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Hospitals, Health and People
By Albert W. Snoke, M.D. 
2002/12 - Beard Books 1587981610 - Paperback - Reprint - 246 pp. US$34.95 Such a wise and compassionate book should be required reading for anyone involved in health care administration, policymaking, and legislation. Publisher Comments This book, written by one of the foremost hospital administrators in America, is an engrossing account of his professional experiences during a career that spanned more than a half a century. Dr. Albert W. Snoke presents his reflections on the growth of health administration during a revolutionary period in its development, the 1950s through the 1980s, with emphasis on the difficulties of financing modern hospitals. He offers thoughtful advice for dealing with reimbursement and cost containment, patients who cannot pay, program management, competition, marketing, and corporation organization. Referring to an earlier version: The author discusses his career as a hospital administrator and addresses such issues as "delivery of health care, changes in the health care system, hospital financing, the impact of an aging population on health services, and ethical issues in medical care. . . . He says 'our chief preoccupation today appears to be with cost, controls, marketing, competition, profit making, and cost effectiveness.'"
From Francoise C. Arsenault Hospitals, Health and People is an interesting and very readable account of the career of a hospital administrator and physician from the 1930's through the 1980's, the formative years of today's health care system. Although much has changed in hospital administration and health care since the book was first published in 1987, Dr. Snoke's discussion of the evolution of the modern hospital provides a unique and very valuable perspective for readers who wish to better understand the forces at work in our current health care system. The first half of Hospitals, Health and People is devoted to the functional parts of the hospital system, as observed by Dr. Snoke between the late 1930's through 1969, when he served first as assistant director of the Strong Memorial Hospital in Rochester, New York, and then as the director of the Grace-New Haven Hospital in Connecticut. In these first chapters, Dr. Snoke examines the evolution and institutionalization of a number of aspects of the hospital system, including the financial and community responsibilities of the hospital administrator, education and training in hospital administration, the role of the governing board of a hospital, the dynamics between the hospital administrator and the medical staff, and the unique role of the teaching hospital. The importance of Hospitals, Health and People for today's readers is due in large part to the author's pivotal role in creating the modern-day hospital. Dr. Snoke and others in similar positions played a large part in advocating or forcing change in our hospital system, particularly in recognizing the importance of the nursing profession and the contributions of non-physician professionals, such as psychologists, hearing and speech specialists, and social workers, to the overall care of the patient. Throughout the first chapters, there are also many observations on the factors that are contributing to today's cost of care. Malpractice is just one example. According to Dr. Snoke, "malpractice premiums were negligible in the 1950's and 1960's. In 1970, Yale-New Haven's annual malpractice premiums had mounted to about $150,000." By the time of the first publication of the book, the hospital's premiums were costing about $10 million a year. In the second half of Hospitals, Health and People, Dr. Snoke addresses the national health care system as we've come to know it, including insurance and cost containment; the role of the government in health care; health care for the elderly; home health care; and the changing role of ethics in health care. It is particularly interesting to note the role that Senator Wilbur Mills from Arkansas played in the allocation of costs of hospital-based specialty components under Part B rather than Part A of the Medicare bill. Dr. Snoke comments: "This was considered a great victory by the hospital-based specialists. I was disappointed because I knew it would cause confusion in working relationships between hospitals and specialists and among patients covered by Medicare. I was also concerned about potential cost increases. My fears were realized. Not only have health costs increased in certain areas more than anticipated, but confusion is rampant among the elderly patients and their families, as well as in hospital business offices and among physicians' secretaries." This aspect of Medicare caused such confusion that Congress amended Medicare in 1967 to provide that the professional components of radiological and pathological in-hospital services be reimbursed as if they were hospital services under Part A rather than part of the co-payment provisions of Part B. At the start of his book, Dr. Snoke refers to a small statue, Discharged Cured, which was given to him in the late 1940's by a fellow physician, Dr. Jack Masur. Dr. Snoke explains the significance the statue held for him throughout his professional career by quoting from an article by Dr. Masur: "The whole question of the responsibility of the physician, of the hospital, of the health agency, brings vividly to mind a small statue which I saw a great many years ago…it is a pathetic little figure of a man, coat collar turned up and shoulders hunched against the chill winds, clutching his belongings in a paper bag-shaking, tremulous, discouraged. He's clearly unfit for work-no employer would dare to take a chance on hiring him. You know that he will need much more help before he can face the world with shoulders back and confidence in himself. The statuette epitomizes the task of medical rehabilitation: to bridge the gap between the sick and a job." It is clear that Dr. Snoke devoted his life to exactly that purpose. Although there is much to criticize in our current healthcare system, the wellness concept that we expect and accept today as part of our medical care was almost nonexistent when Dr. Snoke began his career in the 1930's. Throughout his 50 years in hospital administration, Dr. Snoke frequently had to focus on the big picture and the bottom line. He never forgot the importance of Discharged Cured, however, and his book provides us with a great appreciation of how compassionate administrators such as Dr. Snoke have contributed to the state of patient care today. Albert Waldo Snoke was director of the Grace-New Haven Hospital in New Haven, Connecticut from 1946 until 1969. In New Haven, Dr. Snoke also taught hospital administration at Yale University and oversaw the development of the Yale-New Haven Hospital, serving as its executive director from 1965-1968. From 1969-1973, Dr. Snoke worked in Illinois as coordinator of health services in the Office of the Governor and later as acting executive director of the Illinois Comprehensive State Health Planning Agency. Dr. Snoke died in April 1988. From Nightingale's Healthcare News, June 2006 Snoke’s experience in hospitals goes back to the early 1930s when he was a medical student and resident physician at Stanford-Lane University Hospital in San Francisco. Between then and when he wrote Hospitals Health and People, he was a top hospital administrator at prestigious medical centers in Rochester and New Haven. Snoke began his career as an administrator with Dr. Basil MacLean, one of the giants in hospital administration. The author’s career spanned the post-World War II decades when the place of the hospital in American healthcare expanded dramatically. This expansion was partly due to demographic changes, notably the influx of the Baby Boom generation and the increased affluence of the society and, with this, the expectation of better healthcare. During the 1950s through the 1980s, no one had a more critical role in bringing needed change to healthcare than the administrators at leading hospitals. Thus, Snoke was at the center of the transformation of American hospitals during these critical years. This change occurred incrementally and affected all aspects of healthcare. At the core of the change was, as Snoke notes, “the transition from a physician’s firm dedication to diagnosing and treating a patient’s disease to a broader concern for the patient himself.” This change in hospitals and other areas of healthcare continues to influence current professional and public expectations regarding hospital services, treatment, and results. A perfect relationship between physicians and patients is unachievable. Nonetheless, in the pursuit of this relationship, hospitals have come, says the author, to “join with education, social work, employment placement, vocational guidance, and any number of related services with the help [patients] need to restore them to their maximum functioning.” Hospitals realize they are no longer in the business of simply treating patients’ illnesses and medical problems. They must go beyond this to help patients regain the productive life they lost because of their medical problems. The work of hospitals has, therefore, expanded far beyond simple treatment or cure to rehabilitation. Formerly, after treatment or cure “fixed the problem,” so to speak, patients were left to their own devices to recover their former general well being. But as anyone with any experience in today’s hospitals knows, physical therapy, psychological counseling, and various outpatient services are all a part of the hospital’s mission. To keep this mission in mind, Snoke kept in his office a picture of a statue titled “Discharged Cured.” This statue of a sad-looking man in rumpled clothing carrying a paper bag containing his few possessions symbolized the shortcomings and blind spots of hospitals in the time before their transformation. It was a recognition of these shortcomings and blindnesses – a recognition that hospitals could do better in caring for patients – that prompted the transformation in hospitals that started in the 1950s. No longer would the patient/hospital relationship end abruptly with the treatment of medical problems. “Discharged – cured” was the standard notation used on medical charts for patients who had been treated and released upon meeting the standard of acceptable service. In contrast to this, hospitals today take a broader view. They are obligated to not only cure, but to rehabilitate so as to bridge “the gap between the sick and a job,” says the author. Hospital care extends to the end of putting patients back on their feet, not merely treating their medical problems. The picture of the statue “Discharged Cured” was given to the author when he was at Yale-New Haven Hospital in the 1940s by Dr. Jack Masur. Masur referred to it in an article “Some Challenges in Hospital Administration” published in the October 1955 issue of the Journal of Medical Education. Snoke notes that he saw a copy of this same picture hanging on a wall in the office of one of his former students when he was the head of a major university teaching hospital. The picture is a constant reminder of how far hospitals have come and also how far they have to go to reach the ideal toward which Snoke and others like him worked. During his career as a hospital administrator, Dr. Albert W. Snoke was the director of Yale-New Haven Hospital, President of the American Hospital Association, and advisor on health to the Governor of Illinois. Hospitals have clearly come a long way from the indictment by the pitiable figure of the statue “Discharged Cured.” Yet, as in all relationships between persons, the relationship between hospital physician and patient always has room for improvement. The analyses Snoke brings to bear on the range of topics affecting this relationship – including the hospital governing board, salaried physicians, nursing, training, and national healthcare policies – always have this relationship in mind. While some topics, such as medical school education for prospective doctors, may seem peripheral to this relationship, the author demonstrates, via his thorough familiarity with hospitals and hospital administration, that relevance. In his career in hospital administration, Dr. Albert W. Snoke was director of Yale-New Haven Hospital, President of the American Hospital Association, and advisor on health matters to the Governor of Illinois. From Mitchell T. Rabkin, M.D., President, Beth Israel Hospital, Boston The book conveys most of the sweeping changes in health care and its administration over the past several decades. But by utilizing an autobiographical format and the first person, it brings life to these major events in a manner more vivid and memorable than most such chronicles. From Choice Snoke speaks with candor and forthrightness on a wide range of issues. . . . {He} believes health care should be a right and not a privilege and feels we must get the many competing forces to 'face the many complex issues as parents not as antagonists or competitors.' The book deserves the careful attention of all health providers as well as students and the general public. From The Times Literary Supplement The wise reflections of Snoke . . . should be borne in mind: the hospital belongs to the community, not the bureaucrats, he insists, and human sympathy must take precedence over system. From Roy Porter - The Times Literary Supplement The wise reflections of Alfred W. Snoke . . . should be borne in mind: the hospital belongs to the community, not the bureaucrats, he insists, and human sympathy must take precedence over system. From Alan Liss - Science Books & Films In places, the book reads like a novel, and it would be of interest to anyone wishing to know about the life of a hospital administrator. The information is accurate and the text clearly written, but the material is not well organized; because it is an autobiography, it is also incomplete. For readers of this rather narrow topic, this book is only acceptable.
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Albert Waldo Snoke was born in Fort Steilacoom, Washington, in 1907. After receiving a B.S. degree from the University of Washington in 1928, he attended Stanford University Medical School and received his M.D. degree in 1933. In 1936, Snoke joined the staff of the Strong Memorial Hospital, Rochester, New York, and became its assistant director in 1937. Snoke left Rochester in 1946 to assume the directorship of Grace-New Haven Hospital in New Haven, Connecticut. In New Haven he also taught hospital administration at Yale University and oversaw the development of the Yale-New Haven Hospital, serving as its executive director from 1965-1968. From 1969-1973, Snoke worked in Illinois as coordinator of health services and later as acting executive director of the Illinois Comprehensive State Health Planning Agency. In 1987 his book, Hospitals, Health, and People , was published. Snoke died on April 18, 1988.
