Social Worker Providing Leadership in
Municipal System
An interview with José R. Sánchez, CSW, ASCW
(November/December 2003)
Mr. José Sánchez is
a most influential Social Worker in the field of Health Care in New York City.
This is based on the position he holds as the Senior Vice President of the Generations+/Northern
Manhattan Health Network - the largest acute care network in the Health and
Hospitals Corporation (HHC).
Q. What is the scope of your responsibilities?
As the Senior Vice President of the Generations+/Northern Manhattan Health Network, I have the operational, fiscal and strategic oversight responsibility for the largest multi-hospital Network in HHC. The Network includes three medical centers: Harlem, Lincoln and Metropolitan, three large diagnostic and treatment centers: Morrisania, Renaissance, and Segundo Ruiz Belvis, and over thirty clinics. I have a staff of 8,000 and an operating budget of $800 million. I am also the Executive Director of Lincoln Medical and Mental Health Center.
Q. How is it that you achieved such a role for a social worker?
After graduating from Adelphi University School of Social Work, I worked in
the Department of Psychiatry at Brookdale Hospital. I always had an interest
in management. When a managerial opportunity became available at Bronx Lebanon
Hospital, I took a salary cut and accepted the position. I quickly became the
Chief of Administrative Services and Associate Director of Psychiatry.
Later, I left to take a position as the Chief of Staff with Dr. Luis Marcos,
who at that time was the Commissioner for New York City’s Department of
Mental Health and Mental Retardation. A change in mayors dissolved that position
and a change in governors dissolved my next position as Executive Director of
the Bronx Psychiatric Center. By then Dr. Luis Marcos was President of HHC and
offered me the directorship of North Central Bronx Hospital and later of Metropolitan
Hospital. In July of 1999 the current Network was formed and I was asked to
become its head.
Q. What do you perceive as your biggest challenges?
Our mission is to “take care of everybody who comes through our
doors.” It is a noble mission but costly. In 1997 the act of
balancing the budget by the federal government significantly reduced healthcare
reimbursement streams. In order to fulfill the responsibility of our mission,
I needed to increase revenues consistent with the level required to take care
of patients, in addition to finding ways to maximize the use of the revenues
we collected.
I inherited a whole gamut of complex community issues – poverty, lack
of marketable skills, substandard housing, and a constant flux of new immigrants.
Many households are comprised of young, single parents. The annual income of
Bronx residents is at least $10,000 below that of Manhattan. Many of our patients
have no health insurance - a major barrier to access.
The communities in the Network have some of the worse health indicators in the
entire country and, I believe, even worse than some third world countries. For
example, the Bronx is the epicenter of asthma in the U.S.; Harlem has the highest
infant mortality rate within a 24-block radius; and Mott Haven the highest concentration
of AIDS. Among Latinos and African American men, there are high rates of colon
and prostate cancer, and among African American and Latino women, high incidences
of diabetes, obesity and higher mortality rates from breast cancer.
Constantly changing demographics force us to frequently refocus our strategic
plan to address community needs. Mexicans and Moslem Arabs now predominate in
the Metropolitan Hospital area. Harlem Hospital now responds to the Dominican
community from Northern Manhattan. Lincoln Hospital is a mixture of Mexicans,
Puerto Ricans, Dominicans, African Americans and Africans. A new middle class
has moved into the Central Harlem area as a result of the Empowerment Zone initiatives.
Each group brings a different set of challenges to the delivery of care in terms
of languages and cultural issues.
Q. How have you addressed some of these challenges? And, what other
things do you want to do?
I try to keep in the forefront those issues that affect the communities we serve.
I meet with my six Community Advisory Boards (CABs) on a regular basis. I find
that I am very effective in bringing together communities (Africans, African
Americans, Latinos) to work with me, to hear their concerns, and for them to
work together as communities who can benefit from each other’s strengths.
We need to take the time to acknowledge their perception as to why things happen
and respect their views. The CABs are great advocates and supporters of the
public health system. I have really enjoyed this aspect of my work.
In this Network, an Urban Health Conference is held annually to focus on the
prevalence of certain diseases in our communities and to highlight work done
in the public health care system. I ask myself why some conditions are found
in our communities and nowhere else in the country. If I aggregate the budgets
of all the services in the Network, it would show that we spend a huge amount
of money. So why do we have such poor health outcomes?
Patients need to be at center of what we do. We should be training physicians
to take care of people, to focus on taking care of patients’ illnesses
and making a difference in the community. The constant cycle of doctors who
come and train, do research, publish results, gain reputations, are not applying
that knowledge in our communities. There are two standards of care in the City
and it concerns access to care - other communities benefit more than our communities
from research findings. I would like to see this change.
Q. Has your social work training influenced your career?
As a social worker I have been in a very unique and challenging position. I
must prove myself more than others because CEOs who are trained in business
don’t understand how I am able to do what I do. People don’t understand
social work. They think of social workers as professionals who work with the
poor and destitute, which we do, but they do not think of us as professionals
who can run a large organization such as this. There is an “image”
problem
I would not have been able to accomplish all that I have if I had not attended
social work school. The basic skills I learned during my training – individual
dynamics, understanding behaviors and organizing skills – have attributed
to my success. I also had to learn a lot on the job, including budgets, understanding
hospital systems and helping people work together. I think when you combine
social work training with knowledge about finances and policy, you end up with
the best administrators.
Q. What contributions do social workers make to the Network? To the
financial integrity of the hospital?
Their role has changed as the health care field has changed. Social workers
have an important role in reducing the length of stay and following patients
through the continuum of care from emergency room, admission, to discharge and
post discharge. Where social workers once provided more concrete services, in
today’s world, they are an integral part of the treatment team. Social
workers make better case managers than other allied professions because of their
knowledge of human dynamics. This knowledge makes them more effective in dealing
with case management issues that also take into account patients’ social
and support systems.
When social workers get involved with the care of patients and insure that they
follow through with their health care needs, it can reduce the need for further
treatment and/or having their conditions worsen. When they insure that the patients
leave the hospital within an appropriate time frame, it helps the finances of
the hospital. So they are improving the health and safety of the patient and
the financial health of the hospital.
Social workers are important members of my Revenue Enhancement Committee whose
role it is to review investment of time and resources that are needed to enhance
the health of our community. This is consistent with our social values of helping
people and changing communities.
Q. What are your views about maintaining distinct social service departments
in hospitals?
All disciplines have changed in how they do business. I don’t believe
it’s so much a question of having social service departments, as it is
a question of changing roles of social workers in the health care system. The
more traditional departments that existed in the past are not functional in
today’s health care environment. Market forces have pushed us to reduce
length of stay and to be more mindful of finances. For social work to be a vital
profession in the health care field, social workers have to become indispensable
professionals. They must integrate the human and business aspects of the field.
Q. What changes do you think are needed in social work education?
I try to influence social work training in a number of ways including being
a member on the Board of Adelphi. More placements in middle management, not
just casework, need to be available. We need a new breed of social workers -
highly skilled and qualified - to take on the new challenges in the health care
field. Once people’s behavior is understood and you have human concern,
it’s important to combine this with business knowledge. We don’t
have enough minorities in high level positions - Latinos, African Americans,
women - we don’t give them enough access. The effectiveness of any organization
has to do with how leadership and their staff reflect the diversity of the community
they are serving. The field is not keeping up with the growth of minorities
in this country.
Editor’s Note: The beautiful waterfall in the reception
area of Lincoln Hospital portents of many user friendly aspects of the complex
- lovely in-and-out door waiting areas, soft pastel colors through out, multilingual
and multiracial staff, specific care centers, like Women’s Health. Mr.Sanchez
rightfully takes pride in the atmosphere and caring environment of this public
health center.