How to run a successful hospital: Give patients what they want; HealthSouth's
philosophy; not the HMO philosophy.
This is why HRC will prosper and HMOs won't.
All IMHO,
TA
---------------------------------
October 27, 1999
To Run a Hospital in Brooklyn
Amid Cuts, It Takes a Politician
By LUCETTE LAGNADO
Staff Reporter of THE WALL STREET JOURNAL
BROOKLYN, N.Y. -- It's 10 p.m. Stanley Brezenoff pours himself a tall
glass of Chivas Regal, then joins a circle of men in black hats and long coats
dancing the hora.
Actually, he smiles gamely and shuffles his feet. But it's the thought that
counts. Mr. Brezenoff, the chief executive officer of Maimonides Medical
Center here, is courting some of his constituents.
Tonight, he is the guest of Bernie Gips, who helps manage an Orthodox
Jewish volunteer ambulance service, Hatzolah, in a neighborhood called
Borough Park. The occasion is an engagement party for Mr. Gips's son. Mr.
Brezenoff wants Hatzolah to steer its clients to Maimonides. So he shows up
to drink and dance and, above all, to schmooze.
A few days later, Mr. Brezenoff ties a red
bandanna around his neck to affect the look of a
Venetian gondolier and walks in a small Columbus
Day parade in nearby Bensonhurst, a heavily
Catholic, Italian-American neighborhood. He won't
ride in the gondola-float the hospital has rented.
"There are limits," he says, as he marches up 18th
Avenue, waving to the crowd.
Ah, the life of a hospital chief in the age of
managed care, Medicare cuts, expensive new
technology -- and declining hospital -- occupancy
rates, all over the country, but especially in New
York.
At Maimonides business is booming, with more than 80% of beds occupied,
but it wasn't always thus. Nearly five years ago, Mr. Brezenoff, who is 61
years old, took over the hospital, having been recruited by Martin Payson, a
former Time Warner executive, Brooklyn native and chairman of the
Maimonides board who was looking for "talent." Maimonides -- a Jewish
hospital in the heart of an Orthodox Jewish enclave -- had fallen into such
disrepute that Orthodox Jews themselves were shunning it. Hatzolah, the
ambulance service, wouldn't bring patients to the emergency room "unless
they weren't going to make it," says Mr. Gips.
Maimonides suffered from "uncaring behavior by staff" and "excessive"
bureaucracy, according to a scathing consultant's report it ordered up.
Maternity suites didn't have their own showers. The emergency room was
overcrowded. A respirator, on one occasion, exploded and killed three
people in 1993. And people complained about hospital food: The baked
chicken had feathers in it, says Pamela Brier, the hospital's chief operating
officer. The Joint Commission on Accreditation of Healthcare Organizations,
which inspects hospitals, gave Maimonides a dismal score of 62.
The 88-year-old Jewish hospital had its strengths, including a loyal group of
affiliated physicians and strong cardiac surgery and neurology departments.
But many doctors felt alienated from the old administration, and a war-like
atmosphere prevailed. Then Mr. Brezenoff, who had been deputy mayor in
the 1980s under Ed Koch, arrived.
In tackling Maimonides's turnaround, Mr. Brezenoff has applied lessons
from clubhouse politics, where every block, every neighborhood, is staked
out. But now he is courting patients instead of votes. And the bosses he
woos are rabbis and priests.
One vintage political tool Mr. Brezenoff employs: hiring from the community,
which in this case is diverse. Mr. Brezenoff has tried to fill openings with
people fluent in other languages. New signs in Chinese, Spanish and Russian
are going up throughout the hospital; Urdu and Italian signs are next. The
emergency room has been expanded; more nurses have been hired; a
recruiting drive is under way for doctors; the halls and rooms are cleaner.
But the key is attracting more patients. That's why Mr. Brezenoff keeps a
busy social calendar.
Because relations between Maimonides and members of the Orthodox
Jewish community were poor when Mr. Brezenoff took over, he made
efforts to woo them, trying to satisfy people's wishes concerning visiting
hours, respecting religious practices, and hiring a new vendor to provide
properly plucked chickens.
A result of these tweaks: Hatzolah's ambulance drop-offs at Maimonides
have more than doubled since 1995. Mr. Gips says other hospitals now
complain that he is neglecting them.
Problems with the Italian community in Bensonhurst were stickier. "People
felt that it was a Jewish hospital," says William Guarinello, who heads a
community board.
Mr. Brezenoff pondered the problem. His hospital indeed is Jewish, though
roughly 55% of its patients are not. But how to lure Italian-Americans and
other non-Jews? He drank espressos with Bensonhurst's community leaders
and dined with Catholic priests from Bay Ridge. He added a priest to the
hospital's board of directors.
"Food was one of the impediments," Mr. Brezenoff says. The hospital's chef
kept a kosher kitchen, so when he served Italian specialties, they had to
meet kosher prohibitions against mixing meat and milk -- like vegetarian
lasagna or lasagna with mock cheese. An Italian chef was put on the
payroll. Says Mr. Brezenoff: "If we want to get Italians from Bensonhurst to
use our hospital, you need a decent tomato sauce."
There is a booming Chinatown two blocks from the hospital. Mr. Brezenoff
and Ms. Brier hired more Chinese physicians and staff, about 130 altogether.
Now, the kitchen is experimenting with kosher Chinese dishes. And to court
the Haitian community in the nearby Kensington neighborhood, Mr.
Brezenoff held a Creole lunch for several hundred parishioners at a church.
The Haitians, Mr. Brezenoff noticed, felt totally isolated.
But Mr. Brezenoff's biggest test came last April when the powerful
92-year-old rebbe of the Bobov sect of Hasidic Jews fell ill. Hatzolah
somewhat reluctantly brought the Brooklyn rebbe to Maimonides, fearing he
wouldn't survive the trip to some hospital in Manhattan. The hospital jumped
through hoops to accommodate him -- rounding up the requisite male nurses
to care for him; posting security guards inside the intensive-care unit and a
police officer outside the ICU to control crowds in the event of his death
during his stay of nearly two months.
As it happened, the rebbe recovered, but, Mr. Brezenoff says, "I almost
didn't." |
