The Royal Aberdeen Children's Hospital: 'hospital of the year 1989'.

In 1929 the Royal Aberdeen Hospital for Sick Children moved from a cramped Victorian building in the city centre to a new hospital on a greenfield site in the suburbs, constructed in the then fashionable pavilion style with tiny wards whose glass fronted verandas entrained draughts more often than they caught the sun. Linked by endless corridors, these wards which were 'lightly built to last for thirty years or so' remain the nucleus of the present Royal Aberdeen Children's Hospital, which has been awarded the accolades 'Best teaching hospital' and 'Hospital of the year' in the Sunday Times Best of Health Competition for 1989. This competition between NHS hospital managers 'to find Britain's finest hospitals' attracted 212 entries, the diversity of which was reflected in the submissions reaching the final round. The entry from Argyle and Bute Hospital described a five year plan to improve the quality of life for its psychiatric inpatients, the development of a community outreach programme, and the stimulating effects of an active teaching and research programme. Bolingbroke Hospital reported a quality initiative in a geriatric inpatient unit, with changes including new uniform design, the reintroduction of the post of 'matron' (who says we can't learn from the past?) and the daily hoisting of the hospital flag. The submission from the Royal Earlswood Hospital described the interaction between hospital and community in a mental handicap hospital, and that from Withybush Hospital described the impact of an 'Aspiring to excellence' programme on the care of patients in a district general hospital and the community it serves. The winning Aberdeen submission described the organisation development initiative and the quality enhancement programme which were central to the introduction of general management in the maternity and child health unit. The Griffiths report was implemented late in Scotland and a general manager was appointed to our unit only in 1987. He came from a nonmedical services background and his plan of campaign was awaited with some trepidation. In the event, the nearest military analogy was that of the 'hundred days,' spent not in frenetic activity culminating in disaster but in listening, observing, and evaluating; the frenetic activity was to come later and the disaster (fingers crossed) has yet to appear. An early product of general management in Grampian was the establishment, with the help of management consultants, of an organisation development initiative, designed to resolve numerous problems identified in questionnaires completed by over 1000 staff members from all grades in all disciplines. The problem list included poor internal communications, a defensive management style, resistance to change, the lack of a cohesive strategy, and a planning process that was opaque and secretive. These and other deficiencies were tackled by holding regular management briefings and seminars, by appointing a 'change agent' with specific responsibility for promoting innovation, by inviting a clinician, with the help of senior medical, nursing, and paramedical staff, to write a 10 year strategic plan for the hospital, and by appointing a clinician to a part time management role as 'clinical services coordinator' (that's me, folks). Two years later a repeat survey showed that the staff now felt much less isolated from management and that they belonged to an organisation that was (in the optimistic words of one of the questions) 'going places', even if (after the white paper) no-one knew quite where. As elsewhere in the acute sector, it was departmental policy that developments had to be paid for by efficiency savings. The first task of this 'new improved' management team was therefore to develop a strategy that would generate savings to pay for essential developments. Substantial savings resulted from competitive tendering (the in house team beat all comers), energy saving and so forth, but our area of greatest inefficiency lay in a permanantly low bed occupancy. This was addressed by a team of clinicians chaired by the manager, and the results of our deliberations radically altered the disposition of our patient and parent accommodation. The Children's Hospital had long been proud of its mother and baby unit, the first purpose built unit of its kind in the UK, opened in 1950 after a devastating epidemic of infantile gastroenteritis two years previously. Designed to allow hospitalised babies the protective effect of breast feeding, the unit had declined in popularity over the years, and attempts to resurrect it were never entirely successful. The function of the unit was therefore changed from that of a fully staffed ward for 12 parent-child pairs to a hostel staffed by a part time receptionist and catering for 24 parents. The demand for this accommodation is now almost insatiable. Surgical activity was shared between three wards, two of which were consistently under utilised. A small dermatology ward was conRoyal Aberdeen Children's Hospital, Cornhill Road, Aberdeen AB9 2ZG