This weekend, Yale-New Haven Hospital President and Chief Executive Officer Joseph Zaccagnino will hand over his position to current Executive Vice President and Chief Operating Officer Marna Borgstrom, the first woman to assume the top post in the hospital’s history.

Borgstrom, who has worked at Yale-New Haven for 26 years, will inherit an institution marked by both accolades and criticisms.

In the recent past, Yale-New Haven has received high rankings from U.S. News and World Report and recognition from the American Association of Retired Persons as the ninth best employer in the nation for workers over 50. At the same time, employees and local activists have continued to clash with Yale-New Haven over efforts to unionize its workers and development plans for its cancer center.

History of medicine professor Naomi Rogers said the hospital’s presidents have historically has a difficult time running Yale-New Haven without conflict, especially since the 1960s, when unionization was on the rise.

Many of those conflicts have been endemic to all large non-profit organizations in the country, said history professor emeritus Gaddis Smith ’54 GRD ’61. The hospital’s difficulties have, for the most part, coincided with the University’s own fund-raising and labor problems, he said.

Beyond its relationship with employees, patients and neighboring city residents, Yale-New Haven’s historically nebulous relationship with the University will underscore many of the challenges Borgstrom will face.

This blurred affiliation evidenced itself recently when hospital workers lodged complaints against Yale-New Haven, asking for compensation equal to what the University pays for similar jobs. Hospital spokesmen responded by pointing out that Yale and Yale-New Haven are separate corporations and that the hospital pays better than other medical institutions in the state.

The University differs from many of its peer institutions, such as the Johns Hopkins University, in that it does not own Yale-New Haven, Smith said.

“At times in Yale’s history the University has toyed with the idea of buying it, but it has never decided to,” Smith said.

Yale-New Haven was founded in 1826 but did not become a partner of the University until nearly a century later. And the hospital’s current working relationship with the University evolved only after 1950, Rogers said.

“The presidents of the hospital up until then reflected the New Haven power structure rather than Yale’s power structure,” Rogers said. “Today the board is more carefully balanced between Yale people and New Haven people.”

Smith said the relationship between the University and Yale-New Haven grew out of necessity at the turn of the century, when the hospital was a charity institution and the School of Medicine faculty was only about five professors. The Medical School wanted its students to have full access to hospital patients as teaching tools.

“This led to a lot of acrimonious debate,” Smith said. “At first the hospital wanted Yale to pay much more for access to patients, as it was running a deficit … Eventually Yale did pay a considerable amount.”

By the 1980s, medical professors began earning large sums from clinical practice, shifting the School of Medicine’s role with relation to the hospital, Smith said.

Smith said Borgstrom’s appointment coincides both with a trend of hiring women to top positions at Yale and with the number of female students at the School of Medicine beginning to exceed that of men.

“Yale did not admit women to the medical school until 1916 and, until the 1960s, enrollment and faculty were miniscule,” Smith said. “But … when almost half of your doctors who have gotten medical degrees in the last 20 years are women, it is about time.”

It remains to be seen whether Borgstrom will take the hospital in a different direction than did her predecessors.

Hospital spokesman Vin Petrini said Yale-New Haven expects a smooth changeover of leadership as Borgstrom assumes her position, and the hospital’s board of trustees intends to “maintain a consistency of purpose and principle during this transition.”