A plaque remaining from the Big Apple Night Club at West 135th Street and Seventh Avenue in Harlem.

Above, a 1934 plaque from the Big Apple Night Club at West 135th Street and Seventh Avenue in Harlem. Discarded as trash in 2006.

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Entry from March 11, 2013
“No margin, no mission” (health care adage)

"No margin, no mission” began as a saying at Catholic and Presbyterian hospitals. The hospitals were owned by non-profits, but a hospital needed turn a profit ("margin") to accomplish the non-profit’s mission. “No margin, no mission” has been cited in print since at least 1985, when it was said by a nun.

“No margin, no mission” became popularly used by health care facilities of all kinds.


30 June 1985, Philadelphia (PA) Inquirer, “High costs force cuts in free hospital care,” pg. A1:
When the hysterical woman arrived at the emergency room of Presbyterian-University of Pennsylvania Medical Center, hospital officials had no idea it was the first time she had ever been outside the cramped cellar room in West Philadelphia where she had been shut away by her parents.
(...)
“As one nun remarked to me recently: ‘No margin, no mission,’” said Walter McClure, an economist who has studied the subject.

Google Books
Health Care Administration:
Principles and Practices

By Lawrence F. Wolper and Jesus J. Pena
Rockville, MD: Aspen Publishers
1987
Pg. 49:
A succinct summary might be “no margin, no mission,” and it takes abroad base of skills — entrepreneurial, accounting, professional and administrative — combined with an increasingly substantial time commitment from every board member, to maintain that margin in today’s competitive environment.

OCLC WorldCat record
No margin, no mission : conflict, commitment and organizational restructuring in a Catholic hospital
Author: Marie Wolff Dwyer
Dissertation: Thesis (Ph. D. in Urban Social Institutions)--University of Wisconsin-Milwaukee, 1989.
Edition/Format: Thesis/dissertation : Thesis/dissertation : Manuscript Archival Material : English

Google Books
Dimensions of the Healing Ministry
By James E. Hug; Center of Concern (Washington, D.C.)
St. Louis, MO: Catholic Health Association of the United States
1989
Pg. X:
Increasingly we hear the slogan, “No margin, no mission.” Others object that there is no reason to struggle so hard to scrape out a margin if we end up sacrificing our mission in the process. The mission is not what is achieved after expenses are met.

Google Books
Choices and Conflict:
Explorations in Health Care Ethics

By Emily Friedman
Chicago, IL: American Hospital Pub.
1992
Pg. 114:
It became one of the stock hospital phrases of the 1980s, having first been used (so legend has it) by the sisters who govern Catholic hospitals: “no margin, no mission.” If the hospital cannot cover its costs and get a little bit ahead in order to have reserves, it cannot remain open, and its ability to fulfill its mission will, of necessity, be destroyed.

OCLC WorldCat record
“No Margin, No Mission”: Challenge to Institutional Ethics
Author: Marie Wolff
Edition/Format: Article : English
Publication: Business & Professional Ethics Journal, v12 n2 (Summer 1993): 39-50
Database: Arts & Sciences IX
Other Databases: MEDLINE

OCLC WorldCat record
A piece of my mind. No margin, no mission.
Author: B Blackwell
Edition/Format: Article : English
Publication: JAMA : the journal of the American Medical Association, 1994 May 18; 271(19): 1466
Database: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

OCLC WorldCat record
Preparing Tomorrow’s Nurses for the No Margin-No Mission World of Health Care
Publisher: [Pitman, N.J.] : Anthony J. Jannetti, Inc., [c1983-
Edition/Format: Article : English
Publication: Nursing economic$. 17, no. 4, (1999): 193
Database: ArticleFirst

OCLC WorldCat record
No margin, no mission : health-care organizations and the quest for ethical excellence
Author: Steven D Pearson; James E Sabin; Ezekiel J Emanuel
Publisher: Oxford ; New York : Oxford University Press, 2003.
Edition/Format: eBook : Document : EnglishView all editions and formats
Summary:
Can the ethical mission of health care survive among organizations competing for survival in the marketplace? On this question hinges not only the future of health care in the US, but that of the health care systems of all advanced countries. This book presents both an analytic framework and a menu of pragmatic answers. The team of authors, physician-ethicists from Harvard Medical School and the National Institutes of Health, worked with a consortium of health care organizations to explore some of the most challenging dilemmas in health care today: How can health plans determine medical necessity in a way that ensures quality care, controls costs, and builds trust with patients and physicians? What are the strategies for caring for vulnerable populations that meet their special needs without dramatically increasing costs? To answer these and other similar questions the authors blend ethical analysis with real-world example. The outcome is a rich analysis of the ethical challenges facing health care organizations, combined with tangible examples of exemplary methods to address these challenges.; This book will help health care leaders, regulators, and policy makers incorporate exemplary practices, and the underlying themes they embody, into the very heart and soul of health care organizations. 

Posted by Barry Popik
New York CityWork/Businesses • Monday, March 11, 2013 • Permalink