I knew Tim as a medical student. We were members of the same department. I recommended to the dean that Tim be appointed as director of the hospital.
The hospital had a problem with high mortality surrounding heart surgery. I got all the charts on deaths and set up a blue-ribbon committee to review them. One change we made was to bring in internists to monitor surgical patients-attending who were good 20 years be-fore needed educational programs. There were dramatic drops in mortality afterwards. Tim provided what we needed and helped develop it all. You need to do this [quality assurance] with delicacy, which Tim has more of than I do. Tim is a master at that. In the end, the affiliations program was succeeding so well I got accused of conflict of interest; by filling up the hospital I, according to attending, hurt quality.
We in this organization are a very heterogeneous group with different agendas. How do you orchestrate those agendas and deal with a medical college that feels it should run the hospital without having the qualifications to do so? How deal with practitioners who use the hospital, have given a lot, but who haven't kept up? How deal with people like me who have big ideas of our own, and how deal with others-when we need space and money? How deal with department heads still not imbued with the modern necessity of working together (for example, having an open-bed policy rather than bed allocations)? How deal with the nursing profession, which has changed dramatically over the last 25 years, wanting to assume the role of M.D.'s when there weren't enough M.D.'s? Now that there are too many M.D.'s, how get rid of the nursing school, which isn't cost-effective anymore? How keep the unions out? How deal with regulatory agencies? It's an impossible job.
Tim must deal with his own staff and the board of governors. How balance them all off and pick out the right ones to work with? Someone is always angry at the director, and they may have a case, but they don't see the other side. They may be better off if they don't open their mouths, but they don't realize this. Tim has an equanimity and imperturbability that is ideal for the job.
Tim's done good things for me. He's kept unions out of the hospital. He's kept us financially viable. Although the hospital is 50 years old, most things are state-of-the-art. He's walked the line at the medical school and admirably, with people viciously trying to take his job, withstood their attacks and held things together. His staff is devoted to him, although people criticize them. All past deans would attack the staff for apparently justifiable reasons, but he never attacked back.
I'll call Tim on the phone. I usually don't have formal meetings. I'll drop down and see him. It's never very long-10 to 15 minutes. The dean is concerned about affiliations again, and I talked to the two of them for 30 to 45 minutes. It was the dean's meeting.
Tim gets things done through the system he set up. In the hospital he has a lot of power, which the deans have envied, over his people. He recognizes the limitations of his power. You can get frustrated with him that way. I've gotten angry with him about this but realized subsequently that he couldn't do what I wanted. Or that what I wanted didn't need to be done, with the benefit of hindsight.
What I've learned is that Tim's main interest is doing a job. Some of our objections don't relate to the job he's doing, so they get ignored. At times I've been furious with him. For example, in the affiliations program, I didn't want committees, I wanted authority. They made me associate dean and associate director; I became a member of the executive faculty but not of the medical board. He said it didn't make any difference in getting the job done. He was right. He said he would do it [make me a member of the medical board], and he couldn't do it, and I wasn't succeeding as I wanted to, so I was angry.
There's talk now that Tim is leaving and a search committee will look for a replacement. I haven't talked to him about this. He's still trying to steer a course where the hospital would be separate. We're setting up a lipid center with the hospital, and there's a new world of cancer treatment that we're working on. As an institute, we don't have to go through department heads. For example, at the next board of governors meeting the hospital will vote $2.1 million to establish the lipid control center with us. Tim's role is significant in saying it's important for the hospital. We're getting space too.
As a person, Tim is a man of the utmost integrity and honesty. Tim is equal to anyone I've known in these respects. He's thoroughly devoted to principles of medicine and good medical care. He always considers academic benefits and the good practice of medicine as well as budget. Other hospital directors lack his academic sense.
As a manager, he's been criticized. As I look at it from a distance, I think he's an excellent manager. When I ran the kidney center I used to scream, I need more nurses and staff. When I had to start paying the nurses, I changed my tune. Attending don't like the way rooms are kept, but it's a 50-year-old building. Other hospitals aren't as clean as they used to be either. Tim takes a broader view than deans of the medical school, who don't fully comprehend the hospital side.
I rate Tim's performance as excellent, although there were times I didn't do that because I felt that I was justified in my criticisms. If someone has a good argument, Tim will always listen. I couldn't get anything from Tim without a detailed plan, including finances. He looked in thoroughly on what was necessary. He was an advocate of our institute, but only after we had done our homework.
Tim has developed a broader perspective over time, and he has learned. Good judgment comes from bad experience. He's experienced what anyone in the hospital field has experienced. The people who were against us are no longer here. He's very loyal to the people who have worked for him. If he's erred, it's been in keeping people longer than he should. He has let incompetent people go, but it's painful for him to do so.
Everyone would say he has tremendous integrity. Some deans would say he's a terrible manager because they wanted to manage the hospital themselves. Board members see the complexities of hospital management when they get into it. As a hospital director, Tim would come out better than most-they are whipping boys. People say he doesn't get along with the state health commissioner, but I think this is not the case.
In forming our institution, Tim steered it through all the regulatory agencies. We had gotten through one of the first committees, which never reject anything, but it rejected us. He called the commissioner and said we weren't understood, and the meeting was rescheduled. He called in a nice way and was persistent.
I remember his being viciously attacked by a former dean. Tim reacted to that with much more equanimity than I would have-I would have been furious.
Tim has a lot of influence on costs. If he doesn't want it, it doesn't happen. The board waits to see what Tim has to say. They trust his judgment. He's kept the union out. Tim has the most power here, which has burned the deans up. He controls most of the budgets.
Tim's had a great deal of impact on quality. I know this personally. I had all the money I needed to do quality assurance, hundreds of thousands of dollars. I've been out of that for four years. I'm not satisfied with what they're doing now, but they're doing a good job. There are a thousand M.D.'s here. I used to have private sessions on who would be watched and who wouldn't be watched. The administration gave that top priority. How do you deal with poor physicians? Tim would back every scheme we could think of. Tim has been the leader of that.
Over 20 years ago, the professor of medicine attacked the artificial kidney. I said I was through. We got out of the department of medicine. The only person who went to the chairman and said he shouldn't do this was Tim. This was the kind of group that attacked Tim. The deans were jealous of Tim's power, and they didn't recognize it themselves. Hospital budgets dwarfed the college's budget.
