Affiliation Questions

I received two interesting questions from our faculty regarding our affiliation discussions with Hartford Hospital. Here they are, along with my thoughts:

1) Perhaps you could explain how the leadership of the merged institutions would be able to maintain the mission of the Health Center (training a large portion of the state’s physicians, as the only public hospital) as a top priority. The desire of clinicians at Hartford Hospital “to be more academic” appears genuine, but in practice, it requires a much more than just that desire. For an institution with a different bottom line, some of the teachers and educators here who really make the medical and dental schools what they are could be the first to be cut when the finances need to be tweaked.

This is among the more complex issues I and many others have been discussing since the negotiations got underway. Of course, what we are talking about is a blending of two very distinct cultures. We all know that academic medicine is much different than private practice and there is no quick, easy solution to bringing these two worlds together in a way that respects all interests. We are not relying on one “magic bullet” here. Instead, we expect the solution will be derived from a number of sources, including governance structure, organizational structure, compensation plans and operational policies. Importantly, we recognize the importance of maintaining academic integrity and we will not lose sight of this going forward.

2) I am concerned, like the editorialist, that the merger did allow Hartford Hospital to prevent enlargement of the JDH. The original CASE report stated that expansion was key to the JDH’s survival. Yet apparently the new proposal provides for minimal expansion of the JDH, because Hartford already has some 750 beds. As I understand it, the aspect of our size that makes us unviable is the number of patient beds on site, not the total number of beds owned by an organization, regardless of whether most of them are at least a half hour away through a busy city. Why, if this is our one chance to build a new hospital, would the priority be “to be unthreatening to HH,” rather than to increase the number of beds on site, so that the JDH is financially viable?

We need to look beyond the traditional view of bed counts and bed locations in the region. Instead of “us” versus “them” lets consider “we.” Working with a larger clinical partner allows us to create economies of scale and clinical and financial synergies not otherwise possible. In so many respects, bigger is indeed better in health care delivery today, especially in academic medicine. If we can successfully partner with another clinical enterprise in our region, the designations and locations of the beds within the system are reduced to a manageable operational issue.