Sam is my last resort. I'm careful how I approach him. You don't bring him things you can solve yourself. We don't let our friendship interfere with business. We see each other socially three or four times a year, and I never discuss business issues then. Sam is a hard taskmaster. You must have your facts very clear. He goes right to the heart of the issue. I've come to Sam six to eight times over this period. For example, I've seen him about marketing issues. The senior vice-president in the main office was responsible for marketing issues in our subsidiary, and we weren't getting the attention we needed. It took time to get a full-time marketing director, about nine months.
A second example is that of a center that wouldn't allow us to grow. We and the facilities staff in the main office chose a new site; Sam was involved in the site selection. The new center, 20,000 square feet, is up and running now in a different community. The old center has stayed flat at 8,200 members; we opened with 300 members in the new center and now have 6,200 members there.
What Sam has been able to do is (1) surround himself with trustworthy and knowledgeable people; (2) grasp the overall needs of the organization very quickly; and (3) set in place a course of action after discussion with everyone around him. He's not arbitrary, and he involves everyone in the establishment of goals. He is goal-oriented, which is nice because you understand what you're trying to do. He gives you tasks and expects them to be completed: Take care of it and don't screw it up. His door is open, but the task is there and you're supposed to handle it. It took a long time and a lot of patience when we transferred functions from here to the main office; people in the main office thought, this isn't the way we have done things. We had to get down to operating on a breakeven basis.
The board is different here. At another HMO where we worked together the board was business-oriented and more intellectual; it understood the marketplace and what had to be done. Here at Wilson there are conflicts between unions whose members are served by the plan, which gives the board a parochial rather than a global view. Sam had to be concerned with the board's direction, to get it to go from medical care delivery to HMO, to be at risk for the hospital side. To Wilson members, this reduced their freedom of choice. To get the board to move to an HMO was difficult; so was getting it to decide to move medical groups to full-time.
Key for us has been his getting the board to assist Wilson in our state as part of the organization and getting it to fund us, opening members' eyes to see that Wilson has a larger scene to play in and to continue to move it in a different direction (this has been important). The board now accepts that we may have to do things differently in this state to succeed in the market. To stand still is to fall behind.
Sam gets things done by asking. There's no such comment as, I can't do it. If you need help, he'll supply it. He expects it to be done and therefore you do it-and do it without disruption to other people.
He is determined to make this the best organization in the country-to make it equal to or better than Kaiser's organization-not in size but in stature. Kaiser's a well-run business organization. We wear our hearts on our sleeves more than necessary. We became a public whipping boy, and it's not justified. And he's correct. There was a lack of pride here which Sam has changed, but it's difficult to overcome. They always used to make excuses about everything, and we really weren't bad at all.
His power comes from two areas: (1) his knowledge of everything that deals with medical care and of HMOs in particular and (2) his ability to get things done. He is able to identify problems that have to be solved to accomplish an end result. For example, when we opened the second center I wanted to shut down the first center and open a new one someplace else. Sam said we couldn't afford to have two faucets open-the old center and the new center are both losing money. If we closed the old center, we should strengthen the new center before opening another one. He said we should put all our eggs in one basket until the new second center gets into the black.
He's more human, able to discuss issues not on a power basis. He doesn't flaunt his power or beat you up with it. He's willing to listen to what you have to say. He's demanding and expects detail, but he will explain his reasons. He's sensitive to what his word was if you are following through on something. He doesn't want problems brought to him as problems, but as resolved issues. Others would say, Take care of it, and threaten you. As long as you give your best effort, Sam doesn't want to give you more than you can do or expose your weaknesses in front of other people.
He has an undying loyalty to people he's been involved with. It's phenomenal. He'll put up with a lot of incompetency because of loyalty to people. He has a strong feeling about the inequities of the social system to minorities and wants to respond to those as much as possible. He was the first in this field to put a woman in the top marketing position, for example. You'll see it on his staff.
I'd rate him an 8 out of 10. He surrounds himself with people he is comfortable with and who can do the job. He's got a good handle on determining people's abilities and using them to the fullest. He hangs on to incompetent people too long. There is no fast action on this kind of matter.
He's not nearly as naive as he used to be. Sam had stars in his eyes. He surprises me in his ability to read people. I was away from him for ten years. He became much more confident and directed.
Sam has taken this organization from what it was to a prepaid group practice plan that rivals Kaiser in every feature-buying out facilities and making them consistent, keeping the organization moving forward during a time of transition. When we go out to talk to people, the reaction is often negative. Physicians are now committed to this organization and its members.
He wants Wilson in this state to lose as little money as possible, so long as we can be effective. He expects us to get the best deal from hospitals. For example, if we are high performers with DRGs, it should be reflected in our deal. He questions areas of our financial report at every board meeting. As to financing of our facilities-we were going to do it through banks, but we did it through the state health authority because it cost less, even though it delayed completion of our center.
He doesn't really get involved in quality assurance. Our medical group must conform to the same policies as groups in our home state. He's told the medical director in the home state that's what he wants (she used to be medical director here). On service, he only gets involved if someone sends a letter.
It's difficult to know the pressures he's under on an ongoing basis. He doesn't really tell you. You know they are there. His position is unique-it's quasigovernmental because of Wilson's history and membership. A person who's running a business doesn't have to so respond. He's sensitive to damaging information in the newspapers. Corruption in the city has made him doubly concerned.
