What kind of hospital does L+M want to be?

In a Dec. 29 guest commentary, "L+M to Finizio: Learn facts, stop false rhetoric," William A. Stanley, vice president for development and community relations at Lawrence + Memorial Hospital, called for a renewed dialogue on the challenges facing his institution. Stanley left unanswered, however, lingering questions about the dispute between the administration of L+M and its professional caregiver workforce.

First, are community values being reflected in the decisions of the hospital's leadership - or have they instead chosen to follow a corporate model?

L+M is a private, not-for-profit hospital, and as such, is first and foremost a servant to the community. We expect our not-for-profit hospitals to take their basic cues from the needs of their patients. That means we expect our hospitals to share the values of community residents whose taxes offset those not paid by the hospital.

We expect those hospitals to share the perspective of board members who are community leaders, not the perspectives of distant or disinterested investors. Most important, we expect our hospitals to share the values of the professionals who care for us, our nurses, and our doctors, especially those who are independent judges of quality.

To be clear, we all want our community hospitals to succeed - and we need them to survive. But as our hospitals succeed financially, we want them to spend money to support values we share.

Second, is it sufficient to have physicians sign-off on "outsourcing" patient care services to outpatient facilities?

Commonsense calls for caution when considering "fixes" from fields that do not involve patient care. The hospital management field has a penchant for adopting "methods" and "techniques" from business, often 20 years late and long after their limitations have become obvious to others.

Yes, shifting services away from the hospital's main campus can "work," but it will always work best with community and caregiver input, in addition to the advice and counsel of independent physicians. Collaboration and partnership are needed to be sure that core competencies are not lost, needless unemployment is not created, and that patients are not forced to settle for price cuts over quality care.

Finally, do L+M's leaders regard their professionals who deliver patient care merely as revenue-producers or expenses?

Enrichment of staff in the hospital field is shown to save all of us from our worst mistakes. We know now that skilled caregivers - and enough of them to meet patients' needs - yields rewards in Medicare reimbursement. A field like hospital management that suffers unnecessary annual mortality should make safety "job one," but at least now there will be additional payment for satisfied patients and reduced error.

Historically, society has relied on the hospital as a public charity, to do good, treat us fairly and to employ skilled professionals who are themselves treated fairly.

Even the most prestigious hospitals will find that, in the end, their credibility in public policy will depend on the public and the government's perception of their performance. Ultimately, the pay of their executives, the shine of their technology or the grandness of their leaders' houses will contribute little to their reputation for delivering quality care.

We need hospitals to be the community bedrock. Ongoing upheavals over insurance, health delivery strategies and cost will continue to produce a dizzying array of controversies. Our primary local resource for care and service will remain the community hospital, its physicians and the individuals who have chosen health care as their profession.

Dr. Fred Hyde is a clinical professor in Columbia University's Mailman School of Public Health, a fellow in the Global Healthcare Innovation Management Center in Fordham University's Graduate School of Business, and an independent consultant who has worked with AFT Connecticut, which represents employees at Lawrence & Memorial Hospital.

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