Governance of Teaching Hospitals

Turmoil at Penn and Hopkins

John A. Kastor, M.D.

Publication Year: 2003

What forces lead to changes in governance among medical schools and their associated teaching hospitals? To what extent do such changes affect how well those schools and hospitals do their work? In this book, John A. Kastor, M.D., focuses on the academic medical centers of the University of Pennsylvania and the Johns Hopkins University, two institutions that underwent dramatic change in governance during the late 1990s. Drawing on extensive interviews with more than three hundred administrators, physicians, and other medical professionals at Penn, Hopkins, and elsewhere, Kastor identifies the factors that influenced changes in governance at these two institutions. Chief among these, he finds, are structure, personality conflicts, and current events. This book will be of interest to administrators of teaching hospitals as well as professionals in health policy and management.

Published by: The Johns Hopkins University Press

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In this book I investigate how the leaders of the University of Pennsylvania and the Johns Hopkins University, two of the most renowned American universities, responded to the pressures agitating their academic medical centers by changing the systems governing their institutions. ...

1. Introduction

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pp. 1-4

There is a well-worn phrase, so familiar to most observers of American academic medical centers that it has probably reached the status of a cliché: ‘‘If you’ve seen one medical school, you’ve seen one medical school.’’¹ Although it is true that the structure and culture of these institutions vary widely, there ...

Part I: University of Pennsylvania

2. Before Kelley

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pp. 7-27

The University of Pennsylvania* appointed Dr. William N. Kelley dean of its school of medicine and leader of its medical center on August 2, 1989, and discharged him from these responsibilities on February 16, 2000. During the intervening ten and a half years, the Kelley administration formed a health system; ...

3. Kelley the Builder

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pp. 28-76

‘‘One of the most difficult markets in America’’¹ was the description often given to the Philadelphia medical scene by the mid-1990s, a time producing severe problems that William Kelley would face as his tenure at the University of Pennsylvania progressed.² ...

4. Kelley in Trouble

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pp. 77-132

As he approached 60 years of age, William Kelley could look with satisfaction on his accomplishments at the University of Pennsylvania since starting there on October 1, 1989. With the help of his longtime friend and colleague, Bud Pittinger, the Hospital of the University of Pennsylvania had generated large surpluses, ...

5. After Kelley

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pp. 133-156

On March 16, 2000, Peter Traber was confirmed as permanent CEO of the University of Pennsylvania Health System,¹ his other position as dean of the school of medicine remaining interim pending the results of the usual academic search. Traber and trustee Russell Palmer then convinced Robert Martin to return ...

Part II: Johns Hopkins University and Hospital

6. Separate Governance

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pp. 159-212

Sun readers now knew what most at Hopkins knew. A serious conflict between the leaders of the Johns Hopkins Hospital and the Johns Hopkins University School of Medicine was roiling one of the country’s most respected academic medical centers. ‘‘In twenty-three years, I’ve never seen anything like it,’’ ...

7. Unified Governance

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pp. 213-278

For a century, the Johns Hopkins University School of Medicine and the Johns Hopkins Hospital, despite being governed separately, had coexisted and flourished, with faculty and staff dedicated to the same missions. Now, however, the conflict between the leaders of the two entities grew so intense that the boards of trustees had to enter the fray ...

8. Conclusions

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pp. 279-294

What accounted most for the change in governance at the medical centers of the University of Pennsylvania and Johns Hopkins University, problems with the governance structure, current events, or internal conflicts produced by leading personalities? ...

Images

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Appendix 1: Governance of American Academic Medical Centers

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pp. 295-302

Appendix 2: Interviewees

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pp. 303-320

Notes

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pp. 321-346

Index

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pp. 347-356

E-ISBN-13: 9780801881442
E-ISBN-10: 0801881447
Print-ISBN-13: 9780801874208
Print-ISBN-10: 0801874203

Page Count: 368
Illustrations: 15 halftones
Publication Year: 2003