Tim is an M.D., and a lot of hospital directors are not. Institutions like this function better with someone of his background in the post. Board members don't understand this. Economically, we would never have built the burn center. A non-M.D. would have no feel for it at all. The burn center does fine economically now; it loses a little money, but the community service is phenomenal.
Long-range planning has been well thought out, financed, grants offered to do it. Managed care is being looked at as hard as it can be analyzed. He's always in on the appointment of professional people. The dean and the director are always involved in this. They need to work together-staff have joint appointments, in the hospital and the medical school. In some hospitals there are major rifts between the hospital and the academic side, but not here.
I see Tim at least three or four times a week apart from formal meetings. I see him on an individual basis about various things- personnel, operating rooms, whatever.
Like most of us, Tim has a staff with responsibilities broken down; he meets with them to describe who's going to implement what and how. He goes to a lot of meetings and does a lot himself.
Right now, he's trying to maintain a good operation in the face of regulation and managed care. In most states, you don't even know who the state health commissioner is. Tim spends a lot of time on regulation and managed care.
His power comes through the board and meeting with its committees. Most of his power comes through the position.
Tim is a good manager. A couple of his people needed to be changed-one were changed, one will be changed. People say that this should have been done earlier. Most of his people have been OK. He's better than most hospital directors-his whole view of medicine is better. He's had honors reflecting that from leadership associations; he's held offices in them. His are not knee-jerk reactions to regulations but careful, considered decisions on the issues. In some places, you have center directors [chiefs] directing grants who aren't responsible to organizational objectives and patients. Tim works well within the system without disrupting their efforts. This is a result of his own efforts and him working with the people concerned. This is a major problem in some places: the policy under which center directors work is important. One center was spun off as an independent research group; this was done on an outside contract basis. It's been done both ways, depending on the thrust of a center, which I think is good.
He is a very stable, amiable, thoughtful fellow, well respected here, regionally, and nationally.
I would rate Tim's performance as excellent. He keeps a major operation going harmoniously. Complaints about him are mostly minor, compared to those about CEOs in institutions of this size elsewhere. Clashes between the voluntary physicians and the hospital occur elsewhere almost to the exclusion of the institution's needs. Practitioner complaints are related to practice. Some hospitals are not responsive to academic needs. Tim won't do things if the monies aren't there, unlike other places.
His techniques haven't changed over time. He's changed in response to changes in the system-the regulators, the strengths and weaknesses of the staff-what he's had to do to keep a big operation going. With managed care, we shall have to make changes. Hopefully, the way it's done, as with other changes, will be so as to get the best possible out of it. If you don't watch economics, they'll be dictating to you how to run the hospital.
Costs were watched all across the board, in personnel, equipment, supplies, and salaries. There is continuing surveillance; everyone's aware of cost-benefit ratios. When costs change, they react to it and do something about it.
Tim influences quality through selection of personnel. He's responsive to new technology as well. He sees every candidate for every major position; helps determine whether they get hired.
In most hospitals outside the Northeast, hospital directors are not MDs. It's almost impossible to translate the patient care implications of cost-effectiveness or quality to them. I've dealt with them. Non-MDs do at a big disadvantage not know medicine; they're at the mercy of the people giving them medical input, as far as knowing what the priorities should be. This doesn't result in as good an operation.
The hospital administrator's job depends on the whims of the practicing staff, and the administrator knows that. This makes for different priorities.
At a hospital I know, last week was the first time the hospital director met with all the chiefs at one time. Administrators maintain power by playing off one chief against another and against the voluntary staff. It takes a good manager to do things openly. The chiefs at those hospitals need a surveillance system to know about deals that will affect them. That's a major thing I appreciate in working here. That kind of politics can be extremely time-consuming.
The dean and director meet twice a week. This is important-it gets rid of a lot of that divide and conquers business. Deans use it as well as hospital directors. Meetings dispel that secret service stuff. There are places where the dean and director don't help each other, don't meet, have their own initiatives, and have collisions.
Unitary management of the medical school would be a disadvantage here: one institution would be favored. No one has both types of expertise. The present system works well.
