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Regulating Humanism
by Elizabeth Kanabe

Do you want to add a bed on the third floor? You must ask for permission from the state in what can be a several-hundred page application process. Seem a little extreme? It is how the hospital industry operates. Health care is extremely regulated, especially in New Jersey where I work. A hospital must ask for permission for every bed that it wants to add or take out of service.

Almost every function is regulated in New Jersey hospitals. The state decides if more psychiatric beds are needed, and hospitals must compete to be chosen for permission to be the one who opens those beds. Nursing ratios, overtime work (even down to the cleaners), among other aspects in every department are all regulated.

In most industries competition, money, new ideas and demand dictate what will happen. For hospitals, the state takes on this job. Applying for any change, addition or restoration takes a very long application process, approval time, and not to mention the thousands of dollars in application fees each time. When the hospitals can't keep up the supply side of care because of this process, the state might loosen a regulation, but it usually adds several others at the same time.

Some will argue that this oversight by the state is needed to ensure patient safety and that services are always available for all that need it. Others see it as huge obstacles to overcome every time a change is to be made in hospital services. But almost all who work for a hospital consider it a nuisance in the least.

A few weeks ago I was at a talk given by Arnold Gold and his wife, Sandra Gold, founders of the Arnold P. Gold Foundation*. Dr. Gold was a practicing neurologist at Columbia who noticed the decline of physician interest in patient care and compassion as new technologies and advances in medicine appeared. Rather than complain about it any more, he formed the Foundation that promotes humanism in medicine.

The Golds and their organization visit hospitals that feel they are doing well in the area of patient interest, as well as those that are interested improving. They provide resources and give talks for ways to encourage humanism in patient care. Hospitals benefit from the process because as their patient satisfaction goes up, patients return to them. Once they are feeling better, patients donít remember what medications they were given as much as they remember how they were treated. The Foundation does not have a desire to force hospitals to implement any programs. Hospitals utilize their services and can use outside consulting companies to measure patient satisfaction before and after changes are made, if they so choose.

When it came time for the question and answer session after the talk, I was amazed that three of the four questions were people that wanted to know how this could be regulated in hospitals. "How could the state ensure that every hospital implements this great new idea and what standard measurement tool can be used to compare hospitals to each other?"

The reason that the question was asked three times is because each time the Golds tried to explain that they have no desire to regulate this for every hospital, and some people could not grasp this. This is simply voluntary on the part of hospitals that have a desire to improve their patient services, but the idea is not meant to be forced onto hospitals.

Most of us understood this and agreed, but had we not ran out of time I expect that the question might have been asked a few more times. Some administrators can no longer imagine doing something simply for the sake of it improving performance and patient satisfaction at their hospital if they are not measured in it, forced to do it, and compared to other hospitals in a standard fashion.

* www.humanism-in-medicine.org

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