Urban hospitals, an endangered species, still fill a unique role in their communities
As the CEO of a hospital named after Albert Einstein, I’m often asked which of his quotes is my favorite. My answer is always the same: “Life is like riding a bicycle. To keep your balance, you must keep moving.”
Our ability to keep moving has enabled Einstein Healthcare Network to survive 150 years and grow from a 22-bed hospital in an old farmhouse to a comprehensive healthcare provider and education leader with hospitals and outpatient-care centers across the Philadelphia region.
We’ve adapted, adjusted and advanced—to the changing financial environment, to new trends in healthcare, to the dizzying onslaught of new technologies. Other urban hospitals have not survived this torrent of change. The startling truth is that nearly half of urban hospitals in 52 major cities closed between 1970 and 2010, according to one study. But survival is possible, as our story proves.
Some hospitals followed their affluent patients to the suburbs. Others were doomed by competition, which led to over-expansion, duplication of services and, ultimately, mergers, acquisitions and closures. Even now, beds remain empty at too many hospitals as healthcare rapidly pivots toward ambulatory care, and new technologies enable patients to be treated without hospitalization.
Einstein has been buffeted by these same circumstances. But we’ve never altered the one thing I believe has kept us from faltering in this new world: our mission. Einstein began in 1866 as the Jewish Hospital with a motto that appeared over the building’s entrance: “Dedicated to the relief of the sick and wounded without regard to creed, color or nationality.” This powerful phrase assured Jewish Civil War veterans, freed slaves, immigrants and the impoverished that they could rely on us for outstanding medical care delivered without discrimination. The Jewish ethic of Tikkun Olam— meaning “repair the world”—is still our guiding principle.
Our commitment to serving a vulnerable population informed our decision not to abandon the urban neighborhood we serve today, even as we opened a new suburban hospital four years ago. The expansion was a strategy to diversify our payer mix and support our efforts in Philadelphia as our neighborhood began showing the wear of fleeing middleclass residents. Our commitment was reinforced when 17 other city hospitals made a financial decision to close their labor and delivery units. Einstein not only remained committed to providing this essential service, we expanded to provide greater access.
As we grow in other locations to enlarge our patient base and safeguard our financial security, we’re staying put in the city. Our Philadelphia campus remains the largest independent academic medical center in the region, training over 3,500 health professional students a year. We know that urban hospitals play a pivotal role in maintaining the vibrancy and health of a city.
We not only care for some of the city’s most vulnerable populations, but we anchor challenged neighborhoods, maintaining stability by providing thousands of jobs and acting as an oasis for folks with a tenuous foothold in society. One out of four residents in our urban ZIP code makes less than $10,000; 1 in 10 is older than 65 and living in poverty; the median income is half the national average. Many of our patients remain uninsured, despite the expansion of Medicaid, and are beset with chronic conditions such as heart failure and diabetes, which require consistent treatment.
Surviving 150 years in an urban setting that has undergone tumultuous change isn’t really a miracle. It required having a strategy and vision that propelled growth while reinforcing our mission. We set out to change the world but adapted to a world that changed us—while we remained devoted to our founding principles. Perhaps this loyalty to mission and devotion to neighborhood can compel other urban hospitals grappling with the same upheavals to find a way to survive while staying put.
Barry R. Freedman is president and CEO of Einstein Healthcare Network in Philadelphia.