ROLE OF THE HOSPITAL IN THE COMMUNITY

Washington hospitals have their roots in a commitment to caring and community service. Hospitals began as charitable refuges for the sick poor. They were organized by communities and religious organizations to pursue shared societal goals that would otherwise have to be provided by government. Hospitals represent a pluralistic approach to providing health care and reflect the unique needs of their communities.

Progress and changes have occurred over the years since hospitals began serving Washingtonians. Medical knowledge and skills have advanced. Medical technology has been developed and improved. Health and societal needs have changed. The ways of delivering and paying for health care have changed. Integrated delivery systems have emerged. Hospitals have joined with local public health organizations and others to address the broader community health needs of their communities.

THE HOSPITAL’S COMMUNITY HEALTH ROLE         Top

Hospitals have certain unique roles and attributes. Examples are noted below.

• The improvement of community health status
• The integral relationship of the hospital within the community
• Access to care for those in need of services
• The obligation to provide high quality health care services
• Recognition that public expectations from nonprofit and public hospitals are unique
• The importance of fiscal responsibility in ensuring the long-term commitment of hospitals to their communities
• The maintenance of traditional values of compassion and charity
• Voluntary governance and accountability to the community. The governing body of the hospital provides the critical linkage between the values of the community and the day-to-day operations of a complex health organization
• The physician-hospital relationship. The trustee leadership and hospital management work in partnership with the medical staff to create the delicate and vital balance between institutional imperatives and professional independence

TRUSTEE’S RESPONSIBILITIES         Top

Trustees are the caretakers of Washington hospitals. Trustees must be sure that their hospital’s community service role is articulated in the hospital’s mission statement, particularly with respect to non-profits and public hospital districts. The service mission should assess the institution’s structure and activities to determine how responsive the hospital is to community needs and interests. Trustees need to consider the following questions.

• Do your policies support community service and programs?
• Does the Board monitor and evaluate the hospital’s progress in meeting its community service goals and objectives?
• Do you seek philanthropic gifts to fund community service programs?
• Does the composition of the Board represent a broad spectrum of community perspectives?
• Does the Board balance its community social ethic with its business ethic?
• To what extent does the hospital compete with businesses in the community and how does this competition affect relationships with the business community?
• Is the community’s perception of the hospital one of a charitable institution or a business organization?
• Is the Board aware of the extent of the community’s health care needs?
• Does your hospital have an image-building campaign as part of your marketing and public relations programs?
• Do you expect your CEO and other management and professional leaders to be active in the community?

Trustees are a key link between the hospital and the community. They must make a conscious effort to communicate all of the benefits that the community derives from the hospital: 24-hour care, a variety of community services and programs, education of health professionals, medical research, employment and purchase of goods and services. They must also communicate the needs of the community to hospital administration.

In Community Stewardship: Applying the Five Principles of Contemporary Governance, Scott Goodspeed highlights 20th and 21st century community health governance principles. These are noted below.

Goodspeed goes onto to describe the skills that Governing Boards will need to successfully move into the next century. These compentencies differentiate the 20th from the 21st century Board.

• Community stewardship - creating healthy communities, focusing on population health status and serving the public
• Visionary leadership - picturing and articulating what a better future might look like
• Systems thinking - seeing the interrelationship between what board and their organizations do and the health of the communities that they serve
• High-leverage actions - becoming change masters, practicing effective strategic planning, and communicating effectively
• Basic business skills - striving for cost-effectiveness, quality improvement, and increased productivity

WASHINGTON HOSPITALS         Top

Washington hospitals fulfill their community service mission with a variety of activities, depending on the health and social needs of the residents of their communities. Community service activities of Washington hospitals include:

• Provision of equal access to care for uninsured and underinsured patients
• Provision of care 24 hours a day, 365 days a year
• Performance of medical research for the long-term improvement of health care
• Provision of training and education for health care professionals, including physicians, nurses and other allied health care professionals
• Provision of essential services that are not necessarily economically viable, such as care of AIDS patients, burn care, intensive care, neonatal and pediatric services, obstetrics and trauma care
• Provision of community health education programs and preventive services for individuals and groups such as the indigent, women, children and teens and the elderly
• Hospital-sponsored community services and activities including ambulance services; availability of 24-hour emergency medical services; health screening services; programs for hazardous waste disposal; immunization services; rural health clinics and outreach services; transportation services; community revitalization activities; volunteer fund-raising activities for community organizations; emergency medical coverage at school district sporting events; hospital research activities; community education through radio, TV, newspaper ads, hospital publications and brochures on current health care matters; and sponsoring meetings or volunteer space (rooms) for community organization meetings
• Participation in broad based community partnerships with the goal of addressing prioritized community health needs

WSHA COMMUNITY BENEFITS PROJECT         Top

While Washington does not yet have community benefits legislation, in recent years, a handful of states have passed legislation that redefines a hospital’s tax exempt status. These laws require monitoring and reporting of charitable care, community benefits and government-sponsored indigent care.

The Washington State Legislature and the general public believe non-profit hospitals/systems should engage in charitable, community-based activities, in part because of their tax-exempt status. Tax-exempt status is granted to organizations that meet the requirements outlined in Section 501(c) (3) of the Internal Revenue Code. Typically, the exemption is based on the charitable purpose of the organization. The fact that an organization is non-profit does not necessarily mean it will qualify as tax-exempt.

Organizations demonstrate their charitable purpose in a variety of ways. The charitable purpose of a tax-exempt organization is reflected in its mission and vision statements, core values, and community-based activities.

To evaluate the accountability of Washington’s hospitals/systems to their communities, WSHA has developed valid and credible measures of community benefits. A number of Washington’s urban hospitals/systems are using these measures, or guidelines, to account for the benefits provided to their communities.

WSHA’s Community Benefits Program has three goals:

• Provide information to inspire and support collaborative community benefits activities among hospitals and health care delivery systems
• Support public education activities aimed at reinforcing the image of hospitals/systems as exemplary community service organizations
• Provide information to support the tax-exempt status of non-profit hospitals/systems in Washington state

As noted above, the hospitals/systems in Washington state provide a wide variety of valuable benefits to their communities. Most hospital/system services are delivered with an expectation that someone will pay for them. Many services, however, are delivered with the expectation they will not be billed for, since the service is part of the "community benefits" provided by hospitals/systems. The definition of community benefits has two components: "community services" and "charity care." Charity care data are already collected and reported annually by the Washington State Department of Health. WSHA’s Community Benefits Program is focused on preparing an inventory of community services and tax data on an annual basis.

Community services include programs and activities aimed at improving the general health and well being of the whole community, or community members with special needs, as well as improving the health system in general. These services are not expected to be financially self-supporting and are available to all members of a community.

SUMMARY         Top

Trustees have the responsibility as a two-way link between the community and hospital and to help guide their hospital into the 21st century. This will mean not only responding to the acute care needs of patients but the broader population as well.

REFERENCES         Top

Bailey, Charles, General Counsel, THA - The Association of Texas Hospitals and Health Care Organizations, Austin, TX, January, 1998.

The Catholic Health Association of the United States, Social Accountability Budget for Not-for-Profit Healthcare Organizations, St. Louis, MO, 1989.

Goodspeed, Scott W., Community Stewardship: Applying the Five Principles of Contemporary Governance, AHA press, 1998

Health and Safety Code, Vol. 1, Chapter 311, Subchapter D, Vernon’s Texas Codes Annotated, St. Paul, MN: West Publishing Co., 1992 and 1998 supplement.

Henry, Ann, Director, Division of Data Development and Management, Texas Department of Health, Austin, TX, January, 1998.

Hospital Trustees of New York State and Hospital Association of New York State, Ten Steps to Building a Community Service Plan, Albany, NY, July, 1991.

Hospital Trustees of Pennsylvania, HTA Trustee Folios, Harrisburg, PA.

Texas Hospital Trustees, Texas Nonprofit Hospitals: Guidelines for Meeting Tax Exempt Status Requirements, Austin, TX, 1993 and revised 1996.

Voluntary Hospitals of America, Voluntary Standards: A Framework for Meeting Community Needs, April, 1992.

WSHA Community Benefits Project-Interim Report, August 1999, Washington State Hospital Association