The Autonomous Unit System at the Ontario Hospital, New Toronto: Part II
Authors: Ray Edward 
Published: April 2017

Part I gives a description of the unit system type of hospital organization and the other changes that were brought about at the same time. The conditions leading to the adoption of this plan were also discussed. The second section describes some of the effects of this plan in terms of hospital population movement. By necessity, the historical approach was employed although the weaknesses inherent in this approach are well known. In spite of insufficient data there are indications that the plan is producing favourable results. Results suggest that in-patient population is decreasing in spite of increased admissions, the difference being accounted for by more extensive use of hospital approved homes and of probations. Discharge rate has also increased since the inauguration of the unit system but data on re-admissions must be gathered before this situation can be properly evaluated. Also, patients who are to be discharged within a year will be discharged earlier than under the previous system. The third section deals with the advantages and disadvantages of the unit system, gathered from a series of interviews with many members of staff. A discussion of changed roles and functions of the various professions brings the paper to a close.

At this point it is important to consider the difficulties encountered in this type of study. Basic to any mental health scheme is a formal statement of objectives. It is important to know if a programme is aimed at returning patients to the community as soon as possible or restructuring personality according to some ideal, treating symptoms or curing a disease, providing custodial care or striving to reduce mental illness in the community. Are programme planners to accept present techniques and concepts or strive for progress and improvement? Is a programme to be service oriented or research oriented or both? Many of these goals are implied in projects but the point to be made is that these objectives need to be explicitly stated. Once this is done it is then necessary to state and develop objective criteria to indicate to what extent these objectives are being attained. Discharge and re-admission rates can reflect either patient status or hospital policy. What are the criteria for judging improvement after therapy? Rating scales, questionnaires and mental tests are a few attempts in this direction. Certainly more attention is needed to develop sensitive measures of change in these areas. Closely related to this matter is a lack of information in hospital records on which to base these estimates. Relevant information is not consistently obtained or recorded. To remedy this situation various departments need to contribute, on an equal basis, their recommendations concerning information to be collected. Then, as mentioned in the May 1961 issue of Mental Hospitals, the data could profitably be handled by an automatic data processing system so that uniform and necessary information is readily available for large numbers of patients.

Therefore, if evaluations of mental health programmes are to rise above the descriptive and subjective level, a critical review of objective criteria to measure progress or regression, and methods of collecting and recording patient data is warranted.

This paper is intended to be suggestive rather than conclusive. It is premature in the sense that one year of operation does not lend itself to a thorough investigation. The preliminary examination, like an initial intake interview, does, however, suggest answers to several general questions. In five years an exhaustive survey of this unit system will be undertaken and answers to many specific questions will be attempted.

This paper presents a subjective evaluation of the unit system approach to hospital organization. Advantages and disadvantages were gathered through interviews with staff members at all levels. Advantages generated improvements in many aspects of patient care and treatment, relationships between staff and relatives of patients, and the quality of work of the staff members both as groups and as individuals. Disadvantages were noted in duplication of services, role of the unit director, increased variability in clinical judgments and some areas of patient care. Some suggestions were made to eliminate these disadvantages.

Also discussed were changes in the professional roles and functions of the psychiatrists, psychologists, social workers, occupational therapists, nurses and attendants. All interviewees reported expanded roles and increased functions and felt that the unit system represented an improvement.

The paper closed with a consideration of the difficulties encountered in this type of study and the questions that must be answered before an accurate evaluation can be achieved.