Governance of Hadassah Hospitals

Governance of Hadassah
Hospitals
Yair C. Birnbaum, MD, MPA
Associate Director General
Director Medical Services
Hadassah Ein Kerem Hospital
A Few Comments Before Starting …
On Hebrew Words
On Hebrew Words
• What do these numbers stand for
– 8150
– 25000
– 450000
On Hebrew Words
• What do these numbers stand for
– 8150: Number of words in Bible
– 25000: Number of words in Hebrew Dic.
– 450000: Number of words in Webster
Dictionary
Governance:
An Historical Glimpse…
A Glimpse on Governance in
Jerusalem Hospitals
• Between the years 1872-1897, a German
Catholic pediatric surgeon operated a
children’s hospital in Jerusalem.
• The hospital served the multi-ethnic
population of the greater Jerusalem area.
• Although operated by a fervent Catholic
believer, the hospital was approved
(“kosher”) by rabbinical authorities during
the later half of its activity.
The Governance of the Marienstift
Children’s Hospital
• Dr. Max Sandreczky used to correspond
with existing and potential donors.
• The communications dealt with a range
of issues which are common, even
today:
– Personal stories of patients and staff
– Needs of the hospital
– Capital development
The Governance of the Marienstift
Children’s Hospital
• In 1893, Dr. Sandreczky felt he had to explain to
his supporters why “the Marienstift Children’s
Hospital had no governing board”. (‫)ועד מנהל‬
• The first board was dissolved with no
intervention by Dr. Sandreczky. The members
did not suit the purpose for which they were
nominated.
• Dr. Sandreczky could not form a second German
board because all the possible candidates from
the small community in Jerusalem were already
involved in their own institutions or connected
to one another in other ways.
The Governance of the Marienstift
Children’s Hospital
• The formation of a Germany-based
board was not practical. In order to
accomplish this, Dr. Sandreczky felt he
had to spend significant time in
Germany.
• “But there are those who know that my
work and family obligations did not
allow me to visit my homeland during
the last 19 years.”
Experience has shown that success can be
accomplished even without a governing
board, like the Schneller Orphanage.
The Governance of the Marienstift
Children’s Hospital
• At the end of his words regarding the issue of
a governing board, Dr. Sandreczky refuted the
notion in theological terms that such a board
is necessary.
• The fact that the hospital was active and
successful without a board was a sign that this
was the will of the Lord (voiding the mistaken
human notion).
• “I will work as He wills and as He guided me.”
Fast Forward to Hadassah Hospitals
Glossary
• HWZOA: Hadassah Women’s Zionist
Organization of America
• HMO: Health Maintenance Organization
• HMO: Hadassah Medical Organization
• BOD: Board of Directors
Background
HWZOA, the
owner of the
HMO in
Jerusalem,
was
founded in
1912.
Background
• The organization laid the framework for
the public health system in Israel and
later on, for the hospital system.
• In 1918, Hadassah took over a small
hospital in the center of Jerusalem and
opened its own hospital on Mt. Scopus
in 1939.
First Hospital Opened in
1918
Mount Scopus Campus
Completed in 1939
Hadassah Medical Organization’s
Hospitals in Israel
•
•
•
•
•
Jerusalem
Tel Aviv
Haifa
Beersheva
Safed
Background
• During the War of Independence, the hospital
on Mt. Scopus was vacated and inpatient
services were provided in a few locations in
the center of town.
• After the War of Independence, Hadassah
handed over the public health system and all
hospitals outside of Jerusalem to the
government. Hadassah dedicated its efforts
to create a strong academic tertiary care
center in Jerusalem.
Background
In 1961, the Ein Kerem campus was
dedicated.
The Ein Kerem Campus
The Ein Kerem Campus
Background
In 1976, Hadassah returned to the
renovated Mt. Scopus hospital.
Governance Up To 1997
• Governance was based on the
leadership of HWZOA interacting
mainly with the Director General.
• After some stormy years and the
recognition that managing a hospital
needs a variety of capabilities, a BOD
was founded.
HMO Board of Directors
• The Board is comprised of three main
groups:
– HWZOA: represented by the leadership.
– American public/professional figures
– Israeli public/professional figures
• The Board meets four times annually for
two days with committee teleconferences
in between scheduled meetings.
Governance of Hadassah Hospitals
HWZOA - Owners
Board of Directors
Management
External
Audit
HMO Board of Directors
• HMO BOD has the following permanent
committees:
– Executive
– Finance
– Investment
– Business Development
– Research
– QA & Safety
– (Audit )
Audit Committee
• External to the Board.
• Approves audit plan for the year.
• Meets regularly to review comptroller
reports, management response and
give recommendations.
• Reports to Board on main findings.
• Approves audited financial reports
prior to BOD approval.
HMO Board of Directors
• Examples of recent topics debated:
– Major capital development
The Front
Yard
‫החצר‬
‫הקדמית‬
The Back
Yard
‫החצר‬
‫האחורית‬
HMO Board of Directors
Examples of topics debated:
• Major capital development
• Risk management and self-malpractice insurance
• Affiliation of other hospitals with Hebrew UniversityHadassah Medical School
• Business development (medical tourism, quality of life)
• Significant issues in the Jerusalem and national health
care system.
• Strategic planning
• Hadassit (technology transfer arm of Hadassah) IPO
HMO Board of Directors
• The HMO BOD nominates the Director
General of HMO in Jerusalem.
• Board approval is necessary for the
following:
– Yearly financial reports
– Nomination of heads of department
– Real estate issues
– Opening bank accounts
Issues for Discussion (1)
• The HMO BOD has no resources
available as an independent board.
• The HMO Board’s approval for capital
development or yearly support goes for
further approval to the HWZOA BOD.
Issues for Discussion (2)
• HMO is funded mainly by the National Health
Law via the sick funds.
• The government has curtailed the power of
foreign citizens in the higher education arena
due to the fact that the majority of funding
comes from national sources.
• The majority of HMO BOD members are not
Israeli citizens and not well acquainted with
the local health care circumstances and
practices.
And What about the MOH?
A Final Word
• There is no doubt that BOD supervision
of a hospital is necessary and can
improve the overall quality and
development of the institution.
• The issues to be considered are
balancing between different
systems and cultures and
setting borders between
micromanagement and
oversight.
As she sat for her
portrait one day,
Henrietta Szold cried
out to the artist:
“Make my eyes look
towards the future.”