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Annual Report the Surgeon General United States Army Fiscal Year 1959


Revision in Hospital Staffing Report

Army Regulations No. 40-202, dated 29 October 1958, revised the hospital staffing report, Assignment and Utilization of Army Medical Service Personnel, to reflect the incorporation of the composite medical care work unit implemented late in fiscal year 1958. This new work unit, which is considered a better index of hospital workload, combines in weighted fashion the numbers of beds occupied, admissions, births, dispensary and clinic visits, and physical examinations. The combining of inpatient and outpatient care work units has eliminated the need for prorating medical care personnel at the hospital level between those charged to inpatient care and those charged to outpatient care. This action, in conjunction with the realinement of the functional table in the report to conform with the management structure prescribed in AR 1-11, makes the report not only easier to prepare but more meaningful for purposes of analyzing personnel utilization. It is now possible to get a better basis for comparing personnel utilization between hospitals to one another. Personnel reporting is more accurate due to the elimination of the arbitrary proration between inpatient and outpatient care, and workloads are more realistically portrayed through the use of the composite work unit. While these are technical points, they are important in that they have improved the validity of the report and enhanced the use of the data it contains in making studies of personnel utilization within the hospital as well as in evaluating personnel performance between hospitals, between major commands, and among the three medical services, and also in distributing medical care personnel among the functional elements of the hospital.

Hospital Command Management System

By the end of the fiscal year, the ACMS (Army Command Management System), of which the HCMS (Hospital Command Management


System) is an integral part, was functioning at all of the installations and activities under the command of The Surgeon General that operate under the appropriation entitled 'Operations and Maintenance, Army.' Previous to fiscal year 1959, the HCMS had been installed only at the Walter Reed and Brooke Army Medical Centers and at five Army hospitals (Valley Forge, Fitzsimons, Letterman, Madigan, and William Beaumont).

The programming, budgeting, accounting, manpower management, and supply management systems continue to become more clearly aligned with each other and interrelated as originally intended by the Army Command Management System. This process of improvement is due to the impetus of the requirements of the new AR 11-45, Army Command Management System, published 9 March 1959, as well as to the detection, through operational processes, of inequities in the design of the system. While most of the objectional features of HCMS are believed to have been eliminated, the improvement process can be expected to continue for some years as individuals and organizational elements detect additional flaws.

Hospital Methods Improvement

Hospital staffing guide.-Department of the Army Pamphlet 20-557, Staffing Guide for U.S. Army Hospitals, issued in October 1958, provides guidance for determining the number and kind of personnel required to operate U.S. Army hospitals of varying size and workloads. The qualitative staffing information contained in the guide is designed primarily to aid in staffing hospitals at the installation level and in properly identifying positions in hospital tables of distribution. The guide does not constitute an authorization for personnel. While intended chiefly as a means of guidance for determining proper personnel requirements for performance of hospital functions, the guide also has an important aim-the conservation of manpower resources. In accordance with the Department of the Army policy of exercising utmost economy in the use of manpower, every effort is made to operate within the allowances and ranges of the guide, or to operate with fewer personnel. The management improvement program of the Army should result in increasing efficiency of operations. Such improved productivity is reflected in the periodic revisions of the staffing guide.

Revision of hospital organization manuals.-A program to revise the hospital organization manuals was undertaken early in fiscal year 1959. Comments were requested from army surgeons and class I hospital commanders in CONUS concerning a revision of AR 40-22,


Organization of Class I United States Army Hospitals, dated 29 April 1955. Their comments will form the basis for a revision of OTSG Administrative Letter 10-2 and for the publication of AR 40-22 in revised form. In this connection, all army surgeons were queried regarding the functions of the post surgeon and organization of that office. An evaluation of these comments will be coordinated with the revision of AR 40-22.

Outpatient medical records.-OTSG Administrative Letter 40-19, Machine Preparation of the Outpatient Report (DD Form 444), was published 5 December 1958. This publication contains detailed instructions in the prescribed method of preparing DD Form 444 at those medical treatment facilities having the use of electric accounting machines. The instructions cover those procedures which have been designed to collect the necessary source data and provide a mechanical method of consolidating and preparing the outpatient report prescribed in AR 40-419.

A study of mechanical record writing in the outpatient service resulted in the publication of a change to AR 40-425, Outpatient Medical Records, dated 18 January 1957, and the preparation of a Department of the Army circular in the 40-series. The study indicated that a system for mechanical record writing for the outpatient service in U.S. Army hospitals was both feasible and economical and has advantages over the conventional system now in use. This is especially true considering that the implementation of the system will provide uniformity for entry of repetitive information on outpatient medical records.