This is an academic medical center. You must accept the fact that power rests with the clinical chairmen and nurture that. Some are more powerful than others. Intelligence, personality, and resources determine their power. Medicine and surgery chiefs are powerful. Tim recognizes that. To be truly effective, he must touch base with a lot of people. You can turn the board around faster if you tell them the chiefs are behind you than the other way around.
Secondly, this is a human service business. Dealing with people means you must be able to listen and have the patience to listen. Board members tend to come from a different kind of environment.
Clinical chiefs are not analogous to division presidents in business. There have been more successful palace revolts in academic medical centers than at Citibank.
Tim has consistently demonstrated an ability to convey to every-one that, even in the wildest storm, everything is fine and calm; he projects that. Tim insists on looking at things from a no personal perspective-what is best for everyone else, putting himself last. I don't find this too often in hospital CEOs.
His successes have been mobilizing the place, improving the place financially, and continuing in a crazy period to advance delivery here to the cutting edge-we have the first lithotripter and MRI. He recruits quality academic leaders. Tim's biggest weakness is his loyalty to people he's recruited; he is uneasy about dealing with their human failings and accepting the fact that people change over time and adjustments have to be made. He tends to wait for a crisis before he deals with it. Tim gives you the performance appraisal forms to fill out on yourself-he finds that process difficult. He has no problem dealing with a medical matter, with the professional quality of care.
Tim recognizes that one has to decide on matters for the short term or long term, and he sees that the long-term impact may be more important. Sometimes that gets him into trouble, because people think he's procrastinating. Managed care is an example. Other hospitals went in for an equity position with Maxi care; now they find they can't deal with other insurance players.
I try to touch base with Tim every morning. He's better then. It's very informal, no set format. To really get Tim to react, it's got to be in writing. We used to spend Friday afternoons together, my being his student; that was very helpful to me. He's wise and a good teacher.
Tim gets things done by first touching base with people who are important in implementation, with people who've had experience on a similar issue. He builds a data base and explores different ways to proceed. He elicits others' ideas to build consensus. This makes implementation easier. He's more concerned with success two years from now than with making the decision now. Tim is here for the long pull.
Tim's more of a committee chairman than an autocrat. He's very programmatic. He's patient and deliberate and tries to avoid surprises and glitches. He has no ego as a manager. It doesn't matter to him whether he gets the credit, so long as the thing gets done.
As a person, he is Mr. Integrity, honor and integrity. He takes the position which is best for the institution.
I would rate his performance A- or B +; no one should get an A. Anyone who can survive here for over 20 years has to be doing something right. He took us through difficult times, and the place is poised to be substantially better when he leaves. He's determined to get renovation approval for inpatient facilities.
For the most part he hasn't really changed. Tim is always a learner, doesn't profess to be an expert, and is always open to new ideas. Because of increased demands on his time, he's had to make decisions on how he spends his time; and since the former director of nursing's retirement, he isn't as much in tune on delivery issues. His data base is built from a lot of people. He doesn't have time to walk the floors now. He recognizes that this is a problem and is trying to redress it. Given his druthers, he'd enjoy being chief operating officer more than CEO, I think. He'd rather be a doctor than a shill or a speaker.
Tim's been a proponent of being a leader in introducing new technology (for example, CCUs). This has been very costly. We're not being paid for our lithotripter; he doesn't think twice about that. He looks at budgets as his own dollars and is tightfisted about routine matters.
He scrutinizes the financials. Tim pushed for a financial tool to review DRGs, to put on one page what he needs to know. He looks at the census every morning. A CEO knows if the census is down to get on the phone and get some patients in the house.
Tim has clinical credentials. I think he's had a big effect on quality. He believes quality begins with the chairman.
Sometimes Tim's assumed that the chairmen are as diligent as he is. He established a patient services representative program. That is his audit process. Every administrator hears from doctors and board members about patient care. This is how he hears from patients and their families. He reads or used to read all letters that come in from patients. He's not as in touch with those things as he used to be, and he would like to get back in touch.
In summary: Tim is often misjudged and misinterpreted as not being very impressive. But he's not trying to be impressive or dominate at any moment. He should be judged on his overall track record, over the long run, or on specific matters.
Among our peers, our length of stay is the lowest and our costs are the lowest. We win popularity polls of independent deans and directors-they told us we had the best array of clinical leadership around the country. We got money to look at this from Mellon, for an eight-person panel of deans and directors from other parts of the country. They interviewed chiefs and looked at their plans. They agreed with Tim's assessments.
When Tim came on board, this medical center was dominated by researchers. Now it has a more balanced array of clinical expertise.
The goal of the place is to be preeminent in all three aspects of mission [patient care, research, and teaching]. There was debate over whether this was possible or whether we were to be no different from anyone else, but what was different was that we could do it. We are devoting attention to getting research straightened away. The second biggest issue is facilities renovation, which we are also trying to address.
Tim gives you a lot of latitude, which gives you confidence. He doesn't like a surprise, that’s all; so it's important to brief him. He disciplines humanely and constructively, as a good professor does with his students. People are concerned about losing Tim's influence as a stabilizer; who will provide that when he's gone?
