"I Said It My Way"--the latest hospital news, explained

(Paul Scott has resurrected "I Said It My Way" for one week only.  Today, he tackles this week's most popular question: "What's going on at the hospital?")

It's likely that by the end of 2014, Winneshiek Medical Center will have had three Chief Administrative Officers and two Interim Chief Administrative Officers in three years.  That doesn't include resignations and retirements among other administrators, doctors and other health care providers.  So it's perfectly understandable that a lot of people have been asking me lately "What's going on at the hospital?"

Here's my answer: "I don't know."

But I do have a theory about the overall management of Winneshiek Medical Center that I'll share with you--and you can determine for yourself whether this rings true for you.

Who runs the hospital?  There are two models of management for most hospitals in the country.  One model is of a community hospital in which a board hires administrators who report to the board.  Another model is of a hospital that is owned by a health care organization, which runs the facility itself.

Winneshiek Medical Center has an unusual model of management.  The hospital is a community hospital in the sense that Winneshiek County owns the property the hospital sits on and pays nearly $500,000 a year in property tax collections towards the operation of the hospital.  But the hospital is also like a hospital run by a health care organization in that by signing a Management Services Agreement with Mayo Clinic Health System, the hospital is run by Mayo instead of by administrators hired by the hospital board.

Contrary to popular opinion, this is not a "Mayo versus Gundersen" issue.  Both are world-class health care organizations.  It's a management issue and, specifically, an issue about an unusual management model that combines the worst features of both models.

For instance, if Winneshiek Medical Center's board returned to its previous practice of being a community hospital which hires its own administrators, the hospital board would set its own priorities instead of being affected by having Mayo Clinic Health Systems set priorities.  On the other hand, if the hospital were totally owned and managed by Mayo (or Gundersen), local taxpayers wouldn't be subsidizing the operation of the hospital to the tune of almost $500,000 a year--plus free land.

When a hospital management set-up is unique, there's usually a reason for it and that reason is that other hospitals around the country have seen the problems with that management model and have avoided it. 

The latest administrative departure underscores just how little influence the hospital board is currently wielding (my opinion).  The Winneshiek Medical Center board gave no indication of dissatisfaction with the performance of former CAO Gretchen Dahlen--the decision to part ways with her seems to have come from Mayo. 

I believe there are only two logical alternatives for Winneshiek Medical Center: 1) End the Management Services Agreement with Mayo Clinic Health Systems and return to local control by having the hospital board hire its own administrators; 2) Put the hospital up for sale to the highest bidder--Mayo or Gundersen or anyone else, so county taxpayers no longer have to fpay property taxes in order to have an out of town health care organization run the local hospital.  Either model would be fine with me.  But whatever the choice, the current management model continues to show its shortcomings.