In 1949, Vernon Collins was appointed first medical director at the RCH. He believed the hospital's medical administration needed restructuring if modern advances in knowledge, training methods and clinical research were to be successfully implemented. As medical director, he was now responsible for all medical and ancillary services, and able to control and initiate policy.
The three objects of the (Royal) Children's Hospital, as Collins saw them, were patient-care, research and teaching. His prime achievement in the area of patient-care was to substitute a senior, salaried staff for the time-honoured system of honorary medical officers. Clinical assistants were replaced by senior specialists on a salaried, sessional basis. The large departments were administered by paid, full-time specialists with a salaried staff. The existing clinical research unit was able to expand. Closely integrated with the hospital, it comprised a small research ward with an independent nursing staff and adjacent laboratories. On the teaching side, Collins insisted that undergraduates receive instruction from salaried, senior doctors, both in the wards and the clinics.