Healthcare leaders are probably stressed at present when they assess regional healthcare finances; the need for a healthcare system to be fiscally responsible is very real. Tennessee is the No. 1 state for rural hospital closures. Consider the impact on rural communities such as Sneedville or Mountain City if their hospitals were to close. While consolidating resources should improve the bottom line, hospital mergers are no guarantee of healthcare improvement, so it is likely that regional healthcare leaders are anxious about the future. It is also reasonable for the community to pay close attention to decision making.
So whose designated responsibility is it to ensure Ballad’s decisions reflect what is best for the communities served? It is the Ballad board of directors. This group is composed of nine men, two women and no persons of color. In the past, when I held a leadership roll in healthcare, I studied the deliberations of the former Mountain States board of directors and felt that too often the board rubber-stamped the decisions of the administration. Hopefully the board of the new Ballad organization will do better.
It is reasonable to ask who might have significant influence on the Ballad board of directors. In our region, we don’t have a Hospital Authority which is required to report to the citizens as is the case in Nashville and Chattanooga, so we must look at other sources of motivation.
Some citizens feel the local medical school might be a brake on poor decision-making. While I have little knowledge of the present workings, I do know about the past; my opinion is that some previous medical school administrators meekly followed instructions from hospital leadership. Historically, the local medical school freely acquiesced to the administrative decisions of hospital systems. And this may be wise. The primary missions of medical schools are to care for the patients they serve and train the healthcare providers of the future. Inserting themselves into arguments over regional healthcare may interfere with their primary missions.
How about the state of Tennessee as guarantor of good decision-making? Certainly, it is a responsibility of the state given the regulations set forth in the laws which allowed the creation of Ballad, codified as the Certificate of Public Advantage (COPA). One must keep in mind, however, the reality of political decision making. It is hard to keep track of all Ballad interactions with state politicians, but it is known that Tennessee Sen. Rusty Crowe has listed Ballad Health as an income source on his Disclosure of Interest statement. This financial arrangement is a legal activity, but it does increase skepticism that COPA enforcement will be diligent.
So we are back to the Ballad board of directors as the group citizens hold responsible for the region’s healthcare interests, and it looks like citizen groups are the folks most likely to engage in promoting constructive change. I’m sure that each individual Ballad board member genuinely wants what is best for the region’s healthcare. A review of available members’ credentials shows physician input does exist, but business acumen is the predominant characteristic. Healthcare is a business and this expertise is needed. But there is no public health expert, there is no designated employee advocate, there is no expert in medical ethics, there is no expert in medical technology and there is no one person whose sole responsibility is to advocate for the patients of the region.
Many boards are self-perpetuating. When terms end, the current board members elect the next board members. This has the advantage of ensuring that new members are capable and have a strong work ethic. It has the disadvantage that future board members tend to look a lot like past board members, some groups of citizens become marginalized, and the boards may end up reporting to themselves instead of communities. Since Ballad is a dominant force in the region’s healthcare, regional citizens should have input into the running of the organization. Tennessee law provides for a “Hospital Authority” which reports directly to the citizenry. While it is probably too late to establish such a system in Upper East Tennessee and Southwest Virginia, I do suggest that discussions begin on identifying a mechanism for the region’s citizens to select at least three members of the Ballad board of directors.