Hospital boards evolve, not always for the better

By 
  • January 26, 2011

When Ontario Minister of Health Deb Matthews appointed a supervisor to run Windsor’s Hotel-Dieu Grace Hospital Jan. 5, the government-appointed new man took charge of the hospital’s board — including responsibility for the hospital’s Catholic mission and identity.

The previous board chair was dismissed 10 days before Christmas by Catholic Health International, which owns the hospital. That followed a provincial investigation last summer that highlighted an “alarming lack of respect between medical leaders, senior management and the board of directors.”

The dismissed board chair would not comment on whether the board was getting the job done at the Windsor hospital. Read More

“I have no comment. That’s a rather loaded question,” Egidio Sovran told The Catholic Register. “I thought our board was fine when it came to expertise.”

Sovran still doesn’t know why he was let go. Robert Stewart, President and CEO of Catholic Health International, has not returned calls or e-mails from The Catholic Register.

The 19-member board of Hotel-Dieu Grace remains in place in an advisory capacity to supervisor Ken Deane, who has effectively become the board. While what precisely went wrong at Hotel-Dieu has not become public, board competence is an issue for Catholic hospitals across the province, said Wayne Taylor, a professor of health services management at the DeGroote School of Business, McMaster University.

“It’s competence. I think we had much more competent boards in the past,” said Taylor.

“We had the town’s leading CEOs and lawyers and accomplished people — men and women of whatever background who had experience in governance, who sat on company boards, who ran companies and understood the role of due diligence and oversight. Today, frankly, a lot of not-for-profit volunteer boards have become social clubs.”

There are 35 major Catholic boards in Ontario’s publicly funded system overseeing hospitals, nursing homes and community nursing.

If a Catholic board stumbles, the Catholic identity of the hospital often becomes an issue.

As with school boards, when a Catholic hospital board falters Catholics and non-Catholics begin to wonder why tax dollars are going to a Catholic organization that appears unable to govern itself.

“Whether it’s fair or not, it’s probably even more imperative that the quality of the (Catholic) board members is better than it might be under other circumstances,” said University of Ottawa professor of health care management Doug Angus.

Denominational boards “probably would come under a little heavier scrutiny than say the regular-type board,” he said.

Recruiting a good board has become more difficult in part because many senior business leaders now feel out of place on volunteer boards, said Taylor. “It’s not business-like. They don’t have the time. You see them not volunteering like they used to,” he said.

The problem is compounded by hospital CEOs who prefer a weak board, said Taylor. “It diffuses responsibility,” he said. “They can hide behind a weak board.”

But Taylor’s view isn’t shared by Dianne Moser, author of A Culture of the Heart, Mission and Values of Catholic Health Care. While boards do get into trouble now and then, the quality of Catholic health care boards of directors is excellent, she said.

The situation in health care is much better than in education where “lifers” can be re-elected over and over based more on name recognition than any skills they may contribute, said Moser, who has served on Catholic health care boards and consults on board training.

“When we go offside it’s because we don’t have adequate information or we choose not to take the information and use it right,” said Moser.

“You have boards that get all the information, but you still have members on the board that refuse to read them, or come to it with a bias or an agenda.”

According to Ron Marr, Catholic Health Association of Ontario executive director, Catholic hospitals have a proud history of providing a unique healing experience.

“We’ve got a 200-year history of providing high-quality care to the people in the community, regardless of religion,” he said. “Catholic hospitals offer an added dimension to hospital care in the sense that the focus is on the whole person — body, mind and spirit.”

The Catholic mission hasn’t changed since five Religious Hospitallers of St. Joseph came to Windsor in 1888 to serve the poor and the sick. But the role of hospital boards has changed as the province has searched for ways to control health care costs.

Where boards were once free to shape a strategic direction for their hospital, they’re now in charge of ensuring their institution is fulfilling its contracts with Local Health Integration Networks.

LHINs fund hospitals by purchasing services from them. The role of any hospital in a regional or even provincial network is now defined by which services the LHIN is willing to purchase.

“There’s less autonomy for hospitals today than there used to be,” said Tom Closson, president and CEO of the Ontario Health Association.

The 2010 Excellent Care for All Act and the system of “accountability agreements” between hospital management and the province further defines the board’s oversight role as enforcing the province’s limitations on spending.

“The main way the Catholic Church has influence on the system is through the values they establish in the strategic plan,” said Closson.

Keeping Catholic boards in place and ensuring a distinctive identity for Catholic hospitals is important to the health of the whole system, said Taylor.

“When you have a public hospital and a faith-based hospital across from each other it gives the patient choice,” he said. “We’re losing choice in so many regards in this country. I would hate to see us lose choice.”

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