Jewish hospitals keep traditions alive after mergers

The U.S. hospital sector has long struggled with how to manage secular-based hospitals alongside religious-backed hospitals, complicating matters both before and after a merger or acquisition between the two types of organizations.

Over the last decade or so, the integration process at several of the hospitals has forced executives to have frank discussions about what faith means to their organization's mission and values, and more broadly, what it means to be a faith-based provider in the 21st century.

It's fairly well-known that Catholic hospitals follow tighter restrictions regarding reproductive services and other types of medical care, but Jewish hospitals quietly have faced their own set of challenges over the years in combining with secular or Christian hospital systems.

KentuckyOne Health, Louisville, was formed through the combination of Jewish and Catholic hospitals, and has settled on an approach to managing hospitals with different religious affiliations. The system was created by the combination of Louisville's Jewish Hospital and several Catholic hospitals in 2012. KentuckyOne made a very intentional effort in the two years after its founding to preserve its Jewish roots. But now its parent, Catholic Health Initiatives, Englewood, Colo., is looking to sell some of its facilities and recently bought out its partner, the Jewish Heritage Fund for Excellence, to further that process. A sale to another organization likely means that KentuckyOne officials would have to review its approach again.

Still, KentuckyOne's decision to preserve faith-based initiatives in its culture is fairly common. Historically, Jewish hospitals have provided patients access to kosher food and rabbis and respected the rules of the Jewish Sabbath and holidays. More notably, the hospitals protected patients from Christian proselytizing and provided work for Jewish physicians, who in many cases had trouble getting work at non-Jewish hospitals.

But the latter issues are no longer a significant reason for Jewish healthcare to exist, as it would be highly unlikely for Jewish physicians and patients to experience that type of discrimination at a facility today. Yet, plenty of facilities that are now Catholic- or secular-owned still reference their Jewish heritage, either in name, decor or culture.

Rabbi Nadia Siritsky, vice president of mission for KentuckyOne, said it's her job to frame the hospital's mission of "healing the world" through a Jewish lens. She distributes a reflection on each week's reading from the Torah—Judaism's main scripture—and hosts several health-related events with a Jewish connection. "I'm not just here to serve the Jews," Siritsky said. "I'm here to think, 'How do I live my Jewish identity by serving the broader community?' "

Jewish-Catholic mergers have led to some odd shows of unity in hospital nomenclature—like Barnes Jewish Christian in St. Louis and Beth Israel Deaconness Medical Center in Boston—and the retention of religious-based rules and traditions. Despite now being Catholic-owned and serving few Jewish patients, the operating rooms of Jewish Hospital in Cincinnati, which is owned by Catholic Mercy Health, are closed for non-emergencies during the Jewish High Holidays. That dedication comes in large part from a traditions agreement between Mercy Health and the hospital's board members at the time of the merger. They worked together to outline the future faith culture of the hospital, including religious symbols, the hospital's name and its logo, which includes a shofar, a ram's horn traditionally blown during certain Jewish holidays.

"The people in control of the hospital—have the same pride in its Jewishness that it originally had. I think that's very key," said Dr. Jeff Zipkin, former president of the medical staff and former trustee of the Jewish Foundation of Cincinnati, a charity created with the proceeds of Jewish Hospital's sale.

"What makes a community? It's the things that you have," said Dr. Donald Wayne, vice president of medical affairs at Jewish Hospital. "If you have a place that's got a 160-year plus history, why would you want to lose that?"

Agreements surrounding religious traditions and directives are often signed by facilities of different faith traditions that are merging. They often outline an agreement to honor the faith of the hospital being acquired, sometimes with specific tenets or traditions that will be continued.

Some would argue that there are a number of Jewish hospitals out there that, for all visible purposes, don't seem to have a significant religious connection specifically to Judaism. But, because Jewish hospitals don't subscribe to directives from a prevailing central authority like the Vatican, it's a lot harder to say what makes a hospital "Jewish."

Chicago's Sinai Health System is sponsored by the Jewish United Fund of Metropolitan Chicago. Its Mount Sinai Hospital building has historic Hebrew inscriptions on it, and there are some Judaica-themed art pieces hung in its religious reflection room. But it otherwise lacks any obvious Jewish imagery throughout its hallways, and has a largely non-Jewish patient population.

"I think Mount Sinai sees itself very much as an embodiment of Jewish values," said Roberta Rakove, the system's senior VP of strategy and external affairs.

Sinai is an unusual case. The system is one of the few, if not the only, Jewish health system in the country that acquired a Catholic hospital—Holy Cross Hospital, Chicago.

Rakove doesn't believe that ritual objects like a Star of David or mezuzahs—Hebrew scrolls posted on doorposts—would give the hospital a bigger sense of Judaism. Churches near the hospital have plenty of those symbols because they used to be synagogues when the community was predominantly Jewish and Eastern European. But those symbols don't define the churches' missions, she said. "We've talked about how do you meaningfully make that connection?" Rakove said. "I'll tell you right now, it's not in the physical symbols."

Kingsbrook Jewish Hospital in Brooklyn was founded in the 1920s to serve the needs of a then-significant Jewish community, though its patients now are more likely to be African-American or Caribbean, said Dr. Linda Brady, who was CEO of the hospital when interviewed for this article. Yet, the facility still has a small kosher kitchen available for a limited Orthodox Jewish patient population and celebrates some Jewish holidays. The hospital displays Jewish ritual objects and allows volunteers to celebrate Jewish holidays as a way to keep in touch with its roots.

There's been discussion over whether the hospital should continue to maintain a kosher kitchen given its largely non-Jewish patient population, but board members have largely maintained it should stay, she said. This is a common, difficult discussion that executives at current or former Jewish hospitals have faced given the significant reimbursement pressures that hospitals are under.

The facility isn't widely used by a nearby Orthodox community because it doesn't provide obstetric or acute pediatric services, according to Brady. The facility may be called a Jewish hospital, but its safety-net mission isn't based on any faith, she said.​

Some formerly faith-based hospitals have been very intentional about dropping their religious affiliations. St. Louis-based BJC HealthCare contains the initialism BJC for Barnes-Jewish Christian, the components of the merger of Barnes-Jewish academic medical center and Christian Health Services, a suburban community hospital network.

John Dubinsky, former chairman of Jewish Hospital of St. Louis, said the feeling among BJC's founders was the system would thrive because of its exceptional treatment and not simply because of a faith-based mission.

When Beth Israel Hospital and New England Deaconess Hospital, a neighboring Methodist facility, merged in 1996, the providers agreed to forgo any religious affiliation and become a secular hospital.

But today, the unified Beth Israel Deaconess Medical Center's two chapels are clear reminders of the system's predecessors: the chapel on the former Deaconess side has a steeple and Christian-themed stained glass, while the chapel on the former Beth Israel facility has an eternal flame, Ten Commandment tablets and other Judaic imagery.

"We've made them neutral interfaith spaces, but the architectural differences are hard to miss," said the Rev. Katie Rimer, director of BIDMC's spiritual care department.

Though BIDMC continues to be a secular hospital, Rimer says its leadership decided a few years ago to embrace the facility's faith-based history while embracing the power of faith in general. BIDMC encouraged the creation of employee religious groups, which have organized events for Muslim prayer, Buddhist meditation and celebration of a Hindu holiday. The hospital also had a sukkah, a temporary ritual shelter in which Jews host festivities for Sukkot, a fall holiday that will end this year Oct. 11. "The consensus of that committee was to lift up religious diversity and go back to some of those roots to embrace the rich history of commitment to social justice that both hospitals had," Rimer said.

These hospitals clearly want to harness the power of faith to improve healing and enrich the experience of patients and clinicians, but there are reasons why Catholic systems don't "convert" Jewish hospitals into Catholic facilities.​

Most Catholic system executives who have taken control of Jewish hospitals have an earnest desire to embrace Jewish traditions, said David Craig, a professor of religious studies at the joint campus of Indiana University and Purdue University in Indianapolis. There may be disagreement around sensitive topics like reproductive services, but those are eventually worked out, he said.

Brian Yanofchick, former senior vice president of mission at KentuckyOne, said the system chose to retain Jewish Hospital's name and eventually embrace its culture to respect the local community and the history of the hospital. Louisville clergy have told Yanofchick that the Catholic and Jewish communities in the city have had a strong, collaborative relationship, and he believes the hospital's honoring of its Jewish history demonstrates that in a very public way.

It also seems that some executives believe that keeping Jewish traditions can help development efforts. Several facilities have reported that Jewish philanthropists were interested in supporting their mission because they retained their Jewish heritage. "There is a sense in the Jewish community, in my experience, to want to give to the hospital, and that has been tremendous," said Pat Davis-Hagens, CEO of Jewish Hospital in Cincinnati and central market president for Mercy Health.

A number of community members have re-established financial and leadership support for St. Francis Hospital and Medical Center in Hartford, Conn., because it has embraced Jewish heritage following its merger with Mount Sinai Hospital in 1995, said Chris Dadlez, CEO of Trinity Health of New England, part of Livonia, Mich.-based Trinity Health.

"It's not the driving force—we love philanthropy from anyone," Dadlez said. "We didn't do this to gain a philanthropic presence in the Jewish community. We did it because it was the right thing to do."

But that doesn't mean the strategy doesn't work, said Stuart Rosenberg, past president of Mount Sinai Hospital and current president of Johnson Memorial Hospital, another Trinity Health facility in Stafford Springs, Conn. "Usually when you do the right thing, good things happen."

Editor's note: This article was reported and written when Adam Rubenfire was a reporter for Modern Healthcare. He now is custom content strategist for Modern Healthcare Custom Media.