The use of technology, professionalism, data survey, and patient-oriented strategies in the 21st century may cloud our judgment or appreciation of the improvement in the healthcare sector. It is impossible to think of an era where patients did not have qualified personnel to address their diseases and the high mortality rates that a contagious disorder such as smallpox would cause. Thinking of the pain cancer patients would have endured, or the spread of viral diseases makes it essential to study the evolution of hospitals and the changes that facilitated the growth of the health sector that has led to some of the lowest mortality rates. The 20th century has changed the landscape of hospitals and service delivery it is essential to begin the study by focusing on the characterization and practices before the 20th century to understand the various changes. The effectiveness of this study is not based on hospitals only as hospitals can only improve healthcare delivery are dependent on policies, financing, and education or professionalism among other factors. Therefore it is imminent to address these factors to achieve the research objectives.
History of Hospitals in the U.S. Since Independence
According to Loker (2012), the U.S. healthcare following independence was based on a system that included home remedies and doctors with inadequate training in disease diagnosis or treatment. Most diseases that are easily treated or prevented in the modern era were fatal at the time. Family played the most prominent roles in the success of the home remedies as women had to take care of the injured or ailing relatives. Midwifery was performed by old women at the homes of the pregnant mothers thus reading to the high infant mortality rate (U.S. Department of Health, Education, and Welfare Public Health Service National Institutes of Health, n.d.). The more than half deaths among the infants at birth is a depiction of the ineffective and unqualified practitioners. The itinerant doctors that visited patients in their homes were incompetent and had poor service deliveries. According to the national archives on healthcare, the inadequacy of trained personnel and institutions to treat patients was due to the lack of educational institutes that would educate medical practitioners hence the reliance of the French and British to aid in treatment. The two European nations possessed better medical knowledge that they used for the treatment of their military.
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Americans would only acquire higher-education in European universities until Morgan and Shippen, graduates of Edinburgh, founded the first medical institute in Pennsylvania, which is currently part of the University of Pennsylvania in 1765 (U.S. Department of Health, Education, and Welfare Public Health Service National Institutes of Health, n.d.). However, the levels of service delivery were still inadequate with the fear of contagious diseases leading to the start of quarantine stations which increased the spreading of ailments (Rothman, & Wheeler, 2013). Bellevue Hospital is one of the first forms of hospitals but as the “Poor House of New York City” established in 1736. In 1789 the Public Hospital of Baltimore was built but was aimed at patients suffering from mental or physical illnesses from the low-income population (U.S. Department of Health, Education, and Welfare Public Health Service National Institutes of Health, n.d.). The pest houses dominated the 18th and 19th centuries with the poor sanitation increasing the mortality rates and spread of ailments such as cholera. In 1889, the Johns Hopkins Hospital was opened. The hospitals in the 19th century were characterized by dirt and containment in unventilated houses thus influencing the increase in infections. Religious groups played a crucial role in enhancing change with Catholics and Protestants providing nursing training (Helmstadter, 2008). The nursing profession was preserved for women and limited the women to pursue medical degrees as doctors.
Modernization and Improved Service Delivery in Hospitals
The end of the 19th century saw the transformation of hospitals and the healthcare provision due to the focus on sanitation to reduce the spread of germs and the change in the medicine courses to focus on research. The focus on researches and surveys complemented by the over 131 medical schools in the U.S. with most joining to form stronger institutions by 1920 changed the scope of the healthcare sector (U.S. Department of Health, Education, and Welfare Public Health Service National Institutes of Health, n.d.). The introduction of insurance following WWI made hospitals and service delivery focus on patients’ well-being rather than isolating them as had been the norm. The Hill-Burton Hospital Construction Act signed in 1946 depicted that the aim was to expand the health sector by enhancing innovation, research, hospitals, diagnosis, and financing of the health sector. Significant scientific and medical discoveries, for instance, the penicillin, x-rays, laboratory tests with improved or advanced technology reduced the misdiagnosis that had dominated the earlier periods (Loker, 2012). Since the 1960s, surgeries, technologies, changes in policies, advanced and diversified education have enabled the transformation of the health sector.
Studies in patient-oriented and evidence-based treatments have been used in the growing number of hospitals. The advancement in financing through financing and changes in service delivery with the government support even for the private sector led to the growth of hospitals from the 173 in 1873 to 7,200 in the 1980s is a testament of the changes facilitating hospitals growth. The Medicare established in 1966 provided aged patients to acquire quality health with the different health insurance playing a vital role in the expansion of hospitals (Loker, 2012). Government support and merges to improve the health sector have led to the improved healthcare delivery in hospitals.
The use of surveys and statistics since the 1990s have improved the service delivery with patients’ satisfaction dominating the objectives of the hospitals. Electronic health records (EHRs) since the start of the 21st century have enhanced data recording with the intention of strengthening efficient patient treatment by reducing errors (Burstin, Leatherman, & Goldmann, 2016). Evidence-based studies since the 1990s have focused on communication and teamwork in the health professionals thus improving the entire healthcare delivery in the modern hospitals.
The history of hospitals in America is depressing, but the progress that has taken place is encouraging. Hospitals are clean, diagnosis before treatment is mandatory, proficiency in diversified skills within a hospital and the embracement of technology has changed the landscape of health and service delivery. Patients’ opinions are valued, and pest house is a thing of the past.
References
Burstin, H., Leatherman, S., & Goldmann, D. (2016). The evolution of healthcare quality measurement in the United States. Journal Of Internal Medicine , 279 (2), 154-159. http://dx.doi.org/10.1111/joim.12471
Helmstadter, C. (2008). Authority and leadership: the evolution of nursing management in 19th century teaching hospitals. Journal Of Nursing Management , 16 (1), 4-13. http://dx.doi.org/10.1111/j.1365-2934.2007.00811.x
Loker, T. W. (2012). History and evolution of healthcare in America: The untold backstory of where weve been, where we are and why healthcare needs more reform . Bloomington, iN: iUniverse Inc.
Rothman, D. J., & Wheeler, S. (2013). Social History and Social Policy . Burlington: Elsevier Science.
U.S. Department of Health, Education, and Welfare Public Health Service National Institutes of Health. 200 Years of American Medicine . Nlm.nih.gov . Retrieved 16 March 2018, from https://www.nlm.nih.gov/hmd/pdf/200years.pdf
