Hospitals and healthcare systems have the opportunity to fight a variety of social ills by changing their governance structure, according to Robert Toomey.
Toomey is a 1993 inductee into MODERN HEALTHCARE's Health Care Hall of Fame for his creation of the Greenville (S.C.) Hospital System, a vertically integrated community health system that was a precursor to today's healthcare networks. In a recent paper on governance, he says providers need to address the issues of teen-age pregnancy and violence, drug addiction, homelessness, child abuse and AIDS.
"Community interest, pride and well-being for the 21st century are at stake," writes Toomey, who is now president of Toomey Consulting Services in Greenville.
To that end, Toomey suggests that boards create a new organization that is affiliated with hospitals and healthcare systems and is solely responsible for promoting a healthy environment.
Unfortunately, Toomey says, most systems are too hobbled by their governance structure to address this particular issue. Even as healthcare has become a corporate interest, with mergers and acquisitions the driving forces, governance structure has been largely unchanged since World War II, Toomey observes. Although patients might be well served, they have become incidental to healthcare's new economic purpose, he adds.
Likewise, physicians and other members of the medical staff have little say in a hospital's operation or finances-a situation that has remained unchanged for decades.
Although Toomey concedes that there has been an effort to make governance more effective by the creation of advisory and subordinate boards, governing-board membership has usually been reserved for businesspeople and professionals.
"In a sense, the board was saying (to doctors), `You take care of patients, and we'll take care of the facility,' " Toomey says.
Nowadays, Toomey believes, physicians should hold one-third to one-half of the seats on governing boards. They should be recruited directly from the hospital or system. Regional and national physician leaders from medical schools and major teaching and research centers also should be appointed.
Nurses should also be represented and act in part as patient advocates, Toomey says.
With this new configuration, according to Toomey, medical policies and strategies such as alternative care, management of ancillary businesses such as nursing homes, and physician recruitment may be developed at the board level.
Nurse and physician placement on boards would finally allow governance to parallel and emulate the other changes taking place in healthcare, he concludes.