Monday, August 13, 2007

The search begins

Imagine the buzz this would cause: Ford Motor Company announces a search for the head of its new mid-sized car division. The search committee comprises the comparable division executives from Toyota, Honda, General Motors, and Chrysler.

Well, what would be odd elsewhere is the norm here at the Harvard hospitals. As I have explained elsewhere, the Harvard medical system has an odd assortment of customs and norms. One of oddities surrounds the search for a chief of any of the clinical departments at BIDMC, MGH, Brigham and Women's, Children's Hospital, and the other Harvard affiliates.

For example, we will soon start a search for a new chief of OB/Gyn, as our Dr. Ben Sachs goes off to be Dean at Tulane Medical School. Without a doubt, the heads of the OB/Gyn departments at the Brigham and MGH will be invited to serve, along with some senior level faculty from BIDMC. The actual committee is formally appointed by the Dean of Harvard Medical School, with advice from his Council of Academic Deans representing the major Harvard affiliated hospitals.

The Dean, you say? But the new chief reports to the hospital CEO and is paid by the hospital and its faculty practice, not by the Medical School. Where does the Dean come in? Well, the new chief will not only be chief of service at our hospital but will also be head of the BIDMC Department of OB/GYN at Harvard Medical School. In that capacity s/he has certain academic responsibilities. For example, the executive committee of the three chiefs of OB/Gyn reviews academic promotions in their field (in any of the three hospitals) and could collaborate on areas like graduate medical education programs.

As CEO, I also get to serve on the search committee, which also -- somewhat paradoxically -- makes it recommendation to me -- and also to the Dean.

I hope this is now totally clear to you.

By the way, have I reminded you that HMS and Harvard University do not own any of the affiliated hospitals? We are all 501(c)(3) nonprofit organizations that are totally separate, in terms of governance, charter, and finance, from Harvard. (This last point is probably something about which the president of Harvard wakes up each morning and says, "Thank you, Lord." Among other things, it means that we do not have access to that wonderful endowment portfolio, which would otherwise come in really handy when the new Medicare rates are announced each year.)

Now, I am sure that the entire arrangement is totally clear to you. If not, start at the top and try it one more time.

9 comments:

Anonymous said...

But where does the new dean come from? :-)

Paul Levy said...

Aha! You have found the secret passageway through the maze.

Matt said...

I hate to bump a Comment/Question I posted earlier, but this topic reminds me of a question I had for your Wednesday Student question days. The topic on choosing leaders/management strikes a chord with me lately.

Tommorrow's Wednesday~ and I'm still clamoring for good advice.

Here is that question again so you dont have to search:

"I'm currently an MBA / MHA student, and work full time at a Louisiana hospital as a decision analyst in the Decision Support & Performance Improvement department. I've always worked in hospitals, even doing minimum wage student work. I spent a summer with the IT guys at one charity hospital, a year in an HR department filing papers and answering phones, and I've been the sole revenue cycle person at a small 15 bed psych hospital. Now I do productivity and opportunity analysis.

Once I get my Masters completed I want to start looking for opportunities to jump into a management role. That is where my questions and fears come into play. How do you take that first step? Is there some transitional type job I should consider? I fear, because of my non clinical background, I will be at a disadvantage in the industry. I've even seriously contemplated even going back for more education for a clinical background.

What is your take on that sort of situation?"

Just thought you might like to start Student Wednesdays up again, since the Semester has begun, here at least.

Paul Levy said...

Thanks, Matt. You are first on the list, but it might be in a few weeks. I still have trouble thinking about school during the summer!

Matt said...

No summer break here~

My program is 18 months straight....no breaks except X-mas, 8 hour Saturdays and way too many group meetings to argue over the direction a project should go. Of course those meetings occur after my 8 hour day at work, and generally last another 2-3 hours.

I've learned, the real challenge in getting this degree is working in the group. The quote "Could we stop talking about it and just do it?" has come out of my mouth way too many times.

Stan Jonas said...

Are you sure this isn't a system designed by a managed care company to help hospitals and medical schools hire the right talent?

Anonymous said...

Nice job in clearly describing a fantastically confusing organization. Of course, the HMS/teaching hospital/faculty interpedencies were created long before hospitals saw themselves as competing businesses in a marketplace.

In many parts of the country, the local medical school and its primary teaching hospital are both owned by the local university. I once heard a medical school CFO say, with respect to his university employers: "Thank God we don't get all the administration we pay for!" Imagine your life if you had to report to five levels of adademic administration . . .

Jn Kingsdale said...

Paul, your observations, as a relatively "new" hospital CEO, are especially interesting in part because you do not take history for granted. As a professionally trained, but lapsed, historian, I have to note how readily most "long-timers" dismiss the past.

If you had read back another 20 years before Dr. Groopman's account of his residency (to the 1950's), you might have been amazed to learn how little physicians earned back before the "golden age" of medicine--before Medicare and Medicaid and widespread private insurance relieved all but "carriage-trade" physicians of the burden of giving care free (or in barter) to as many as 25% to 50% of their patients; and how outpatient hospital care was provided in block booking--long lines of patients waiting on wooden benches for a morning "appointment" or, again, for an afternoon "appointment."

Had you gone back 75-100 years, you would have learned as well that most ER care was donated by physicians as a professional responsibility, partly in return for free access to their hospital "workshop"; and how relatively paternalistic charity hospitals became competitive, market-driven, production facilities, but still governed and managed as academic fiefdoms.

I note from your description of the search for a new Chief of OB/Gyn how little the university-like governance/management structure of AMCs has changed, since the Johns Hopkins imported this model from Germany in the 1880's. That the core "factories" of our medical economy--a sector that now accounts for one-sixth of our entire GDP--have preserved university-like management, even as they evolved into multi-billion dollar, fast-paced, high-volume, medical production facilities, helps explain some of the most archaic aspects of modern medicine.

Think about managing any other complex, fast-paced, high-volume production operation--a computer chip factory or a commercial airline, for example--by committees composed of mathematicians or pilots, and without the coordinating help of a National Standards Board or the FAA.

Good luck--Jon

Anonymous said...

I was once a candidate for such a position and disadvantaged by not being part of the Crimson tradition. In addition, being caught between HMS and you Paul (BIDMC) made it clear that this was not a good fit although I would have truly enjoyed working with you. In retrospect, the outcome was probably for the best.