Anyone looking to preview the future of public hospitals may not wish to dwell too long on the hellish situation in Boston detailed in last week's "Bellwether" column (Nov. 25, p. 31).
Still, many public hospitals recognize their future lies in the ability to become part of a unified community-based network of caregivers. And as the effort to create a new Boston Medical Center amply proves, establishing such connections won't be easy.
In San Francisco, executives appear to have gotten the network message. Leaders there are endeavoring to bring together two public hospitals, one or two private hospitals, community clinics, and mental health, substance abuse and other public-health services. The public hospitals involved are San Francisco General Hospital Medical Center and Laguna Honda Hospital and Rehabilitation Center.
"We're trying to do the same kind of model in the public sector they do in the private sector," said Rich Cordova, chief executive officer of San Francisco General.
Denver General Hospital, recently renamed Denver Health Medical Center, this year joined Colorado's largest network, Healthcare Colorado. The network hopes to build on its successful effort to undertake Medicaid HMO contracting through Colorado Access. And with Mayor Wellington Webb's support for creation of a quasi-public authority, the public hospital could gain more leeway in responding to the changing marketplace.
The nation's public hospitals face a tough road ahead, and joining together is just a small first step. In many urban areas, explosive union issues must be resolved. While the transformation of Boston City Hospital shows the minefields, the avowed willingness of the influential Service Employees International Union to "partner" with public organizations may signal better working relationships ahead.
To flourish, such networks must provide accessible and affordable services. They must capitalize on their unique community-based perspective. And they and their network partners must develop cohesiveness, whether or not a merger of assets is involved.