5 Very Different Hospitals

As the chief executive officers and chairs of the boards of five Harvard Medical School teaching hospitals meet over the next six months to study ways to further cooperation, almost everything will be on the table.

Power, money and national health care reform plans will influence decisions. Future power and earning potential will be carefully considered and allotted. Personnel questions will likely arise.

But one of the most important factors in the talks is also one that is difficult to quantify--the character of each of the five hospitals involved.

Harvard Medical School now boasts of the separate personalities of these institutions, comparing itself favorably to other medical schools with only one main teaching hospital.

It is the separate personalities, however, that could be lost, or eroded, if the five hospitals formed a single, centrally-governed system, or even if they simply decide to become more reliant on each other.

And it is these same personalities that could prove difficult in the early days of such a system. Resistance and personality clashes could result in the same sort of messy disputes that went on when Time executives dueled with Warner executives in the months following the Time-Warner merger.

Some of the hospitals in question have built and fostered their own characters for more than 100 years.

In a way, this has been necessary. Many cities have one "city" hospital, then perhaps a Catholic hospital and an academic hospital. But in Boston, academic hospitals are so plentiful that each needs a way to differentiate itself in order to attract patients and donors.

As a result, Mass. General, Brigham and Women's New England Deaconess, Beth Israel and Children's Hospital each have their own image, their own personality, their own character, their own corporate culture.

These distinguishing characteristics help each hospital develop its own specialties and provide a wide range of services to the Boston community. But they most likely will make greater cooperation between the hospitals, each of which approaches matters from its own individual perspective, somewhat difficult.

Surely one of the knottiest challenges Medical School Dean Daniel C. Tosteson '44 must face is deciding how much of the individual characters of the hospitals can or should be saved, and to what extent they can or should be replaced with a new common culture.

Consider what the dean and the chairs and chief executive officers of the five hospitals have to start with:

A Giant General

Massachusetts General Hospital is the Big-foot of this bunch. Founded in 1811, the hospital has more than 1000 beds and, with more than 10,000 employees, is the largest private employer in the city of Boston.

Clinically, the hospital tries to be the best in all the major specialties of medicine. Mass. General officials say such comprehensive breadth of excellence can be an advantage to patients who want their body treated as a whole.

Providing such a range of services can be costly, however. Mass. General announced last week that 125 employees will be laid off, and more positions will be cut through attrition.

The hospital, the only one of the five situated away from the Harvard Medical School campus, is located near the Charles Street MBTA stop.

Previous Merger

Long-time employees at Brigham and Women's Hospital are already veterans of a previous merger. The hospital was formed in 1980 from what were the Peter Brent Brigham Hospital, the Robert Breck Brigham Hospital and two divisions of the Boston Hospital for Women.

Since its merger, Brigham and Women's has emerged as one of the mightiest of the Harvard teaching hospitals. In the fiscal year ended September 1991, the most recent year for which figures are available at the state Office of Public Charities, the hospital reported an annual operating surplus of $33 million.

Clinically, the hospital is especially noted for its neonatal intensive care unit (the largest and busiest in the state, it says); its burn care unit and its heart, lung, kidney and bone marrow transplant units.

Hospital president Dr. H. Richard Nesson earned more than $600,000 a year, according to a recent tax filing.

Harvard Business School Dean John H. McArthur is chair of the hospital's board of trustees.

A Specialist in 'Very Severe Illnesses'

New England Deaconess Hospital, founded in 1896, "deals with very severe illnesses," says Director of Communications Pam L. Lawrence.

While all five of the teaching hospitals are tertiary care facilities, dealing with the most complicated and life-threatening maladies, the Deaconess pursues such activities with a single-minded zeal. The hospital has no obstetrics department, no pediatrics department and no ordinary emergency room.

In other words, this is not where to go with a broken arm. It is, however, where to go with cancer, AIDS or complications from diabetes.

The hospital has 431 beds and 3,600 full and part-time employees. In the fiscal year ending September 1990, the most recent year for which figures are available, the hospital reported a $2.5 million surplus.

A Hospital for Children

Children's Hospital will celebrate its 125th anniversary in 1994. True to its name, the hospital's character is bound up in the nature of its young patients.

The hospital boasts of establishing the first independent physical therapy department in 1914 and culturing the polio virus in 1949. Today, its staff is dealing with urban violence as it affects children's public health, operating one of the world's largest centers for cystic fibrosis research and treatment and running regional centers for kidney and bone marrow transplants.

The largest pediatric medical center in the area, Children's is also the largest provider of pediatric services to the residents of Boston.

The hospital reported a surplus of $11 million for the fiscal year ended September 30, 1991. Hospital president David S. Weiner reportedly earned $340,000 that year.

'Individual, Personalized Attention'

Beth Israel Hospital has 504 adult inpatient beds, 3185 full-time employees and delivers 5,456 babies annually, With such high-volume, you might expect somewhat of a mass-production atmosphere.

But Beth Israel highlights its "individual, personalized attention."

The hospital was the first to issue a written statement of Patient's Rights. The statement, which includes the rights to be heard and responded to by hospital personnel, to privacy, to personal dignity, to respect and to detailed information, is distributed to each patient admitted and to each new employee.

"Primary nursing" is another patient care-oriented emphasis at Beth Israel. Each patient is assigned a registered nurse who has primary responsibility for that patient's nursing care. The hospital trains nursing students from 12 different schools, including Yale University and the University of Pennsylvania.

Beth Israel Hospital was established in 1916 by the Boston Jewish community to meet the needs of a growing immigrant population.

The hospital reported a $17.9 million surplus for the fiscal year ending in September 1991. Hospital President Dr. Mitchell T. Rabkin reportedly earned about $422,000 that year.

As the chief executive officers and chairs of the board of five Harvard Medical School teaching hospitals meet over the next six months to study ways to further cooperation, almost everything will be on the table. Power, money and national health care will influence decisions, but the distinct character of the hospitals will be the biggest factor.