It took a British colonel to discover that the laundry for five metropolitan hospitals of Boston could be done by one set of machinery at one place and at a great saving to the institutions. The late Colonel A.W. Smith, a graduate of Sandhurst and the author of books and stories published by theATLANTICwas responsible for this achievement. How he succeeded is described byJ. A. MAXTONE GRAHAM,a Scottish writer and farmer, and the son of Jan Struthers.
by J.A Maxtone Graham
FOR centuries the whiteness and punctuality of the family’s Monday wash were status symbols. Laundry work did not become an organized business until the Gold Rush, when one unsuccessful and disillusioned miner who had noted that women were in short supply in the California of 1849 set up to supply his fellows with one of the services usually performed by members of the opposite sex.
It is surprising that some of the largest users of laundries, the big metropolitan hospitals, should still be operating (even though for six days a week) on a family basis — “family” in the sense that each hospital tends to run its own laundry, which often takes up valuable expansion space within the hospital grounds. Over the world, there are a few groups of hospitals which have got together, usually under government sponsorship, to have the daily wash done in some central building. Now, in Boston, five voluntary hospitals have for the first time joined to get rid of some of the headaches of organizing the matter for themselves.
It might seem a strange transition to make from being a colonel of the British Army, General Staff, to being the organizer of such a project, yet that is precisely what Colonel Bill Smith did. Just before his recent death, I visited him at his office. Colonel Smith, who had been Director of Resources at the Children’s Hospital in Boston, had had a feeling that his forty-year-old laundry was not making the best use of the resources available —— space, labor, and capital. Furthermore, the old laundry was due soon to be brought up to date at a cost of half a million dollars. Could this huge and wasteful investment be lessened in any way? He thought it could, and he sounded out his opposite numbers in neighboring hospitals. His principal argument was that if laundry had to be moved mechanically anyway, why not consider moving it several miles instead of a hundred feet or so?
Several of the hospitals that he approached seemed quite satisfied with their existing systems, and when Smith said to one that a cooperative might be able to launder for as little as five cents a pound, he was told that the hospital in question was already doing it for that amount, or even less. “It was a case of faulty accounting,” he explained. “Later, the same hospital had its costs assessed professionally; the true figure was sixteen and a half cents.” The accounting did not take into consideration depreciation of the building, and the cost of steam and electricity.
Some of the hospitals Colonel Smith investigated did not have their own equipment. They sent their wash to contractors, who charged about $1.25 a patient a day. One staff member was horrified to discover that some of the laundry was being subcontracted as far away as Portland, Maine, a distance of more than a hundred miles. When this fact came to light, it helped to explain why clean laundry was occasionally delivered late.
(COLONEL SMITH spent the better part of two years examining the possibilities of a cooperative scheme with the help of laundry and business consultants; he formally reported progress in his investigations every six months or so to the dozen hospitals that were interested; and in the end the Children’s, the Massachusetts General, the Massachusetts Eye and Ear, the Massachusetts Memorial, and the Peter Bent Brigham hospitals came firmly into the scheme. The Hospital Laundry Association, Inc., now washes and irons for 1700 hospital beds, or about one in seven of those hospital beds within a twenty-mile radius of Boston.
Today, if you visit the association’s building at 175 Ipswich Street, Boston, you may see a five-ton truck, delivering from any one of these hospitals, backing up to the scales on which the wash is weighed. Laundry in this quantity is paid for by the pound, except for articles, like coats, which need individual handling. The volume handled is staggering — nearly four tons an hour; and even with the carefully planned flow system worked out by a Chicago handling specialist, laundry has to be moved about a dozen times before it goes out clean. The average load is eighteen to twenty pounds a patient a day; a pair of sheets weighs seven pounds, to begin with, and then there are pajamas, towels, overalls, and uniforms for nurses, doctors, cleaners, cooks, and so on.
After weighing, the bags are tipped out on a slow-moving conveyer for sorting into four categories: large flat (sheets), small flat (towels, pillowcases), rough dry (pajamas and other things which are returned dried but not ironed), and coats and similar garments which have to be handled by the piece. This appears to be a tedious and souldestroying job, enlivened only by the strange objects which turn up: teddy bears, bedpans, pillows, rubber rings, hot-water bottles, and such troublemakers as nylons, razor blades, lipsticks, and eyebrow pencils, not to mention a thousand dollars’ worth of surgical instruments which are mistakenly bundled up for laundering each week. James J. Mahoney, the laundry’s general manager, pointed out one advantage of cooperation over contracting: “The hospital will get all its stainless steel back again; the other way, everyone in Boston would soon be owning a do-it-yourself appendectomy set.”
Some laundry is not safe to be sorted — sheets from the operating theater, for instance, and any clothes worn by those who have an infectious disease. These are delivered in special red-striped bags and tipped straight into a special washwheel. The rest of the sorting takes place upstairs, to allow gravity loading into the washwheel; each wheel holds twelve hundred pounds of washing at a time, and the wash cycle takes a little over half an hour. Modern laundry machinery has reached such a degree of efficiency that the water from the last rinse has been tested and found to be purer than the drinking water of Boston. There is one commercial laundry owner who, when showing visitors around his plant, will drink a sample of this rinse, saying, “May the Lord strike me down if I am wrong.” He has not keeled over yet.
Absolute sterilization is particularly important in a hospital laundry, the biggest danger being “the golden villain,” or Staphylococcus aureus; while the heat of water at 327° F will usually kill most organisms, two ounces of a “staph inhibitor” are added for each hundred pounds of wash, just to be on the safe side.
Water is used to extract water; wash from the washwheel is still too wet to be ironed, so it is transferred to a rubber diaphragm, the outside of which is subjected to high hydraulic pressure. The amorphous lump which comes out is two hundred pounds of solid linen and cotton, not more than two feet thick or high, compressed into weird blue-and-white contours that could not fail to fascinate any modern painter or sculptor. It would be virtually impossible to disentangle this mass by hand, so it has to be treated by a “reconditioner” — a tumbler-type apparatus — before it is ironed.
The modern flatwork ironer is a ten-foot-wide rotary affair with a built-in automatic folder; you need just two operators to feed it and one to stack the nine hundred sheets that the machine handles in an hour. The laundry’s smallest flatwork ironer measures 110 inches.
After it is ironed, the linen is ready to go back to the hospitals; it leaves by a ramp that is completely separate from the one on which the soiled laundry comes in, and the trucks are steamcleaned before loading. Many of the old hospital laundries were so cramped for space that clean and dirty clothes stood cheek by jowl in the same room — a possible means of reinfection.
Many people on the staffs of the old laundries transferred to the new one. Laundry work has always been one of the more poorly paid professions, and in some of the older buildings the working conditions must have been bad. Certainly there is a big contrast between the dingy, bare brick walls of the disused Children’s Hospital laundry and the light and airy surroundings on Ipswich Street. The work is still monotonous and requires unskilled labor, except in the press line; yet in many cases modern machinery and planning have enabled some of the hundred and eleven workers to sit instead of stand, to wheel instead of carry, to use less muscle power, and thus to be less tired at the end of the day. As with most manual jobs, there is a relatively high labor turnover, but it is not as high as it used to be. Many applicants for jobs have had no experience in laundries; one who applied recently claimed he was an expert “engineer in charge of vertical ascension.” Within a day or two, he was working in the laundry as happily as if he had never operated an elevator.
How much did it cost to set up this kind of organization? Laundry machinery is expensive, and it alone cost $750,000. By the time the building had been bought and converted, the total commitment was around $2,000,000. The participating hospitals decided to use some of their endowment funds to invest in the project; they will get about 6 percent on their money, compared with the 4½ percent which they might expect from trustee stocks. The association was to be a non-profit-making concern; this would give certain tax advantages. But there was still a deficiency of more than a million dollars, and Colonel Smith approached the New England Mutual Life Insurance Company for a loan. At first the request was treated with caution. “A laundry? We’ve never lent money for that before.”
Patiently, the colonel pointed out what a safe investment it would be. What could be surer than a business with a steady and captive market, which had no seasonal fluctuations in trade (except in August, when people tend not to be ill for fear of spoiling their vacations), where the work was repetitive and the product “consumed” within a day or two of completion, where there were no changes in requirements of style, where there was no speculative risk, where the customers were prepared to sign a ten-year service contract and would undoubtedly be prompt payers of bills?
The arguments carried weight, and the loan was made, to the tune of $1,150,000.
Apart from the small increase in investment income, what will be the advantages to the hospitals? There will be, it is true, a small saving in laundering costs, but this is not going to bring about a dramatic lessening of hospital charges; laundry accounts for only 2½ percent of the total expenses of an illness, and the expected drop in costs from seven to five cents a pound might save a patient thirty-five to forty cents a day.
The hospitals will gain most in unfinancial ways: service is certainly more reliable than it was; the latest machinery, techniques, and layout make reinfection of clean laundry less likely; space formerly taken up by laundry buildings becomes available for more important hospital use; and administrative staffs no longer have to cope with this somewhat specialized problem. If Colonel Smith gets his way, the association will take over the ownership of the linen, hiring it out to the hospitals as it is needed and doing the mending, which is still carried out in the hospitals (where there is a tendency for a torn sheet to remain undiscovered for some time. The nurse opens it in the ward, finds it torn, puts it out with the dirty sheets, whence it goes to the laundry and comes back, still unrepaired, to the ward. Masculine readers of this article may have observed, as the writer has, the similar and tiresome cycle which happens at home, particularly with shirts and shirt buttons). Furthermore, laundry specialists will be able to give advice on the question of how long to rest linen between use. Immediate reuse shortens the working life of a sheet; so does excessive storage.
The Hospital Laundry Association has been working only since last October. There are snags, as one might expect, to be straightened out, particularly in the handling and identification of small individual bundles of the doctors’ own clothes; but as the volume handled grows toward the target of nine thousand tons a year, costs will come down to a level below that of any hospital laundry in the country.
As I was about to leave the colonel’s office, one of the staff came in with a batch of papers. “Here,” she said, “are the latest figures. We’ve done 180,000 pounds this week.”
“Fine,” he said. “What about costs?”
“It was eight and a quarter cents a pound last month, and now it’s just under seven and a half.
I guess we’ll be down below seven cents by the end of the month. Maybe we should have a sweepstakes on it.”
Did Colonel Smith anticipate any further expansion? Yes, there would be room to take on an extra 20 percent of work with the existing machinery by putting on overtime or an extra shift. The association would welcome one or two new members. Several other groups of hospitals have inquired about the possibility of copying Colonel Smith’s scheme elsewhere.
As I left his office, I remarked on the red and black sign behind the colonel’s desk, and I asked if the Chinese characters on it meant anything.
“Oh, that?” He smiled. “Of course it means something. ‘No tickce. no shirtee.’ ”