From the Editor


Robert Fromberg, Editor-in-Chief

In the 1920s, British writer E. M. Forster bought his first piece of property.

Acquiring property had a profound effect on Forster-and not a very positive one.

"In the first place, it makes me feel heavy," Forster wrote in his humorous essay "My Wood." "If you have a lot of things you cannot move around a lot." Forster provides examples of how the responsibility of ownership "makes you think twice before you accept an invitation to dinner."

"In the second place," said Forster, owning property "makes me feel it ought to be larger." He found himself looking at the surrounding land, feeling it was unfortunate that he "dared not murder" his neighbor to get her property.

Forster's third point was that "property makes its owner feel that he ought to do something to it." Some days he wanted to cut down the trees; other days he wanted to grow more trees; both impulses he deemed "pretentious and empty."

Finally, ownership made Forster protective, wanting people to stay off his footpath and stop picking his blackberries, feeling like he should "wall in and fence out until I really taste the sweets of property."

Hospitals today are being encouraged to get larger-for example, to acquire physician practices, the subject of this issue of hfm magazine. Reviewing the articles, I was glad to see that they contain excellent strategies to avoid the onerous aspects of expansion that Forster observes.

At the root of Forster's problem was that he was expanding for no particular reason-exactly the situation that the authors of our cover story, "Choosing the Right Physician Practices," aim to avoid. They lay out a smart process for aligning a practice acquisition choice with organizational goals. The article presents a matrix whose axes are defined by the degree of financial benefit and the degree of strategic benefit that each practice would provide. Of course, the ideal is to have practices that provide both financial and strategic benefits (what the authors call "must-haves"). However, the real test is to determine whether a hospital is willing to sacrifice some measure of financial benefit to further a strategic goal and whether a hospital wants to acquire a practice that may be a "cash cow" but not deliver the strategic reach a hospital needs.

The result of this approach should be that a hospital is not weighed down by its physician practices, but that the practices actually make the hospital more nimble by giving it a stronger cash position and better reach into parts of the community that the hospital needs to serve. Similarly, as the hospital continues to grow, that growth will not be just for the sake of growth, but for a purpose that will further both the financial and community-health missions of the organization.

And whereas Forster finds owning property made him stingy and protective, the articles in this issue of hfm point the way to more productive relationships with the partners hospitals will need for a successful future. 

Publication Date: Thursday, December 01, 2011

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