“No Margin, No Mission”

Abstract

Rapid changes in the social and financial environment have driven many hospitals to adopt new strategies to remain financially viable. Especially in the case of older not-for-profit hospitals, however, these strategies are often perceived as violating the mission goals for which the hospital was founded. This report describes an empirical case study of a religious hospital's attempts to remain financially viable in a competitive market while still maintaining its commitment to its historical social mission of serving the poor. Powerful subgroups within the hospital community?administrators, the medical staff, and the Board of Directors?tended to disagree about whether specific accom modations were in agreement with the hospital's mission and formed c-ifferent justifications for their beliefs. The administrative group, which gained increasing power, defended its priority of focussing on fiscal solvency as necessary for the achievement of the mission. However, if this critical task becomes an end in itself, the hospital's original implicit social contract with the community may be altered and the true meaning of the mission distorted. This analysis calls into question whether the hospital's mission can be accomplished and its social responsibilities can be met through strict adherence to the prevailing business strategies adopted by most hospitals and the traditional paradigm of clinical medicine. This study examines the changes which hospital leadership imple mented in the organizational structure of a Catholic hospital as the economic environment made it increasingly difficult to achieve its tradi tional goals?the goals which were determined by its identity as a Catholic organization belonging to a specific religious congregation. To protect its anonymity I have called this hospital Community Hospital.