER SERVICES

psychiatry- - increase.

The public relations and patient morale contributions provided by volunteer service will continue to justify the space and financial resources necessary for such programs.

MEDICAL ART AND PHOTOGRAPHY

The College of Medical Sciences has an ever present challenge in the broad a r e a of communications, Communications figure strongly in the tasks of Service and Research in much the same way and to somewhat the same degree a s seen in the task of teaching. Teaching itself i s wholly an a r t of communication. The problems inherent in this task a r e augmented and magnified by the character of urgency of this endeavor; and the necessity of compacting ever l a rge r amounts of information into already cramped units of time places a s t ra in upon both teacher and student. At the same time the ve ry complexity of the knowledge being t ransmit ted demands careful p r e - sentation, endowed with clarity, simplicity, directness and precision.

Never before has the task of communication been so enormous a s i t i s in this field and a t this t ime. Considering the accelerated ra te a t which m o r e and more knowledge i s being added to the health sciences, the problems of communication faced now will be dwarfed by the same problems faced in the immediate future.

Service P r o g r a m

Our p r imary p rogram i s a service: to produce "visuals" (including char t s , graphs, a r t i s t s ' renderings, three -dimensional models, displays, flip- cards , live movies, animated movies and sti l l ~ h o t o g r a p h s ) which a r e used by the medical staff to supplement, improve, and simplify their communication tasks .

The very rapid expansion of the plast ics industry seems to be pointing to a number of applications in the medical "visuals" field which we should endeavor to incorporate into our department to add yet another facet to our schedule of available se rv ices , The growing adaptation of open and closed- circuit television to industry and education will undoubtedly resul t in even grea ter use of this technique by the College of Medical Sciences, and this department i s the proper agency to supervise and per form these serv ices . Therefore, i t would be real is t ic to assume that in the future this will be a ma jo r role played by Medical Ar t and Photography.

Teaching P r o g r a m

The Department will continue to teach the members of the medical staff how to best present their information; how to organize their resu l t s , methods of communicating, cost-cutting and t ime-saving techniques and the

MEDICAL ART AND PHOTOGRAPHY (cont'd. )

best mater ia l s to use for a given need. It has long been a des i re of the De- par tment to establish an accredited school of Medical Illustration a t the Uni- vers i ty of Minnesota. The development of such a school i s a lmost an obligation to the, cit izens of Minnesota. The space i s available, the teaching staff a t hand, and a very vocal public interested in this c a r e e r . It i s our s incere hope that such a teaching department will be a well-established institution in the next few y e a r s .

SOCIAL SERVICE DEPARTMENT

The activities of the Social Service Department a r e , a s mentioned in the department 's report , determined by a number of factors , many of which a r e external to the Hospitals. The potential impact of such factors should not be considerable emphasis in long-range planning. F o r this reason your attention i s directed to the ent i re report submitted by the Social Service De- par tment .

I . Role

The p r imary role of the Social Service Department i s to a s s i s t the doctor, hospital staff, and community agencies in helping the patient and his family to solve the social o r personal problems which affect medical ca re and adjustment to disability.

The Department a t the University Hospitals operates f r o m a broad base and se rves a s the focal point of contact for community and social agencies concerned with the social problems of people and i s a liaison between the Hospitals and a r e a s of the state f rom which patients come. In doing so the staff in te rpre ts the services of the Hospitals to community agencies and brings to the attention of the Administration those changes and developments which may affect the work of the Hospitals in providing ca re for people. The Department serv ices a r e designed to protect and facilitate the serv ices p ro - vided by the Hospitals staff. A la rge portion of the social worke r ' s concern i s directed to the life of the patient and family in his own community,

A social service department, in o rde r to c a r r y out i ts essent ial functions, must depend upon the cooperation of social agencies to provide serv ices and facil i t ies. The creative skill in casework depends upon the proper use and selection of r e sources . Because of the complexities of modern medical ca re , no community has a l l the r e sources required for the use of patients with varying conditions. A combination of r e sources and the creation of serv ices become a pa r t of this function of coordinating resources for the benefit of patients.

Education

The Social Service Department was s ta r ted to facilitate medical education and has continued in i t s 52 yea r s of existence to participate in the teaching p rogram of the medical school. The staff has been involved in the educational p rogram of medical students, residents , nursing, physical therapy, occupational therapy, hospital dietetics, and hospital administration. The staff

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SOCIAL SERVICE DEPARTMENT (cont'd. )

has a l so been involved in the training program of the School of Social Work. In interpreting the specific medical conditions of patients and the requi rements of the medical plan to community agencies, county welfare social workers , county commissioners , township officials, court judges, e tc . , the Social Service staff contributes to the education of people in the communities who a r e responsible for providing medical care . Periodically the Depart- ment sends mater ia l to 250 agencies on medical subjects o r topics of mutual concern.

Research

The Department has engaged in collaborative r e sea rch with the De- par tment of Psychiatry. Over the yea r s the staff has participated in the r e - s ea rch projects of other departments by following the patients and handling the problems in relation to participation in projects .

11. Future Objectives of the Social Service Department

In o rde r to make i t s greatest contribution to the total University Hospitals program, the functions of the Social Service Department must fit into the state welfare s t ruc ture , In so doing the staff takes an active role of leadership in ass i s t ing the state welfare organizations to plan and operate medical ca re programs for people and fulfills the l a rge r responsibility of a l l University departments to serve the people of the s tate . Therefore, no plan for the Department can be designed without reference to the changes and t rends in social welfare. With the changes now apparent and the ob- servable t rends in mind, the role of the Social Service Department, a s seen a t this t ime, will be modified in the future. The p r imary responsibility of providing social se rv ices to patients will remain the same . There will be new knowledge, refinements of techniques, changes in methods, but the core a r e a of the pract ice will remain.

Service Objectives

(1) To provide skilled social casework serv ices to patients whose social , personal o r family problems require solution a s a p a r t of the medical ca re plan.

( 2 ) To assume a leadership role in helping patients obtain the maximum benefit f rom the medical ca re received, and to p r e - vent r ecu r rences of i l lness .

( 3 ) To participate with social workers and other professions in community agencies in effecting plans for patients in accordance with the medical r e commendations.

(4) To contribute medical, social and psychiatric social work evalua- tions of specific patient situations to a s s i s t the community social workers in their work with the patient and his family.

SOCIAL SERVICE DEPARTMENT (cont 'd, )

(5) To provide consultative serv ices f rom the field of social work, experience in community organizations and general social work knowledge to the medical and all ied professions in the hospital team, all ied professions and community social workers , and o thers involved in programs concerned with health.

( 6 ) To integrate the serv ices of the department into the total p ro - g ram of the Hospitals and to take an active pa r t in ass i s t ing the hospital administration in providing the best possible s e r - vice for the people who come for medical ca re .

( 7 ) To work with medical staff, health teams, all ied medical professions in the total effort to provide a good medical service for patients.

( 8 ) To provide leadership to the social welfare field in the development of resources and programs designed to serve the medical and health needs of people.

( 9 ) To stimulate the development of new serv ices essent ial to good patient ca re .

(10) To participate with community organizations, agency boards, e t c . , in an effort to support and strengthen programs and facil i t ies concerned with various aspec ts of medical ca re o r with the prevention of i l lness .

111. Education

A . Teaching in Medical Education

(1,) To strengthen the teaching programs of the medical school by providing knowledge about the impact of the pat ient ' s social situation upon his medical condition.

( 2 ) To a s s i s t the physician in his concerns for the total c a r e of the patient which extend to family and community relationships.

( 3 ) To enrich the general medical education of doctors by providing those serv ices which will a s s i s t him to obtain maximum benefit f r o m the medical t reatment given to patients.

(4) To implement the teaching program through cooperation and joint participation of serv ices available to a s s i s t h im in his work with patients through social work and social agencies.

(5) To augment the medical plans through knowledge of local, state and national r e sources .

( 6 ) To help the physician define his role a s a citizen in providing


leadership in the development of health care p rograms .

B. Hospital Administration

To provide an educational experience directed in three different a r e a s :

(1) To broaden the adminis t ra tor ' s knowledge of social problems of patients which affect his goals.

( 2 ) To increase his familiarity with the specific operation of welfare programs, particularly those concerned with medical ca re .

(3) To demonstrate the serv ices the social service department p e r - fo rms which a s s i s t h im in his administration.

C. Ancillary Medical Professions

(1 ) To increase the student appreciation of the social problems of patients related to the medical condition.

( 2 ) To interpret the functions of the social worker a s a member of the health team.

(3) To augment the knowledge of resources available to a s s i s t patients o r their families.

(4) To broaden and extend the s tudent 's general information about social welfare p rograms .

D. Research

(1 ) To conduct independent r e s e a r c h programs into a r e a s of social fac tors a s related to medical ca re , motivation and rehabilitation.

( 2 ) To a s s i s t the medical and paramedical field in r e sea rch projects insofar a s patient ca re i s concerned.

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(3) To participate with the medical and paramedical professions in the a r e a s of social work concern of r e s e a r c h projects .

E . Health Education

(1) TO offer programs of health education for social workers , county commissioners , e tc , , and other special groups, planned and given a t the Hospitals by the staff.

(2 ) To plan programs designed to demonstrate the serv ices which the Hospitals can contribute in the social casework plans for people.

(3) To contribute mater ia l s of special significance to county wel fare departments , public health nu r ses , vocational counselors and


other interested groups.

(4) To promote inclusion of timely medical information on programs designed for people interested in the health f ie lds .

(5) To work with other groups - -public health nu r ses , vocational counselors, social workers and citizen groups - -in an effort to extend knowledge about specific medical conditlons and the r e - quirements of ca re and t reatment .

( 6 ) To be ever conscious of the educational importance of well writ ten medical social repor ts on patients.

(7 ) To initiate programs and cooperate with the other departments in the Hospitals in the recrui tment of young people into the health professions.

(8) To be ever mindful of the educational aspects of medical and social work practice a s related to specific patients and their famil ies .

( 9 ) To take leadership in working out institutes and conferences for social workers , particularly those employed in medical sett ings.

COMMITTEE FOR THE STUDY OF PHYSICAL FACILITIES FOR THE

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