Hospitals Board.

But the recent appointment of the post of Chief of Staff has enabled better communication between staff and patients as well as improvements in the Hospital's quality of care.

In the summer of 1991, the Bermuda Hospitals Board asked that the Bermuda Hospitals Board Act be amended. The amendment changed the organisation of the medical staff to make them more responsive to the Board. Instead of having the medical staff elect the officers, the Board appointed a Chief of Staff as well as Chiefs of various clinical Departments.

"It was a framework adopted by the Board to create a more responsive and responsible medical department,'' said Chief of Staff, Dr. William Cooke.

"As a result, the post of medical director was abolished. And the part-time position of Chief of Staff was implemented,'' he added.

The Chief of Staff's duty is focused on medical staff activities and the quality of care in the Hospital. His duty also includes being a member of the Board.

He chairs the medical staff committee which is made up of all Departmental Chiefs, and is advisor to the Board with respect to the quality of medical diagnosis, care and treatment provided to Hospital patients.

"In effect, he is an instrument of the Board used to improve the quality of care in the Hospital,'' said Dr. Cooke.

The medical staff of the Hospital is governed by bye-laws, which are organised in order that staff meet their responsibility to the Bermuda Hospitals Board, to the community, and to the patient, for the provision of good quality medical care. The Chief of Staff makes sure the medical staff abide by the rules of these laws.

"The medical staff bylaws have been extensively revised to effect changes resulting from the Board's restructuring of the medical staff and its determination to provide high quality patient care in an organised environment,'' said Dr. Cooke. "And the bylaws concentrate a great deal on staff discipline -- only high levels of conduct and performance by the staff are acceptable,'' he added.

The Chief of Staff also takes steps to prevent mistakes, complaints, patient injuries and neglect as well as responding to complaints and investigating incidents. "This is a programme of risk management which is connected directly with the Quality Management Department of the Hospital,'' Dr. Cooke noted.