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Mount Sinai Hospital (New York, N.Y.). Office of the Director
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Dates of existence
In January 1852, the Jews’ Hospital in New York was incorporated. The nine men responsible for its creation quickly set about raising funds so they could build a hospital and begin to pursue the "benevolent, charitable and scientific purposes" outlined in their charter. Land was found, construction begun, and in 1855, they looked forward to a June opening. The Directors were hopeful for the success of their endeavor, and carefully guided every aspect of the Hospital's affairs, from decorating the wards, to what type of cases would be admitted.
On April 1, 1855, the Board of Directors (later called Trustees) appointed Julius Raymond as the first Superintendent of The Mount Sinai Hospital, at the salary of $300 per year. This position served as the eyes and ears of the Directors and was responsible for the oversight of the daily operation of the institution. He served at the pleasure of the Directors and the real power remained vested in them.
The extent of the duties of the Superintendent can be seen in the minutes of the Board of Directors for October 11, 1872. They list the "Rules and Regulations for the Government of the Superintendent": He was the steward of the Hospital and lived within its walls; kept the ledgers and accounts; visited every ward at least once a day, as well as once before retiring for the night; had the power to engage or discharge any and all but the medical staff; and could not absent himself from the Hospital for longer than three hours without the permission of the Board. Generally, if the Superintendent were married, his wife was hired as the Matron and took care of the housekeeping functions.
As the Hospital grew and became more complicated, duties were split off from the Superintendent and given to assistants. The first Assistant Superintendent was hired in 1892.
The increasing complexity of the Hospital over time also began to tax the energies of the Directors. Medicine was growing more complicated and they had to rely more and more on the Medical Board to oversee and advise on medical matters and staffing. Also, the Directors were becoming immersed in the planning and fund raising for the new Hospital to be erected on 100th Street and had less time to deal with the daily concerns of the institution. When S. L. Fatman, the Superintendent, announced his intention to resign in 1903, a committee of the Directors was formed to study what the role of the Superintendent was, and to make recommendations for the future.
In February 1903, S. S. Goldwater, MD was moved from Assistant to full Superintendent at the salary of $2,000 per year. He is now known as one of the pioneers of modern hospital administration, and his strong ideas on the subject were developed at Mount Sinai. With his urging, the Board of Directors on April 12, 1903 passed a resolution "making the Superintendent the real boss with final jurisdiction over all departmental disputes", as Dr. Goldwater phrased it.
This was a very important change. It marked the beginning of a new chapter in Mount Sinai's governance. There was a lessening of the role of the Directors in the day-to-day activities of the Hospital, especially medical, in favor of a central administrative staff. Also, it set the pattern of hiring a medical doctor to fill the chief administrative position, when previously there had been no felt need for a medical background.
In 1917 the title of the Superintendent's office was changed to Director, while the Board of Directors became “Trustees”. Yearly appointments were granted the Superintendent until 1920, after which time no limits were specifically set. The responsibilities of the office were not defined in the By-Laws of the Hospital, but seem to have been roughly equivalent to chief operating officer.
In 1970, the By-Laws were amended to note that the Director must be qualified under the provisions of Title 10, Chapter V of the New York State Hospital Code. He represented the Board of Trustees, the Chairman of the Board, and the President of the Hospital and "operates the Hospital in all of its activities and departments."
These last emendations were a part of the changes in structure brought about by the creation of Mount Sinai School of Medicine and the establishment of The Mount Sinai Medical Center, Inc. on October 20, 1968. The Hospital and School were joined together under the overarching organization of the Medical Center and its officers, with the Medical Center administration, were responsible for long-term planning and fund raising for the various corporate bodies that comprised the Center: The Mount Sinai Hospital, Mount Sinai School of Medicine, and The Mount Sinai Hospital School of Nursing, now defunct.
When the Medical Center was incorporated, the Director of the Hospital was given a position and title within the new organization. The Director "shall be chief operating officer of the Hospital and shall have such powers and duties as may be assigned to him from time to time by the President." He reports to the President of the Medical Center and, through him, to the Chairman of the Board of Trustees.
The Annual Report of The Mount Sinai Hospital for 1979 explains the shift in management operations at the Hospital:
In the late 1970's, a new management approach was begun that broke away from the more traditional school of hospital management in which the key decisions were made by the central administration. Policy making and resource allocation decisions are now being placed in the hands of the chairmen of medical departments-how the spending decisions are made, how the policies are developed-is becoming the function of management.
This statement reflects the advent of another era in the administration of Mount Sinai, as well as in the health care industry as a whole. It was no longer deemed necessary for the Director to have a medical degree. Rather, he must have an expertise in management skills and an understanding of the rapidly changing environment in which hospitals operate. For, in truth, it is the environment that has changed the meaning of the role of the Director; the definition itself has not altered much in the past century.
In 1998 the title of Director of the Hospital was eliminated in favor of Chief Operating Officer.
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