Balancing Budgets, Employee Needs
Christine Mejail is worried.
For years, Mejail and her 5-year-old daughter, Emily, have commuted side-by-side to Beth Israel Hospital. Then, with kisses and hugs, Mejail drops Emily at the hospital’s child-care center and begins a long day managing the dermatology department.
When kindergarten starts in the fall, much will change. If Emily gets hurt on the playground, Mejail will be an hour’s drive away. A school play will mean much more than a quick dash from work.
Yet just at the time that Mejail may need extra flexibility in her job, she’s concerned that she might not get it.
Newly merged with its smaller neighbor, Deaconess Hospital, and under financial pressures, Beth Israel is battling to ensure its survival in the 21st century. Amid the turmoil, hospital leaders are determined to preserve a longtime commitment to valuing employees. Beth Israel has won a place on Working Mother’s Top 100 list 10 times in as many years.
But can Beth Israel Deaconess Medical Center continue to win accolades at a time of such tumult, when it’s preparing to cut $4 million from a $34-million benefits budget?
“We’re determined to do so,” said Dr. Mitchell Rabkin, who heads the merged hospital.
*
Employees like Mejail wish they could be sure.
“Everything feels safe now, being with my child,” said Mejail, whose office is plastered with her daughter’s art. But in the fall, “if I get that phone call, I’ll have to say, ‘Got to run,’ ” she said. “I hope it’s going to be OK.”
With mergers happening frequently and restructurings still common, companies nationwide are grappling with similar quandaries: how to make the changes necessary to prosper while valuing their employees. Often, they fail.
None of the tensions rippling through the hospital were apparent one June day at Beth Israel’s child-care center.
Toddlers shrieked with pleasure as they ran through a sprinkler in an open yard. Inside, two 1-year-olds shared a table, cheerfully munching on a messy spread of sweet potatoes and peaches. Teachers were seemingly everywhere, attending as few as three or four children apiece.
In preparing for the center a decade ago, the hospital was determined to make it accessible, said Roger Brown, founder of Bright Horizons Children’s Centers, a prestigious chain that runs both the BI and Deaconess centers.
BI spent years looking for a site that would accommodate more than 100 children, at a time when space for 30 to 40 children was the norm, Brown said.
As well, the hospital set up a sliding fee scale based on gross family income. The system, which subsidizes each child an average of $2,900 annually, is considered phenomenally generous by child-care experts. Deaconess, whose center for about 40 children opened in 1990, also has a sliding scale, and will soon adopt Beth Israel’s more generous standards.
Hospitals were pioneers in the work-family field, setting up some of the nation’s first on-site child-care centers. But the number of hospital centers has fallen to 600 from a high of 1,200 in the late 1980s, according to Diane Schulz of Child Care in Health Care, a national association of hospital-based child-care centers.
*
Hospital child-care centers have been easy targets because few were supported by wider work-family programs, and some were quite lavish.
In contrast, Beth Israel’s child care was never extravagant, and it is just one of a menu of employee offerings that include a breast-feeding support program with private lactation space; a wellness center featuring a subsidized gym; and an earned-time bank that lumps vacation, holidays and sick days together for parceling out at the employees’ discretion with management approval.
“It goes beyond people who have children to people caring for an elderly parent,” said Chris Westerman, who left BI’s public relations office three years ago to work in a New York City hospital. “It wasn’t just focused on women, but on the men who worked there.”
Deaconess, as well, offered enlightened programs, such as an earned time bank, but its overall menu was smaller.
As the merged nonprofit hospital hammers out a 1998 budget that includes a projected $52-million deficit, overall benefits spending will almost surely shrink, said Laura Avakian, a soft-spoken but candid BI veteran who heads human resources.
“Almost anything we’re about is under siege,” she said.
She’s currently looking for ways to cut her budget, perhaps by tinkering with the child-care subsidies. The best and most valued programs from both hospitals will be kept, she’s careful to say.
In the half-year since the merger, the hospital’s operating results show a $7.2-million loss, although a gain of $3.7 million if nonoperating revenue such as donations is included, Avakian said.
“Beth Israel Deaconess is doing better than some other hospitals financially, but they have a great deal to be concerned with,” said Alan Sager, a professor at Boston University’s School of Public Health. Especially discouraging, he said, is the hospital’s 8% drop in average number of patients per day in the last year and a half.
To cope, the hospital will winnow its 615 beds down to 400. Moneymaking ideas such as opening more clinics and operating rooms on weekends are being floated. And 240 jobs have been cut--sometimes amid tense politicking but for now without outright layoffs.
“We can never say never,” said Rabkin, who heads the hospital, but adds, “we don’t do things like that.”
And he and Avakian are adamant that the hospital’s commitment to its workers won’t be decimated.
“It would be shortsighted to quit work-life and reduce ourselves to the lowest common denominator of employers,” said Avakian, noting bluntly that in times of turmoil, loyal employees are more likely to work longer hours, endure a salary freeze or pay a bigger chunk of their health insurance--all hits that BI workers have taken.
