An Inside Look at Running a Hospital

Nicholas Genes, MD, PhD

Disclosures

October 30, 2007

It may happen at the end of a tough shift, when you glimpse some people in suits stepping into a sleek black sedan waiting outside the hospital. Or maybe an errand takes you over to the administrative wing, which always seems more elegant and sparkling than your own department.

But sooner or later, everyone who works in a hospital wonders about the folks at the top: the perks, the salaries, what gets said at those meetings and lunches.

At one of the most prestigious teaching hospitals in the United States, the chief executive officer (CEO) has lifted the veil from his activities.

Paul Levy, the man credited with cleaning up Boston Harbor, now heads Beth Israel Deaconess Medical Center (BIDMC) in that same city. For over a year, he has publicly shared aspects of his job on his blog, Running a Hospital.

Running a Hospital hosts Grand Rounds
October 30, 2007

Any topic is open to scrutiny: the hospital's infection rates, the management's deal with the Red Sox, and yes, even his salary:

[T]he issue often arises as to whether hospital CEO salaries are out of line. Americans are often ambivalent about high salaries for corporate executives: They often complain about them, but, at the same time, everybody hopes that he or she can someday earn them! Putting aside that personal sociological observation, let me ask you the question directly: Do you think I earn too much?

Here are the facts. As noted by the [Boston] Globe, my total compensation was about $1 million in fiscal 2005. Of this, $650,000 was the base salary. Also, I was eligible for a 30% incentive compensation payment if the hospital achieved specified results for clinical quality, patient satisfaction, and financial performance. I received the full amount that year, $195,000. The rest of the million comprised payments made by BIDMC for life insurance and retirement. (Don't worry, there are no other perks, like cars or country club memberships!)

Now, some background on BIDMC: The hospital is a billion-dollar-a-year enterprise, about $800 million in clinical revenues and $200 million in research programs. Our annual capital budget is roughly in the range of $80 million. Last year, we raised $30 million in philanthropic donations from people in the community...

So, if you were on my board, how would you set an appropriate salary? You might look at the competition, and as the Globe notes, the salaries for most of the Boston-area hospital CEOs center around the same level...

...This is serious business that affects both the perception of hospitals in the public eye and also the ability of hospitals to attract the talent they need to run a complicated organization that is vital to the community. What do you think: Do I get paid too much? Here is your chance to send a message to me, my board, or the community at large. I promise, all comments will be included (unless you use bad language!)

What does a CEO gain from this level of disclosure? I recently corresponded with Mr. Levy about his Web site and his open style of leadership.

Dr. Genes: I keep wondering: What's your relationship with BIDMC's press office? Do they live in fear of your blog and the topics you bring up? Do you coordinate their press releases with your posts?

Paul Levy: The press office at BIDMC reads the blog entries when everybody else does, after they have been posted. Sometimes reporters will call them and say, "What did Paul mean by what he said on the blog this morning?", and the press person will answer, "I don't know. What did he say? I haven't read it yet." They do not work with me in any way on it. I do my best not to scoop them on press releases. They do not vet it for confidential information or conflicts.

I told them I planned to start the blog before doing it, and we all thought it would be fun and an interesting experiment. We had no idea if anyone would find it interesting. I avoid posts involving confidential patient information where a patient might be identifiable even if his or her name is removed. Where a patient might be identifiable, I ask permission of the person or the family before posting a story. Ditto for personnel matters.

Dr. Genes: Do you encourage faculty, residents, and employees to blog? Do you think the hospital's Web site should link to such efforts or to your blog?

Paul Levy: I neither encourage nor discourage staff or faculty or residents to blog or not to blog. That seems to me to be inconsistent with the underpinnings of social media. It is totally up to them. However, as none of these personal blogs are official instruments of our hospital, we do not plan to link the official BIDMC Web site to them.

Of course, I would hope that any of our folks who choose to have a blog would follow common sense rules of behavior and propriety, but it is not my place to say how and what is right. If someone disclosed patient information or other confidential material, of course, they would be subject to disciplinary action -- just as if they did so orally or in writing on paper or email.

Dr. Genes: What have you gained from blogging? Does being in touch with critics and sharing news (good or bad) with the public keep you more centered?

Paul Levy: Writing is a good discipline. It makes you think about an issue more clearly to have to explain your point of view to others. For that reason alone, it is worthwhile. I also like hearing different points of view from people. Sometimes I wish that some would be more polite and not engage in ad hominem attacks, but that is one of the characteristics of an open and anonymous forum that comes with the territory.

I really enjoy the community attributes of blogging, especially the cross-linking to other people's sites. It is really neat to watch a thread start on one blog and pass along to others and back and forth.

Dr. Genes: Could your openness promote the culture you're striving for at BIDMC? Do you think the blog is good publicity for prospective patients -- that it lures new faculty?

Paul Levy: I like to think that my blog is consistent with a long-standing social culture of openness and friendliness at BIDMC. I have no idea if it brings in more patients, but I doubt it. I don't think it lures new faculty. Maybe it helps lure interns, but who can really know.

Dr. Genes: Have you had to justify it to some board members?

Paul Levy: My board members love it and read it regularly.

Dr. Genes: If blogging had been available 20 years ago, when you were with the Massachusetts Water Resources Authority (MWRA) working on Boston Harbor, would you have used this tool?

Paul Levy: I like to think I would have had a blog back in the MWRA days. It could have been very useful in many ways while I was engaged in lots of controversial activities.

Dr. Genes: You gave up your Blackberry last year; has blogging filled the void?

Paul Levy: The Blackberry is gone, but the blog has definitely filled up the time I used to spend on it. At least I can try to program it into my life -- early in the morning or late at night when my wife is sleeping -- so it doesn't interfere with normal human relationships!

Dr. Genes: Your Chief Information Officer, Dr. John Halamka, was very open about a big computer network crash at BIDMC in 2002. Did his openness spur yours? Does he discuss your blog with you?

Paul Levy: John and I discuss the blog from time to time, but really not much. (He just started his own!) He and I have a total agreement about transparency that precedes our friendship.

Dr. Genes: Paul Levy's openness may be a rarity among hospital administrators, but online, he is part of a large community of medical personnel, doctors, nurses, students, and patients discussing their experiences and opinions. On October 30, 2007, Running a Hospital hosts Grand Rounds, a collection of the week's best entries on medical blogs from around the world. Check it out, and learn more about "running a hospital" while you're there.

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