The organizational structure and regulation of the Divine Providence Hospital
The Divine Providence Hospital, whose origins, as we have seen, are humble, as it began to operate in an informal manner, received nevertheless, immediately after its foundation in 1797, a proper set of rules to regulate its activity, which became part of the Misericórdia’s Bylaws. Since its beginning, the Hospital’s highest governing body was the Board of the Misericórdia of Vila Real.
The Internal Regulation of the Hospital of 1844 already showed a more elaborated organic and operation, which demonstrated that the establishment was not accommodating only poor patients anymore, and now had a proper medical staff and was a “real” hospital.
This Regulation sets out the obligations of employees and patients, and the operating rules of the Hospital, stating the physician's role as a professional expert who tried to take control of his area of competence. In the chapter regarding the obligations of the medical staff one aspect is worth mentioning, when it states that their duties included "practicing autopsies as deemed appropriate for their own education and science benefit", a fact that demonstrates the involvement of physicians in the drafting of this regulation. In fact, the medic staff even participated in in the process of building and improving the Hospital. Besides, the mentioned rule shows that, by 1844, anatomical studies were practiced in this Hospital.
The general principles of this Regulation, with some minor changes that had to be approved by the District Government, as it happened in 1855 and 1858, remained in force throughout the 19th century.
From the late 19th century on, the Divine Providence Hospital will present a new functional organization, by means of a new regulation. The clinical responsibility continued to be exclusively of its director and other physicians, under the orders of the provedor. But the internal services began to be ensured by Franciscan nuns.
It was, in fact, from 1893 onwards that the Divine Providence Hospital came to have the cooperation of the Portuguese Franciscan Hospitaller Sisters in the management and nursing services. Although officially abolished in 1910 with the proclamation of the Republic, the Franciscan Hospitaller Sisters remained "underground" at the Divine Providence Hospital, continuing to treat the sick, as always, showing a remarkable continuity of service, which only ended in 1973, a year before the restoration of democracy in Portugal.
In the 20th century, the Hospital experienced a new regulation, in 1960, which was approved by the General Assistance Office. As a Regional Hospital, it was responsible for receiving and treating patients in the region, and was also in charge of the creation and maintenance, within its own financial resources, of the services usually associated with this type of hospitals.
Its administration was exercised through the General Assembly of the Brotherhood, the Definitory and the Administrative Board. The Board of the Misericórdia defined the general guidelines of the administration and supervised the activities of all services by means of the provedor: administrative services, clinical services, diagnoses and treatment, nursing, pharmacy, and social and religious assistance.
The Hospital approved a new regulation in 1973, but it never came into force, due to the Revolution of April 25, 1974, followed by the Hospital’s nationalization in 1975, so its final regulation was the one of 1960.
