Rise and demise of the hospital: a reappraisal of nursing

doi:10.1136/bmj.331.7529.1394

BMJ 2005;331:1394-1396 (10 December), doi:10.1136/bmj.331.7529.1394

Education and debate

Rise and demise of the hospital: a reappraisal of nursing

Nick Black, professor of health services research¹

¹ Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT nick.black@lshtm.ac.uk

Doctors, managers and politicians have tended to underestimatethe importance of nursing. Greater recognition is crucial forthe success of modern hospitals

The first 150 words of the full text of this article appear below.

Introduction

Hospitals face an uncertain future. After a century of achievementand progress, the public, clinicians, managers, and politiciansare increasingly expressing concern. Currently, the UK public'sprincipal worry is the danger of hospital acquired infection,particularly methicillin resistant Staphylococcus aureus (MRSA),¹but it also includes mixed sex wards, poor quality food, inadequatecleaning, insufficient attention from staff, and the risk ofbeing the victim of a medical error. In 2000, 850 000 adverseevents occurred a year, costing the health service £2bn($3.4bn; ${euro}$ 2.9bn).² Up to 40 000 patients die each year becauseof iatrogenesis, with a similar incidence in other industrialisedcountries.³ This contributes to politicians' enduring concern:hospitals' apparently insatiable appetite for resources.

Attempts to achieve greater efficiency through economies ofscale are leading to fewer, larger general hospitals.⁴ Ironically,this is happening at a time when public confidence in largergeneral hospitals is waning, with the prospect . . . [Full text of this article]

Previous demise

Transformation of hospitals in the 19th century

Medical responses to nursing reform

Why do hospitals face their demise?

What can save the hospitals?

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