Monday, July 09, 2007

Faith isn't enough

Catching up on the news over the holiday week, Jeff Krasner at the Globe reported on June 29 that a deal by Ascension Health of St. Louis to take over the "troubled" Caritas Christi Health Care system here in Massachusetts had fallen through.

I feel great empathy for the folks in our neighboring hospital system: For several years, whenever we read about about our hospital in the newspaper, it was always the "financially troubled BIDMC." This was an accurate moniker for our place, by the way, and it appears to be so in this case, too. Even though these hospitals compete with us, I take no pleasure in watching them go through these hard times.

While many hospitals have faced financial problems over the last decade, it is particularly troubling to see it happen to faith-based hospital systems. Such hospitals -- whether Jewish, Methodist, or Catholic -- begin life with noble missions. They combine the best of medical treatment with moral and ethical standards of care that are meaningful and heart-warming to their host communities. Their staffs of doctors, nurses, and other caregivers and administrators choose to work in those hospitals as a matter of personal conviction that is generous of spirit.

And yet, that is no guarantee against financial failure. When I took over BIDMC in January 2002, Attorney General Tom Reilly was pushing to sell the hospital to a for-profit company. Why? For several years, he had watched while the organization squandered millions of dollars in charitable assets, and he had no confidence that it would have the business acumen and commitment to engage in the hard-nosed decisions necessary for our survival. He and I had a personal agreement that I would have a financial plan, milestone, and reports -- and that if we did not show progress within six months, we would be put on the block.

A key part of our turn-around and ultimate survival is that I persuaded our Board to reorganize itself and exercise real authority vis-a-vis that of our holding company, Caregroup. Previously, CareGroup was trying to operate an integrated health care delivery system comprising BIDMC, New England Baptist Hospital, Mt. Auburn Hospital, and several small community hospitals. This approach failed, in part, because of animosity among the several hospitals in the "system" and also because the authority of the local boards to set their own direction and to be held accountable had been diluted by the holding company's board.

It may not be my place to say -- but that never stops me! -- but I believe that a governance problem of both a similar and slightly different form exists at Caritas Christi. Having talked with many people in that system, it is clear that both the larger system board and the individual hospital boards exercise no real authority. Rather, the Archdiocese of Boston holds the reigns of authority. CEOs have been relieved of their jobs and suitors like Ascension have been solicited without real input of the lay leaders. This is understandable for historical reasons, but future success requires a change.

The marvelous hospitals of the Caritas Christi system and the caring and thoughtful staff in those hospitals need to be governed by the communities they serve. Local board members who are held accountable for their actions will have the business sense and the dedication to make the decisions needed to ensure that the faith-based mission of their institutions is successful. Referrals among the CC hospitals will be strengthened -- not weakened -- when each hospital has the authority to decide how and if to have clinical relationships with the others.

As mentioned above, the current weakness in the CC system sometimes works to the commercial advantage of BIDMC. But, we draw no pleasure from this. There is place in Massachusetts for all of us, and the people of the state would draw great benefit were this system healthier. But faith isn't enough to solve the system's problems.

3 comments:

MDS said...

Terrific analysis offered in an open spirit. There's plenty of precedent for independent governance in the Catholic college model, though I guess none of those were started by dioceses.

The Catholic mission -- for all of the Church's faults, sins and crimes -- cares for "the least among us." I hope to God the system survives, for the sake of every community the hospitals are in.

I believe you just earned a big fat plenary indulgence.

Anonymous said...

Paul;

You hit on one of my pet peeves, having worked in Adventist hospitals my entire career (I am not Adventist.) My organization endured a financial scandal followed closely by an accreditation scandal, all caused by one rogue CEO who basically corrupted the organization.
Having studied what went wrong, I conclude that faith-based hospitals often have 2 strikes against them, given the extra layer of "supervision", compounded by the naivete and unwarranted trust often exhibited by faith-based boards in their own church-member administrations. It also creates a small and closed circle of insiders. It just seems that every problem a hospital faces is compounded by a religious affiliation, sad as that may sound. I do agree, however, that it is often mitigated in part by the dedication of the staff.

As other corporations have learned to their sorrow, it's governance, governance, governance.

Anonymous said...

And neither were any of these hospitals started or built by the diocese, save one! Specific religious orders went about ministering to patients for years, until hospitals became complex businesses. What made the RCAB think that it could do what very few other diocese do across the country, some would say greed, others mission. But one thing is true Paul, you hit the nail on the head. The communities served by Caritas hospitals would all be better off if the Cardinal would relinquish control to the local Boards and get out of the business, regardless of whether there is a national affiliation.