15 District Hospital A Lesson in Governance Cynthia Mahood Levin Healthcare Consultant, Palo Alto, CA Kurt Darr The George Washington University, Washington, D.C. HISTORY Barclay Memorial Hospital (BMH) has enjoyed a reputation for excellent medical care in an affluent community for over 70 years. In the mid-1940s, its community was mainly agricultural, but urbanization was beginning. Hospitals in the region were operating at capacity. Community members and physicians proposed a solution to the problem of overcrowding at local hospitals: form a hospital district supported by the community through a tax. Voters approved the hospital district in 1945 by a 5 to 1 margin. The first decision was to select a 15 -acre campus. In 1947, voters approved an $8 million bond issue to finance construction and operation of a 275 -bed hospital. The tax district spans seven townships that elect five district community members to a governing board for the district hospital's four entities, which include the hospital. joint ventures that operate an urgent care center and a hospice, and th hospital foundation. DISCUSSION QUESTIONS 1. How could she improve the financial position of BMH? 2. What strategies should be used to increase patient volumes? 3. Should she use the old strategic plan or develop a new one? 4. Would the board support her decisions? Her recommendations to it 5. Should she try to prevent nonunion employees from unionizing? 6. What steps were necessary to control the chief of medical staff? 7. What is the priority of preparing for The Joint Commission survey? 8. What could she do to assist board members in governing BMH ? 9. How could the executive team become more effective in improvin BMH's performance and help it become a market leader? 10. How should these questions be prioritized