Bermuda Hospitals Board executive director, Sheila Manderson. The Royal Gazette's Roger Crombie recently talked with her to find out what comes next.

He files this report. In 55 months as executive director of the Bermuda Hospitals Board (BHB), Bermudian Sheila Manderson has served under five Ministers of Health and two Board chairmen, with the name of the third set to be announced by the Government any day now. With the opening of the new surgical wing at the King Edward VII Memorial Hospital came external changes to the hospital's lay-out, which guarantee that Ms Manderson will leave her mark on the facility when she retires later this year. She succeeded Hume Martin in the post of executive director of the BHB in the summer of 1993, when she returned to Bermuda to take on the position. She had previously worked at the Kaiser Permanente Medical Centre in Richmond, northern California. Ms Manderson regards the new wing as "one of the major accomplishments'' of her tenure, but points to changes in patient care and environmental concerns as being of equal long-term importance to the hospital.

She is also proud of the changes which have seen the character of St.

Brendan's Hospital, also under the wing of the BHB, completely updated. "We are very keen to keep up with changes occurring in the medical field around the world,'' Ms Manderson said. "One such trend, which we have seen here in Bermuda, is a reduction in the number of inpatients, and an increase in ambulatory, or outpatient, care. More than 60 percent of our surgery is now performed on an outpatient basis. Patients recover in the hospital and then go home on the same day.'' The greatest challenge her successor will face, Ms Manderson said, will be "to implement the strategic plan with the current system of financing.'' She pointed out the public, generally, has the misconception that Government funds the hospital entirely. "Government does what it is legally obliged to do, with respect to the elderly, the young and those without hospital insurance medical coverage,'' she said. "But we have to generate what is required financially beyond that. Government is not there to bail us out.'' Government sets the rates for the services the hospital provides, funds 95 percent of the cost of running St. Brendan's Hospital and has an obligation to monitor the Island's state of healthcare. It sets a daily rate per patient, which makes no distinction between those in intensive care and those on general wards. But the BHB has to find its own funding for capital projects. To fund the New Wing and a new central utility plant, the BHB had to float a bond issue. Given the complicated financial arrangements under which the hospitals run, Ms Manderson said that she has always seen her role as that of a business manager. She regards the new wing, which was opened late last year, as one of the BHB's most notable achievements during her tenure as executive director. "It has taken us three years to plan, design and build the new wing,'' Ms Manderson explained. "The focus has been on the operating rooms and the Diabetes Centre.'' The centre, under the guidance of Dr. Tan, has been working with community shareholders to focus on prevention in order to reduce the catastrophic complications which can attend diabetes.

Ms Manderson attended the Berkeley Institute and Alma College in Ontario, before earning her Nursing Diploma at Montreal General Hospital and a B.Sc.

and M.B.A. at Golden Gate University in San Francisco. She carried out postgraduate studies in healthcare management at the University of California at Berkeley and Stanford University at Palo Alto. Ms Manderson said that "the BHB is keeping up with changes occurring around the world in healthcare, including achieving an increase in ambulatory, or inpatient, care.'' She continued: "We are very interested in homecare service, which we have been using to assist patients in achieving a more speedy discharge from hospital.

We are negotiating with the insurance companies to help recover the costs of homecare.'' The next major development for the BHB will take place later this spring, when the Cardiac Diagnostic Unit (CDU) is expanded. "We were enormously fortunate when David Barber donated $1 million towards the expansion of the CDU, and we are planning to make a start in the spring,'' Ms Manderson said. She revealed that the BHB is working closely with the Bermuda Heart Association on the design of the unit, and that the BHA will have a room in the new unit where patients and others can learn about cardiac matters. A similar teaching room has been provided in the new Diabetes Centre in the new wing. Ms Manderson has been instrumental in the significant upgrading of St.

Brendan's Hospital over the past few years. A new daycare centre was opened at St. Brendan's in 1998. Turning Point, formerly the Montrose substance abuse centre at the King Edward hospital, has moved to St. Brendan's, where an area has been specially renovated for the centre. A methadone clinic will follow shortly as will an inpatient detoxification centre. "Our goal was to upgrade the physical plant and to restructure the management of St. Brendan's. It has become part of a thriving community mental health programme,'' Ms Manderson said. St. Brendan's mental health teams oversee six other group homes and works closely with the Mental Health Foundation. "St. Brendan's is recognised by the Royal College of Psychiatry as an approved training ground, which is very gratifying,'' Ms Manderson said. How has the Bermuda hospital scene changed in the time since Ms Manderson was persuaded to return to Bermuda? "There has been a lot of change,'' the executive director said. "Our philosophy has been to continually improve. It is beginning to be recognised that the BHB has very high standards. Our aim is to provide the very best quality care that we can, and I think we do.'' She concluded: We are the only Board outside Canada to have earned accreditation for our hospitals. None of this would have been possible without the hard work and dedication of the excellent physicians and staff of the Bermuda Hospitals Board.'' PHOTO Photo by Tony Cordeiro MAKING HER mark -- After nearly five years as the executive director of the Bermuda Hospitals Board, Sheila Manderson gets set to step aside later this year. In so doing, she leaves a hospital that has seen profound expansion in terms of both physical and technological facilities.