hospitals

Question 1

3 ways the hospital has transformed

Answer 1

charity for the poor
temple of science
complex bureaucracy

Question 2

hospitals as charity for poor - in past

Answer 2

run by religious institutions

• general hospital owned by municipalities
• relied on unpaid labour : nuns + student nurses = lived on hospital, not married, female, undifferentiated work
• go to hospital if no where else to do.
• richer = doc comes to you

Question 3

what did the flexner report find?

Answer 3

marked the beginning of the transformation of the hospital into a temple of science - aspire to highest ideals about how ppl should be taken care of when sick

Question 4

recommendations from Flexner Report

Answer 4

hospitals as places of learning for medical students (few docs attached to hospital in church. now more in addition to practice)
-> medical schools to be affiliated with unis (embody highest ideals - science + knowledge)

Question 5

how purpose of hospital changed?

Answer 5

no longer dispense charity.

provide best diagnostic + therapeutic facilities available.

Question 6

evidence for transformation into a temple of science

Answer 6

1. growing revenues
2. changing clientele
3. changing skills of the hospital worker

Question 7

how growing revenues are evidence to transformation

?

Answer 7

Ontario
1880: average cost (0.57), patient fees account for 9% of revenue

1920: average cost - $2.84/day and patient fees are 65% of revenue

average cost increases, new services, greater attention to hospital.

Question 8

how changing clientele is evidence to transformation

Answer 8

increased number of patients, shorter stays

Question 9

how changing skills of hospital worker is evidence to transformation

Answer 9

• education

- still poorly paid

Question 10

from temple of science to complex bureaucracy

Answer 10

• rising operating cost (greater investment in system)
• increase # of employees
• increased differentiation + specialization of hospital work

Question 11

how operating cost rose?

Answer 11

1948: 130 mill. wage =50%
1973: 4.8 billion wage=70%
2003: 16.5 billion wage =75%
(more wage when more dominance)

Question 12

how number of staff changed?

Answer 12

1934 - 67 workers / 100 beds
1991- 185 workers per 100 beds
- more beds, more external services, more workers

Question 13

how differentiation and specialization increase

Answer 13

- structured hierarchy of workers
= diff tasks assoc w diff functions. 
= male, docs are highly paid.
-- less important jobs- varied ethnicity
- power imbalance

Question 14

describe how mass production of automobile - factory style

Answer 14

start mass produce cars, lower cos, took assembly line idea

-standardized output (same product)
- intensified division of labour (assembly line)
-less skilled labour = single repetitive task (less control to workers)
- increased mechanization to achieve steady flow of production
== greater productivity + greater control over pace/intensity of work by owner.

Question 15

how is HC like a factory?

Answer 15

• standardized output (deliver care in certain/prescribed order)
• intensified division of labour (many diff ppl interact with - each has special function + in charge of that)
• less skilled, repetitive task (no, highly specialized)
• mechanization for steady flow of production (track movement thru hospital - recorded info = yes, tech involved)
• result?

Question 16

how are hospitals a health risk?

Answer 16

superbugs

workplace safety

Question 17

what did charles taylor do?

Answer 17

took studies - noticed how ppl make things. break task into components and make each person do one of those = assmebly line. more efficient.

Question 18

examples of superbugs

- what are they?

Answer 18

MRSA, VRE, C. difficile

- resistant to most advanced antibiotics

Question 19

how many ppl infected yearly? how many deaths?

Answer 19

200,000 in canada yearly.
1/12 hospitalized acquired
8000-1200 deaths a year

Question 20

who is most at risk for exposure to disease/bacteria?

Answer 20

compromised immune system, old, young, long-time care, low hygiene.

Question 21

why is threat of superbug growing?

Answer 21

lax hygiene: improper sterilization + inadequate cleaning/hygiene
over-prescription of antibiotics. breeds resistance
farmers use antibiotics to animals.
pharmaceutical companies focus on chronic > antibiotic treatment

Question 22

CDC says rapidly approaching?

Answer 22

post-antibiotic era

->lose ability to treat infection. concern about safety of hospital.

Question 23

how workplace safety is health risk?

Answer 23

stressful work conditions(worker alienation, lose attachment to work bc dont see reward)

and injury, illness, violence

Question 24

result of stressful work conditions?

Answer 24

high absenteeism, turnover, burnout + low job satisfaction

= psychological + physical threats

Question 25

how stressful work conditions effect workplace safety?

Answer 25

high work demands,
inadequate staffing, poor work morale/low social support, work-life balance (manned 24 hrs a day, out of sync with family)

Question 26

how injury, illness, violence affects workplace safety?

Answer 26

injury: musculoskeletal injuries accound for greatest number of time-loss injuries among healthcare workers
illness: exposure to bodily fluids + sharps - contagions,

violence: sick are vulnerable. sometimes angry, over-react, anger.
attacked at work in HC > prison/police

great risk for physical assault

emotional abuse and threats of violence