Why study the hospital/city relationship at all since this is obviously an emotionally charged issue?
The city needs to ask tough, even painful, questions because it has real, structural budget issues which cannot be solved by a few cuts or some temporary austerity. Even assuming the city keeps receiving local government aid from the state, it cannot maintain the infrastructure and facilities it currently has and struggles to continue services at the same levels. The council is already facing the need to increase property taxes for the new public safety facilities and it cannot use the tax tool to solve all the problems.
What else can the city do? Ask tough questions about everything the city owns, provides, and maintains to understand city operations and be able to make better decisions. Ask if there are different ways to provide services. Ask what the city can do to enhance its economic development potential. Ask what tools are available (legally, politically, practically) to help ensure Northfield is a financially resilient city for the long term.
The hospital is our biggest asset. Over just the last few years, starting in 2005, “the hospital” has grown to be the Northfield Hospital and Clinics in Northfield, Lonsdale, Lakeville, Farmington, and soon in Elko Newmarket. The council and residents need to know how Northfield city ownership of a regional health system works, then ask what actions we might take to ensure the financial health of city and its healthcare system for the long term.
The City Charter divides up the responsibilities between the council-appointed hospital board and the council. The hospital board controls and manages all hospitals and related medical facilities, but has no power to construct additional facilities, buy or sell any of these, or to levy taxes. The council has the powers to construct new facilities, buy and sell them and levy taxes, but has no role in the operation of the hospital. Despite approving the expansion by approving each land purchase, clinic project, etc., the council has not kept current with hospital strategy in a way that lets it understand what it means to own a regional healthcare system rather than a single hospital.
What basic principles will guide the discussion? Perhaps some like this:
- The council will not attempt to study healthcare industry, the future of healthcare, or the success of the hospital (which is shorthand for the entire system) as a healthcare provider – the council has no expertise and the Charter assigns this to the hospital board.
- No action to benefit the city will be taken which can be foreseen to undermine the hospital’s financial or operational success – the suggestion that the council simply wants to get cash now, regardless of the impact on the hospital and the community is ludicrous.
- The city values and wants to sustain a hospital in Northfield – in other words, it is important to have a high quality hospital in the city.
- The city would like to understand more about the hospital, its operations, and strategic planning in order to make better informed decisions within its power as owner.
- The city would like to develop a better framework for collaborating on decisions which impact both city government and the hospital.
Basic, broad questions: what are the costs, benefits, and liabilities of owning a regional healthcare system?
Where do city/hospital needs, plans, missions intersect? For instance:
- what are the hospital’s infrastructure needs, are they considered in the city’s CIP, and how will costs be assessed? The fringe location of the hospital increases these costs, so how do we plan for them effectively?
- What does the city do which impacts public health and could benefit from participation (which could be informational, financial, etc.) by the hospital?
- What development plans of the city impact the hospital or vice versa? For example, could earlier conversations about the EMS facility have helped the council decide on a location for the public safety center sooner? How does creating a public service cluster at that site guide future development?
- How can the hospital participate in the city’s economic development efforts? Healthcare has been identified as a target industry in the city’s economic development plan as has the more general objective of retaining existing businesses (and the hospital is one of our largest employers).
How can the city measure what matters about the hospital as it makes policy? In other words, how does the financial information figure in a larger picture of economic, environmental and social sustainability? We’ve heard a lot about “quality of life” as a goal of city services, as something which attracts residents and businesses, and which contributes to our identity and well-being as a community. In addition to being worth a lot of money, the hospital has great value for the city. How does city ownership of the hospital increase the value?