Harvard University Case 15 District Hospital a Lesson in Governance


Case 15
District Hospital
A Lesson in Governance

Cynthia Mahood Levin
Healthcare Consultant, Palo Alto, CA

Kurt Darr
The George Washington University, Washington, D.C.


Barclay Memorial Hospital (BMH) has enjoyed a reputation for excellent medical care in an affluent
community for over 70 years. In the mid-1940s, its community was mainly agricultural, but urbanization was
beginning. Hospitals in the region were operating at capacity. Community members and physicians proposed
a solution to the problem of overcrowding at local hospitals: form a hospital district supported by the
community through a tax. Voters approved the hospital district in 1945 by a 5 to 1 margin. The first decision
was to select a 15-acre campus. In 1947, voters approved an $8 million bond issue to finance construction and
operation of a 275-bed hospital. The tax district spans seven townships that elect five district community
members to a governing board for the district hospital’s four entities, which include the hospital, joint
ventures that operate an urgent care center and a hospice, and the hospital foundation.

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