Hospital: Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God, and Diversity on Steroids by Julie Salamon

Author:Julie Salamon
Language: eng
Format: mobi, epub
Tags: Brooklyn (New York, Social Science, Medical, Hospital Administration & Care, Urban Hospitals, General, Sociology, Health Care Delivery, Medical Care, Diversity in the Workplace, N.Y.), Hospitals, History
ISBN: 9780143115366
Publisher: Penguin Group USA, Inc
Published: 2008-01-02T00:00:00+00:00

Eight

No Margin, No Mission

From: Lillian Fraidkin, Senior Vice President & Chief of Staff

Date: December 29, 2005

Subject: Budgetary Restrictions

Please be advised that due to major budgetary constraints, there will be no approval of the following until after the first quarter of 2006:

• Monetary support for employees to attend conferences outside of the hospital

• Temporary or agency usage

• Catering, unless approved by the SVP

In addition, there must be a dramatic decrease in overtime usage.

These requests are our last attempts at avoiding layoffs. If we are unable to fulfill them, I will be forced to request a layoff list from each of you.

Thank you.

January 5, 2006, dawned with a crisp burst of light that was soon overtaken by a damp, gray chill. When Pam Brier met with her department chairs and administrative staff at 8:00 A.M., the weather had already shifted from promising to grim, matching her mood.

As usual, the hospital president had chosen her outfit carefully—a pink sweater and an old pair of pink shoes, reserved, she told me, “for occasions that require extra fortification.”

“Happy New Year to all of you,” she greeted the group gathered in 2C, an austere conference room lit by unforgiving fluorescent lamps. “Sorry about this.” She nodded toward the hospital’s preliminary budget, being passed around the table where two dozen of the top physicians and managers waited, glum and hungry. The apology extended to the small table in the corner, usually laden with breakfast pastries, fruit, and coffee, now barren as per Fraidkin’s directive.

No one spoke of the medical matter dominating world news that morning. Israeli prime minister Ariel Sharon had suffered a massive stroke at age seventy-seven, threatening fresh chaos in the Middle East, another potential front in the U.S. war in Iraq. Brier had more immediate concerns, her own parochial crisis, the $8 million gap between the hospital’s projections and the actual budget.

“You’ve heard, I’m sure, of hospitals around the city laying people off, but it can’t be solved by layoffs,” she said. “Union layoffs take forty-five days, so don’t even think of it.”

Bob Naldi, the terse financial chief, explained the problem succinctly: Expenses had gone up 5 percent, and reimbursements had gone up 2 percent; the $8 million lay in that 3 percent differential. Anticipated increases in surgery hadn’t materialized, while the cancer center had produced far greater start-up costs than expected. Naldi looked exhausted; his group had spent the last month narrowing a $30 million budget gap, but even with a hiring freeze, the hospital was $8 million short.

“We need eight point five million dollars over the next two weeks,” he said. “You look at every single item to see if you guys can find more cash.”

When Brier spoke, her voice was steely, but underneath the table one slender leg was bobbing with nervous energy. A few minutes into the meeting, she left the room to call one of her assistants, who soon appeared with a cappuccino in hand.

Brier’s message was unequivocal. “It is the fifth of January, and we don’t have a balanced budget,” she said.

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