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Abstract

SUMMARY
Drawing on the admission records, the medical casebooks and the publications of its director, this article explores how the University of Göttingen's maternity hospital achieved its three official goals: teaching medical students, training female midwives, and providing shelter for needy parturient women. Since educating medical men was the most important aim of the hospital, the paper particularly focuses on how the demands of instruction shaped day-to-day obstetrical practices, especially under the directorship of Professor Friedrich Benjamin Osiander (1792–1822). He was a keen advocate of the forceps, whereas the first director, Professor Johann Georg Roederer (1751–63), had taken a moderate, that is a much less interventionist, approach to obstetrics. Osiander avowedly was determined to subordinate the parturient women to the demands of the clinic and to treat them as 'living manikins'. In spite of that, there is evidence that the pregnant and parturient women, most of whom were unmarried and from the lower classes, made use of the lying-in hospital for their own purposes, and that sometimes they refused to play the role assigned to them. The link between the maternity hospital and the rise of the man-midwife and of 'scientific' obstetrics appears to have been particularly strong in the case of Göttingen and other German university hospitals, compared with lying-in hospitals in other countries where the link was more indirect.

Introduction. Today there is no doubt that mergers have permeated all sectors of society, including health care. Starting in the US, extensive waves of hospital mergers occurred at a record pace in the 1980's typically justified by promising dramatic financial and operational improvements. In the 1990's, the merger trend reached Europe and by the turn of the century "merger mania" had taken a strong hold within the UK. By the end of the 1990s, there had been a number of hospital mergers in Sweden. In 2004, Karolinska University Hospital was formed through the flagship merger between the Karolinska Hospital and the Huddinge University Hospital. In 2010, yet another prestigious merger of two university hospitals was announced with the formation of Skåne University Hospital. However, there has been almost no research on hospital mergers in Sweden. The aim of this thesis is to increase our understanding of the pitfalls and possibilities in merger processes by exploring the Karolinska University Hospital merger. The merger in brief. On 1 January 2004, the Karolinska Hospital and the Huddinge University Hospital merged to form the Karolinska University Hospital. Although the merger was controversial and far from obvious, the merger decision passed by a single vote in the Stockholm County Council on 9 December 2003. To achieve a balanced budget by the next political election in 2006, the new director of the merged hospital was told to reduce expenditures by €70 million over the next three years. The top management delegated identical assignments to all clinical managers: to reduce costs and to consolidate 125 clinical departments into 74 new departments each with a common management. Over the three-year period (2004 to 2006), the predicted cost savings for the merger were not achieved. Eventually the original implementation plan was withdrawn and the hospital director left the organization. Methodology and research questions. An embedded case study design was used to explore pre- and post-merger processes, in which data was collected by interviews, non-participant observation and extensive documents (allowing triangulation). Three studies addressing different organisational levels examined the following issues: how and why a merger decision that was considered "impossible" became possible (Study I); how and why top management's radical ambitions resulted in an unintended convergent process and dysfunctional outcomes (Study II); how and why considerably different outcomes in terms of clinical integration occurred at the clinical department level (Study III). Results. Spanning from the years 1995 to 2007, the three studies show that the merger processes evolved through a non-linear, undirected and complex interplay between external and internal actors. The process was mainly driven by the competing institutional logics of managerialism in a political and administrative arena, and professionalism in a scientific and professional arena. Means convergence and a politico-economic crisis led to the merger decision. The top management was overwhelmed by the "vertical clash" between managerialism and professionalism. On the clinical department level, managerial factors that hindered integration were a sole attention on the formal mandate from the top management, leadership based on one formal actor, and the use of a planned top-down approach to change. Managerial factors that facilitated integration were a dual attention to two majors stakeholders (top management and clinical staff), shared leadership between multiple actors, including an informal leader, and the use of an emergent, bottom-up management approach to change within the planned assignment. Discussion. The key finding is that the competing institutional logics between managerialism and professionalism seems to be the main driver of merger processes. This vertical conflict is probably the main explanation why intended outcomes were not achieved. While top management followed the merger literature's classic recommendation to focus on the horizontal tension and to take a planned linear top-down approach to change, the unanticipated challenge stemming from the competing institutional logics made it difficult for the management to handle the post-merger process. A true understanding of the intra- and inter dynamics inherent in a context with multiple layers of competing institutional logics, such as public sector health care, seems essential to produce functional organizational outcomes.

The modern hospital is at once the site of healing, the locus of medical learning and a cornerstone of the welfare state. Its technological and infrastructural costs have transformed health services into one of today's fastest growing sectors, absorbing substantial proportions of national income in both developed and emerging economies. The aim of this book is to examine this growth in different countries, with a main focus on the twentieth century, and also with a backward glance to earlier shaping forces. It will explore the hospital's economic history, the relationship between public and private forms of provision, and the political context in which health systems were constructed. The collection advances the historical world map of different hospital models, ranging across Spain, Brazil, Germany, East and Central Europe, Britain, the United States and China. Collectively, these comparative cases illuminate the complexities involved in each country and bring new historical evidence to current debates on health care organisation, financing and reform.

A "place for the sick" (bimarestan) had existed in Iran since the mid-sixth century, but such institutions never developed into real hospitals, except for a few instances during the tenth and eleventh centuries. Thereafter, until the twentieth century, their number was small and declining, and merely served as alms houses (dar al-shafa) for sick and poor pilgrims, which was why they were attached to mosques and religious schools (madrasehs). There was no major change in this situation until the mid-1880s. It was then that changes began to occur through the establishment of dispensaries, and later, hospitals. Four main groups were involved: the government of Iran, the government of (British) India and its affiliates, and American and British missionary organizations. Each had their own disparate policy objectives. Although the first Iranian government hospitals preceded the ones established by American and British missionaries, the services they offered were limited. They did not include surgery, which was the comparative advantage of the foreign hospitals. In addition, the latter offered better trained physicians, nurses, modern medical methods of treatment, and the use of medical instruments and devices. As a result, these Western hospitals had an important impact on the training of Iranian physicians and nurses. They also introduced modern methods of medical treatment, surgery techniques and medicines. Furthermore, they made it more acceptable for Iranian patients to seek treatment in a hospital, an institution not traditionally viewed as a place to heal but rather as a place to die. Despite their increasing role in providing medical care, the urban-based hospitals were too few in number, and not geared to address Iran's public health issues. In particular, they could not meet the medical needs of the country's mainly rural population. Nevertheless, the hard work and sacrifice of the staff of these modern hospitals laid the groundwork for Iran's much needed and comprehensive public health infrastructure and health policies. These were further developed in the 1930s and grew in speed and size during the 1950s. This book, together with Willem Floor's companion volume, The Beginnings of Modern Medicine in Iran, are essential histories for anyone interested in the inceptions of Iran's modern health care system

[Abstract] The modern hospital is at once the site of healing, the locus of medical learning and a cornerstone of the welfare state. Its technological and infrastructural costs have transformed health services into one of today's fastest growing sectors, absorbing substantial proportions of national income in both developed and emerging economies. The aim of this book is to examine this growth in different countries, with a main focus on the twentieth century, and also with a backward glance to earlier shaping forces. It will explore the hospital's economic history, the relationship between public and private forms of provision, and the political context in which health systems were constructed. The collection advances the historical world map of different hospital models, ranging across Spain, Brazil, Germany, East and Central Europe, Britain, the United States and China. Collectively, these comparative cases illuminate the complexities involved in each country and bring new historical evidence to current debates on health care organisation, financing and reform.

The modern hospital is at once the site of healing, the locus of medical learning and a cornerstone of the welfare state. Its technological and infrastructural costs have transformed health services into one of today's fastest growing sectors, absorbing substantial proportions of national income in both developed and emerging economies. The aim of this book is to examine this growth in different countries, with a main focus on the twentieth century, and also with a backward glance to earlier shaping forces. It will explore the hospital's economic history, the relationship between public and private forms of provision, and the political context in which health systems were constructed. The collection advances the historical world map of different hospital models, ranging across Spain, Brazil, Germany, East and Central Europe, Britain, the United States and China. Collectively, these comparative cases illuminate the complexities involved in each country and bring new historical evidence to current debates on health care organisation, financing and reform.

The story of Sunnybrook is one of battle and rebellion in the pursuit of excellence. With each battle endured, Sunnybrook Hospital forged new directions, becoming stronger and greater, often exceeding goals and beating significant odds. These very challenges enabled Sunnybrook to morph into the dynamic academic health sciences centre it is today

During its early history, the Japanese hospital in Steveston, British Columbia transformed from a small Methodist Mission Hospital to a modern medical facility. Unlike many other hospitals targeting non-White groups in British Columbia, it was the Japanese community itself that was responsible for this transition. The Japanese fishermen organized a subscription system and leadership board to establish and operate a modern hospital. The development of this unique institution was driven by broader cultural and political factors that reflected recent changes that occurred in Japan during the Meiji Restoration. During this period, Japan revolutionized and began a campaign of modernization and militarization, with the goal of becoming an imperial power equal to that of Western nations. These ideas were also utilized abroad as Japanese populations faced racism and exclusion from communities that supported the dominance of White-European culture. The Japanese hospital became a symbol of resistance for the Japanese community, an example of the success of Japanese populations in Canada. The history of the Japanese hospital in Steveston demonstrates that hospital development in Canada was not only shaped by medical advancement, professionalization of health care occupations or by state-driven initiatives, but also by the communities that established and maintained health care services during Canada's early colonial history. Presented at Consortium for Nursing History Inquiry 2013 Symposium ; Applied Science, Faculty of ; Nursing, School of ; Unreviewed ; Graduate

In XIX century the modern hospital develops because of and by means of the scientific revolution in medicine, and, in particular, in clinics. In the new hospital the new hospital the hippocratic praxis and the models of experimental medicine combine, together with mechanistic epistemology and the new general theory of illness, health and disease. The new medicine, founding on an anthropological view of life and death, links with a renewed political attention towards social events; the new idea of health proposes a new model for hospitalization in which doctores and manuales ( specialists in surgery) meet. In Italy, the evolution of the hospital tipology develops throught the century. Key words: Ospedali - Assistenza - XIX secolo