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Harvard Business School

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Rev. April 9, 2001

Montefiore Medical Center
I did not want to spend my life reducing head count. I had to make some major
changes to have Montefiore grow and become more customer-focused.
Elaine Brennan was remarking on the challenges she faced in 1996 as the newly-appointed
senior vice president of operations at the Acute Care Division of Montefiore Medical Center. The
Center, the result of a merger of a large urban teaching hospital with a small university hospital, had
a $57 million annual budget deficit and operated within strong functional silos. It was the largest
provider of medical care to the 1.2 million residents of the Bronx, 65% of whom were Hispanic and
African-American. The borough had become a national symbol of urban decay, with deteriorating
tenements, and high rates of unemployment, addiction, poverty and disease. Montefiore’s patients
came from all the ethnic groups of the Bronx, and included more Medicare patients than any other
US institution.

History1
The Montefiore Home for Chronic Invalids was dedicated on the morning of October 26,
th
1884, to honor the 100 birthday of Sir Moses Montefiore, a Jewish leader and philanthropist. The
Home cared for the chronically ill patients that other hospitals could not help—patients with
tuberculosis, syphilis, “the opium habit,” arthritis, and chronic kidney disease. The Home grew larger
and moved from Manhattan’s Upper East Side to Harlem, and then finally to the Bronx. Some of the
best doctors in the city donated their time for patient care, teaching and research, and Montefiore
soon became known for its commitment to social service and scientific progress through innovative
health care, information and discoveries.
In a separate development, Yeshiva University sponsored the creation of The Albert Einstein
College of Medicine2 in the Bronx in 1955. Einstein quickly became a highly successful medical
school. In September 1963,... [continues]

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