We're not owned by the university; there are tensions of separate and equal status. There is tension over mission, balancing academic and clinical. Here chiefs are prominent, with enormous egos and agendas which may not be the administrations. There is a good old boy circle; some chairmen are more in than others. There are normal tensions of nurses and doctors (here nurses will challenge doctors on an order); the financial world of this state and its regulatory agencies; patient care, teaching, and research; and all that. The environment’s changing. The hospital is trying to be all things to all people-a community hospital, a tertiary care center, and a provider of managed care. It's like a mine field Tim must walk through every day-and decisions to take care of one set of problems may upset the balance on the other side. We have 5,000 employees on different levels, environmental regulations, and safety issues. And it's an old physical plant: people's expectations are shocked by our facility.
Tim's done a lot. He's recruited 11 new chairmen. (He's dealt with half-dead wood in some of those positions.) He's worked on the building program, our space problems. He established and has given support for patient services. He does a lot quietly.
I interact with Tim formally. When I need him, I get to see him. Sometimes I stick my head in or set up a specific time, depending on the issues. I'm here early and late, so I can see him then.He delegates a lot the COO. He relies on one administrator a lot for long-range planning and managed care. Tim asks for a plan and then decides, or he reflects and decides at the medical board meeting. His agenda now is to get inpatient units renovated at all costs and to get managed care off the ground-probably equal in emphasis and to make this place survive by its own.
He is enormously respected by the medical staff for his accomplishments and the respect he has from employees. He's the sole reason we're not unionized. He's fair. He is respected by the clinical chairmen and members of the board, but not by all of them. He's survived.
Tim's not reactive. He likes to think things through. He's reflective. He's not demanding enough. There are times when you have to be tough, and I would like him to act earlier than he does. He's fair. He gets as much input as he can. He's not autocratic. When he finally makes a decision, he's thought it through, covered all the bases, and it's a good decision. Getting him to that point is the struggle.
He's Jimmy Stewart, Mr. Smith goes to Washington, a sense of humor, he's fair. He's directed mainly toward his work. He works less than he used to do. He is moral, ethical.
He's changed over the last few years. He's more distracted. The outside environment is the most obnoxious it's ever been. In the last five years, he's been forced to deal with things he hasn't necessarily wanted to deal with. He's not as close to the new board chairman as he was to the old one. Tim's very good.
He matches this place. He knows this place and the players. He gets done what has to be done, sometimes in spite of this place and these players. Some talk of a business type replacing him, but the board doesn't understand that you can't run this hospital like U.S. Steel-Tim's big battle. At U.S. Steel you can make steel sheets of different standard sizes, but no two patients are alike-some don't fit the mold, and the system, within reason, must respond to those patients. Tim realizes this. You can't streamline professionals beyond a certain point either. I'm not sure business people understand that.
Changes-three to four years ago, Tim involved more senior peo-ple in the decision-making process, a positive move. He expanded the director's staff meeting. Tim's not a great communicator. He says something in a room, and he assumes everyone has heard it. I don't sit in on the meetings, and I don't know what's going on. At least indirectly, he needs to ensure that the word gets out to department heads. We're going to try to do that this year, have him communicate directly with them (about managed care, for example, to dispel rumors and give out accurate information). Just exposing them to Tim will be an uplift. Those who've been around the hospital a while respect him, they know he's fair, they see him during rounds in the evenings and early in the morning. He's not pretentious or filled with self-importance. He doesn't care about his clothes. He's not hung up on material things. He never pursues his greater glory to the exclusion of the institution and the people in it, unlike others.
As to influencing quality, if something isn't done the way it should be, Tim is willing to speak to a chief to see that the problem is dealt with swiftly. He is swift on clinical issues, the physician in him rises to the occasion. He has little patience with poor medical care. The few times I've seen him angry were on patient care issues. For example, in one department, attendants, house staff, and clinicians did not comply with our new do-not-resuscitate guidelines, putting themselves and the institution at risk. He still had the wounds of an earlier case in which an 87-year-old lady was not resuscitated and the hospital received bad press as a result.
