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Hospital Documentation Planning: the Concept and the Context

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Hospital Documentation Planning: the Concept and the Context 16 American Archivist / Vol. 56 / Winter 1993 Research Article Downloaded from http://meridian.allenpress.com/american-archivist/article-pdf/56/1/16/2748466/aarc_56_1_18534n31m7132j2p.pdf by guest on 27 September 2021 Hospital Documentation Planning: The Concept and the Context JOAN D. KRIZACK Abstract: Documentation planning is defined in this article as a process within an insti- tution to select an appropriate documentary record for the institution. The author describes the functions and component institutions of the U.S. health care system, identifies the functions of hospitals within the system, offers an analysis of hospital activities and ad- ministrative organization, and presents a typology of hospitals. This information provides the informational context within which a documentation plan can be developed for a particular hospital. A similar planning approach may also be applied to other types of institutions, organizations, and corporations. About the author: Joan D. Krizack is the hospital archivist at the Children's Hospital, Boston. This article was written as a product of the author's participation in the 1988 and 1989 Research Fellowship Program for Study of Modem Archives, administered by the Bentley Historical Library, University of Michigan, and funded by the Andrew W. Mellon Foundation, the Research Division of the National Endowment for the Humanities, and the University of Michigan. It was initially submitted for publication in 1989. The author wishes to thank the individuals who commented on earlier drafts of the article: Andre Mayer; Barbara L. Craig; Joel D. Howell, M.D.; Helen W. Samuels; and the staff and 1988-1989 research fellows of the Bentley Historical Library. The author is also the principal investigator of a project, "Documenting the U.S. Health Care System: Analysis, Assessment, and Planning, "funded by the National Historical Publications and Records Commission, the end result of which is a book, tentatively titled Documentation Planning for the U.S. Health Care System, to be published in 1993. Hospital Documentation Planning 17 "ANALYSIS," ACCORDING TO T. R. Schel- (3) the importance of cooperation—be- lenberg, "is the essence of archival ap- tween archivists, records creators, and re- praisal."1 Deciding what material to collect, searchers and between archivists in different the archivist's most intellectually stimulat- repositories. Larry Hackman, one of the ing task, has become progressively more foremost proponents of the documentation challenging since the middle of this century strategies concept, has argued that "by def- Downloaded from http://meridian.allenpress.com/american-archivist/article-pdf/56/1/16/2748466/aarc_56_1_18534n31m7132j2p.pdf by guest on 27 September 2021 because the nature of institutions and or- inition ... a documentation strategy cannot ganizations has changed. In modern soci- be formulated by archivists within a single ety, institutions are often components of institution, or carried out by a single re- multinational conglomerates or divisions of pository, or even developed or executed only holding companies; even freestanding in- by archivists."2 stitutions are not self-contained but are linked Whether or not one agrees with the need to other institutions and organizations, both for, or efficacy of, large-scale cooperative public and private, through cooperative documentation-strategies initiatives, it agreements, funding arrangements, and should be clear that decisions on selecting government regulations. These intercon- the records of a single institution for pres- nections complicate the archivist's task by ervation, whether by an archivist employed increasing the duplication of information and by that institution or one working at a his- physically dispersing records. At the same torical society or other collecting repository time, reprographics and communications that has acquired a body of institutional technologies have become more sophisti- records, should also be informed by an un- cated, increasing the quantity of records derstanding of the place of that institution produced and the amount of information in the larger universe and by consultation stored. To address these changes, the ar- with creators and users of the records. In- chival profession must adopt a proactive deed, it could be argued that large-scale, approach to documenting institutions and interinstitutional documentation strategies pay increasing attention to the several lev- are possible only if the participating insti- els of analysis underlying the archival se- tutional archives have first come to terms lection process. with their internal issues. In order to ac- Archivists have written and spoken ex- centuate the distinction from the documen- tensively in recent years about the need for tation strategists' call for interinstitutional such an activist approach to the purposeful, planning and cooperation, the internal systematic selection of records with endur- process advocated in this article will be re- ing value. Proponents of the documentation ferred to as documentation planning. strategies concept have emphasized several Archivists can meet the challenge of points: (1) the need for conscious, inten- documenting contemporary institutions by tional planning; (2) the need to make spe- carefully deciding what they are going to cific appraisal decisions based on an awareness of the universe of available doc- umentation and an understanding of the ac- 2Larry Hackman, "To the editor," American Ar- chivist 52 (Winter 1989): 8. Similar expressions can tivities from which the records resulted; and be found in Helen Willa Samuels, "Who Controls the Past," American Archivist 49 (Spring 1986): 115; and Larry Hackman and Joan Warnow-Blewett, "The Documentation Strategy Process: A Model and a Case 'Theodore R. Schellenberg, "The Appraisal of Study," American Archivist 50 (Winter 1987): 14. Modern Public Records" in Maygene F. Daniels and For an overview of the way the documentation strat- Timothy Walch, eds., A Modern Archives Reader: egy concept has evolved in archival literature, see Basic Readings on Archival Theory and Practice Terry Abraham, "Collection Policy or Documenta- (Washington, D.C.: National Archives and Records tion Strategy: Theory and Practice," American Ar- Service, 1984), 68. chivist 54 (Winter 1991): 44-52. 18 American Archivist / Winter 1993 document and then formulating systematic article is to provide the analysis necessary plans that lead to the deliberate selection to devise a hospital documentation plan. of an appropriate documentary record. A The information presented here should ben- documentation plan is formulated in two efit not only archivists employed by hos- stages: pitals but also those at historical societies, • analysis of the institution, its relation to university libraries, or other collecting re- Downloaded from http://meridian.allenpress.com/american-archivist/article-pdf/56/1/16/2748466/aarc_56_1_18534n31m7132j2p.pdf by guest on 27 September 2021 other institutions of the same general type, positories that may have acquired hospital and its larger societal context, and records. It includes a brief overview of the • selection of the functions to be docu- U.S. health care system, an analysis and mented, and deciding which departmen- typology of hospitals, and a description of tal, laboratory, office, or other unit their place within the system.6 The follow- activities or projects will be chosen to ing pages outline the functions of our health support the selected functions.3 care system, identify the institutions and This strategic plan is formulated by an organizations that carry out these func- archives advisory committee, comprising tions, and analyze the administrative or- the archivist, records manager, legal coun- ganization and selected activities of hospitals sel, medical records specialist, and appro- in relation to their specific functions within priate administrators, physicians, and the overall system. Thus, the article pro- historical researchers; the committee con- vides the basis for hospital documentation siders both internal administrative needs and planning. external research uses. In this planning process, a general knowledge of historical Overview of the U.S. Health Care trends, historiographic techniques, and tra- System ditional appraisal criteria remains critically important, as does a specific understanding Since World War II, the American health of the institution's mission, culture, and re- care system has grown into a "vast indus- 4 try," accounting for 11.6 percent of the sources. Although the documentation 7 planning model is focused on hospitals in gross national product. In 1989 the nation spent $604.1 billion on health care, more this article, it is applicable to a variety of 8 types of institutions. In fact, Schellenberg per person than any other country. The health care system in this country, complex suggested a somewhat similar strategy for 5 and constantly changing, may best be de- appraising government records. scribed as decentralized and competitive.9 Hospitals, like many other modern insti- Indeed, if a health care system is defined tutions, have become part of an intricate as "a group of curative and preventative and complex web of regulations and rela- tionships, which raises difficult issues for archivists concerned with maintaining a Tor the purposes of this article, the U.S. health representative record. The purpose of this care system is defined to exclude alternative forms of health care, such as
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