Sanitarium Management by L. M. Bowen

Review and Herald Publishing Association · Takoma Park Station, Washington, D. C. · Nov 25, 1909

Sanitarium Management

By L. M. Bowen

MANY difficulties and failures in our institutional work are due to ignorance as to the duties and responsibilities of its various officers and department leaders and a failure upon their part to realize the importance of co-operation. Whatever may be the plan of organization or management, it is the success of the institution as a whole that is desired. This requires the careful and unselfish operation of its departments individually and collectively.

In planning for successful sanitarium management, we should begin with its board of directors, who should be selected with a view to active service rather than of honorary membership. In other words, men should be selected who are adapted to the work by experience and inclination, and who are willing to help carry the load, rather than those who are already overloaded with the weighty affairs of conference or other institutional administration, with little prospect of giving more than a very limited amount of their time and counsel.

With the board properly organized, the basis upon which the enterprise will be operated is to be considered. Right here is where many mistakes have been made, and some of our larger institutions are crippling along, overburdened with debts, because they were not willing to begin in a small, simple way, and grow, adding to their facilities as the increase of patronage demanded and their experience increased. They wanted to be full-grown immediately, even though lacking in enough experience to operate a small work. The result is that large indebtedness has been incurred, the interest upon which overburdens and discourages the workers until they are dwarfed in their experience, and the work has been permanently injured. Many of our institutions have never fully recovered from these blighting influences of debt, and still worse results will follow unless they are rescued.

It is far better to start in a modest way, providing additional facilities as the profits warrant and the patronage demands, always from the income of the business. Thus a healthy growth is realized and appreciated by the workers, which serves to encourage them in their efforts.

The affairs of our sanitariums must not be conducted after a banking policy. Our business is to save souls, and while we should have value received from those patients who are able to pay, all must be treated with consideration and courtesy, always if possible retaining their confidence and respect.

Relations of Medical Superintendent and Business Manager

Naturally our sanitarium work is divided into two branches, which for convenience we will designate as the medical division and the business division, the former supervised by the medical superintendent, with the business manager as a counselor, the latter headed by the business manager, with the medical superintendent as counselor. These two individuals are directly responsible to the board of directors, and should receive from them their general instruction for the direction of the work. Here is the vital point. These positions should not be filled by those whose greatest desire is to rule something, but by men who are consecrated, unselfish, broad-minded, and liberal, willing to counsel and to be counseled with, and to share responsibilities with others. Neither should feel that the whole institution rests upon his shoulders, but that he is leader of a certain division, and that he has been provided with the very best man available as an advisor, and that in turn it is his privilege to be a helper to his associate in planning for the good of the whole work. Many of the details of the work should be gone over together; if the business manager feels called upon to make unusual purchases, let there be the fullest agreement and understanding between the two as to the necessity and as to how the money can be invested to the best advantage. To ask the physician to assist in the work will tend to enlist his co-operation and confidence. In turn, if the medical superintendent feels the need of additional apparatus or of making important changes, let him advise with the business manager as to the propriety of the action, considering the conditions. If an agreement between themselves is not sufficient, the matters should have the approval of the board of directors. Thus they should feel that it is not only a duty but a privilege to counsel together regarding the work entrusted to their care. No opportunity should be let slip to gain each other's sympathy and support, realizing that independently neither can make his division of the work a success.

Get close together, and keep close together. While differences of opinion will doubtless arise regarding some of the details of administration, never allow them to become personal, but remember that these differences are opportunities to practise the principles of Christianity, "In honor preferring one another," and that it requires two to make a quarrel. Never, under any circumstances, if differences do arise, allow your associates or family of workers to know it, for it is almost sure to be magnified, and the workers will take sides, to the great detriment of the work and disgrace of the principals. Be examples to your workers; as you would have them co-operate with you, you must co-operate with each other. Advantage should also be taken of the advice and counsel of the chaplain.

A business manager should be secured, if possible, who has had experience in conducting a similar business, and who realizes the value of a dollar; whose principles is to make the income to the business meet its expenses, and who fears debt; who is willing to handle the institutional funds as carefully, or more so, than he would his private means. He should also be willing to counsel with his associates and to lead where he expects others to follow; not selfish to draw a large salary regularly, and expect the other workers to sacrifice and receive their allowance in small amounts as the treasury can spare it; and if occasion warrants a donation, he should head the list. He must be approachable alike to patients and fellow workers.

As the duties of the medical superintendent are generally to have the leadership of the medical departments,—which constitute the medical division—and all professional work of the institution; to attend promptly to the needs of the patients as they enter, either personally or by assignment, as he may elect, providing necessary treatment; to supervise the professional training and education of workers; to educate patients and guests by means of classes, lectures, and by personal contact, in the principles to which the institution is dedicated; to give attention to the discipline of all workers connected with the medical departments, and, in conjunction with the business manager, the whole family of workers: so the business manager, as the name implies, is to direct the financial affairs of the institution. He or his deputy should give prompt attention to the location of patients as they enter the sanitarium, having a definite understanding as far as possible as to prices, terms, etc., and if in doubt as to the financial standing of the new arrival, begin at once to look it up. He attends to the prompt collections of bills as they become due. Arrangements for discounts, remitting of charges, correcting bills, etc., should all be handled by

the business office.

The pricing of surgical operations, after consultation with the physician, as the latter is better able to judge a fair fee and is very often better acquainted with the circumstances of the patient, is done by the manager. In fact, he represents the institution in all negotiations involving finance, but he should make no arrangement with the patient which is liable to hamper the physician, without consultation.

He should also make financial arrangements with workers, employing and discharging all irregular help, providing for all obligations promptly as they fall due, and attending to the purchase of supplies and apparatus as directed by the board. He should make a continual study of the finances of the institution in order to be able to take advantage of opportunities to better conditions, planning carefully and wisely for the interests of the work. His assistants are the matron, steward, bookkeeper, clerk, and the department leaders.

(To be continued)

L. M. BOWEN.