"Shaping Healthcare for the Twenty-first Century"

Arkansas Hospital Association Annual Meeting and Trade Show October 3-6, 1999
The Arkansas Hospital Association's last annual meeting and trade show of the twentieth century was a resounding success. The Arkansas Symphony Orchestra kicked off the meeting with a rousing "Big Band" concert during the annual Chairman's Dinner, which set the tone for the two days that followed. Annual meeting participants heard leaders in the field of business, healthcare and politics discuss topics on the healthcare horizon. Keynote speaker Jeff Bauer, a medical economist and futurist, discussed his views on healthcare in the 21st century, including trends in medical science, technology, population, and reimbursement; governance consultant Jamie Orlikoff discussed leadership challenges in governance; healthcare trend analyst Michael Annison looked at both the challenges and opportunities afforded by the Balanced Budget Act of 1997; and Scott Parker, retired CEO of Intermountain Health Care, shared a letter to his son, Tom, a young hospital administrator.

Participants also heard presentations by Chris Foley, M.D., who discussed managing health and disease, an integrative approach; Dan Mulholland, healthcare attorney, who grilled Jim Kopf, Programs Director of the Office of Inspector General, on current fraud initiatives and the OIG's 2000 work plan; consultant Dean Rossiter reviewed expectations for the upcoming Medicare outpatient prospective payment system; Department of Human Services' spokesman Joe Quinn discussed the ARKids First program; and Cathleen Erwin talked about the value of volunteer medicine clinics.

"A Letter to My Son, Tom"

In an October 5 presentation for which he received a standing ovation from members of the Arkansas Hospital Association during its annual meeting, Scott Parker, retired CEO of Intermountain Health Care in Salt Lake City, shared a letter he had written to his son, Tom, young administrator of Legacy Mt. Hood Medical Center in Gresham, Oregon. Arkansas Hospitals is the first publication granted permission to print Parker's touching letter to his son.

My understanding of the Legacy System has been enhanced over the past few years because our son, Tom, has begun his career in health care leadership with the Legacy System. He is currently the administrator of the Legacy Mt. Hood Medical Center. Tom's mom and I are grateful that he is making his early leadership contribution in the Legacy organization. Tom brought his family to Salt Lake City in November so that he and his family could participate in his dad's retirement dinner. His words that evening were most touching to me and we had a wonderful conversation after the dinner, around our kitchen table, about the work that we share in common. It was so thoughtful of him, at the end of that rather brief chat, to suggest that it might be helpful to him for me to put some of my experiences and observations about health care leadership in a letter. I agreed that I would do so.

Since then, my thoughts about my letter to Tom and my thoughts about the theme for this talk have blended into a convergence of similar reflections, and after much thought, I concluded that what might be of interest to Tom, might also have some broader interest to others in health care leadership. That is why I have chosen as the theme for today's comments, "A Letter to My Son, Tom." In this regard, I will be leaving to others at this Arkansas Hospital Association meeting, presentations that are focused toward the politics and economics of today's competitive health care market. Rather, I would prefer to focus my thoughts today on some principles and personal approaches to leadership, an assignment that, in one way or another, we all share in common.

To make this work, I am going to ask the permission of those of you who are in the age range of say, 35 to 45 or younger, to please let me "adopt" you as my sons and daughters for a half hour as I address you like I plan to address my son, Tom. For those who are in an older age bracket, I hope that you will be willing to track along with me and nod a little, if you are in agreement, or just bear with me if your thoughts do not exactly reflect my own.

I am hopeful, however, that there might be at least a concept or two or some observation addressed today that might find broad interest to most who are here. That is my goal.

In my comments, I will reference some thoughts written by my friend, from our growing up days, Dr. Stephen R. Covey, who has written and lectured extensively on the subject of leadership. I will also mention some principles taught by our tough-minded professor at the University of Minnesota, Jim Hamilton, and there will be a few other references along the way as well.

I would like to begin with a principle taught to me by my preceptor, mentor and first boss, Stan Nelson. It is an overarching concept that condenses all other wisdom on successful health care leadership into one sentence. I still remember the setting and the situation that triggered his comment.

Let me begin by talking about these examples of advice. I'd been on the job at Northwestern Hospital as the new assistant administrator in the early 1960s for about a month and I heard a rumor that my mentor and first boss, Stan Nelson, was going on vacation. He had not told me he was going on vacation and I said to myself, "Who's going to run this place while he's gone?" And then I realized it was me‹out of school just a few months with no real experience. I was frightened. I just assumed he would call me to give me a full briefing with detailed instructions before his departure, so I stayed close to my office, next to my phone all morning on the day he was to leave. He didn't ever call.

Late that afternoon, I just happened to look out my window and I saw Stan leaving the hospital with his pipe in his mouth and his Wall Street Journal under his arm, the signals I had learned that meant, "I'm leaving for the day." I could not contain myself. I was desperate. I jumped out of my chair and I raced out into the parking lot and met him just as he got into his car. I said, "Rumor has it that you're leaving." And he said, "Yup. I'm going to be gone for a couple of weeks." I was stunned because there obviously was not going to be a briefing session and all I could think of to say was, "Well, do you have any advice?" He said, "Yup, just don't do anything dumb." And he got into his car and drove off.

That response that was so casual and seemed so terse at the time, did, in fact, bore right down the core of what I have come to know which rests at the foundation of every other leadership principle. Simply stated‹we must lead with common sense and wisdom.

There is more to the story. When he got back, we talked some more and he said, "You're going to make some mistakes. You're young, you don't know a lot and that's OK. Never duck a decision, even if you're going to make a mistake, but if you're going to work with me, over the long run, you should never make the same mistake twice." This, then, is the first thought I would like to share. When we are given that kind of trust, like Stan gave me, we deserve a little patience when we're new at it and, later, we should give our young associates that same kind of slack when they are new at it. But we should encourage them not to take advantage of that good will and never make the mistake twice.

Webster states that common sense is the application of practical judgement. The dictionary states that wisdom is the application of good judgement. The pursuit of wisdom should be a never-ending goal. The pursuit of collegial relationships with persons known for their gift of common sense and wisdom should be a never-ending quest.

Stan Nelson provided that kind of exposure and example to me in the beginning of my career and it has been enhanced by other collegial friends ever since. Stan told me that I would not learn much that was really fresh or new, sitting behind my desk. He argued for the importance of getting up and getting out and seeing other organizations and other leaders in action in order to be able to tap into a continuing source of new ideas.

I personally recommend the pattern. Friendships should be nurtured with some few very close professional friends who will give you honest feedback when you seek their counsel. That kind of honest feedback is what Steve Covey labels "the breakfast of champions." That kind of breakfast might prove to be a little distasteful at the time, but it can be very nourishing over the long run.

As Steve Covey has traveled extensively in his consulting work, he has been inside many organizations and inside the heads, if you will, of literally thousands of leaders. This is his observation about successful leaders and I quote: "Successful leaders will have vision. They will know where they want to go. They will have a passion to get there. And they will have the discipline to make the sacrifices necessary to get there."

Vision, direction, passion about the vision and the discipline to make the sacrifices necessary to get there. According to Steve Covey, these are identified as the core characteristics of a successful leader. I agree.

In one sense, this seems to be elemental and yet, on the other hand, Steve has mentioned to me that he has rarely found an organization that has all of these elements working well together. In my own observation, in having been associated with five different health care delivery organizations, several dozen health or service-related organizations and, in recent years, as a board member of a number of publicly-held corporations, that what appears to make so much common sense is, in fact, not all that common in application.

I have some thoughts about the reason why. First, vision can be easily blurred by trends and sudden environmental shifts. Our friend, Boone Powell, has called this "vision and strategy fulfill jour inspired by last week's Modern Healthcare magazine's cover story."

Vision should not be altered by short-term trends, or fads, but rather, it should be rooted in the very core values of the organization and it should be able to withstand the sudden storms of change that will occasionally try to prevail.

What is your vision for your organization? What is it that you want your organization to become in order to fulfill its highest potential, and what is the mission of your parent organizations? Are the two aligned? Do real mission statements exist, and if so, are they real and are they right?

I would also like to strongly recommend a process that has the potential to bring your vision and mission into powerful application.

First, make certain that your mission statement clearly describes who it is to be served by your organization, where those services will be delivered and what kind of quality of services will be rendered. Some very fine health care organizations have floundered or self destructed because they were unwilling to tightly focus their efforts to a logical geography and/or to a practical scope of service.

After the clear definition of mission, next create a clear statement of understanding regarding the social, economic, political and competitive environment surrounding your organization. Understanding the environment will have a significant impact on your strategy in pursuing your organization's mission. Again, wisdom and common sense argue for such data, but in my observations, such data is not all that successfully pursued or utilized by many health care leaders.

The next step in this process is to carefully prepare a strategic plan for the successful pursuit of the mission, accompanied by measurable, long- and short-term goals that will calibrate and measure the organization's progress and also serve as a tool to evaluate its leadership performance. This will help minimize the subjectivity and politics that can serve to undermine objective evaluations.

When the organization has this whole process from core vision all the way through to short-term measurable goals clearly defined and implemented, there will be a measurable sense of confidence, solidarity, purpose and unity that will permeate the organization and also define the positive reputation of the organization's leader. I strongly recommend this process to you. It will require the leadership traits of vision, direction, passion, discipline and sacrifice.

Before I make further comments on passion, discipline and sacrifice, and while we are on the subject of the organization of work, I would like to mention a simple definition of organization that was taught to our graduate class by Jim Hamilton. His definition was divided into four simple steps as follows:

1. Define the job to be done.
2. Divide the job into specific tasks.
3. Assign the tasks to capable individuals.
4. Follow up.

I have found this simple formula as valuable as any organizational technique I have ever utilized. It has worked well in activities ranging from the organization of a church picnic to putting together a regional integrated health care system.

On the subject of selecting capable individuals, please remember the wise counsel that I received from my first IHC board chairman, Bill Jones, when he suggested that I should ask myself the following three important questions before making a final selection decision:

1. Is the candidate capable?
2. Is the candidate honest?
3. Is the candidate compatible?

This simple formula works and it helped attract some nationally-known and respected individuals to IHC such as David Jeppson, Steve Kohlert, Diane Moeller, Dr. Brent James, Bill Nelson and many others who have added immense strength to our organization.

Now, I would like to move on to the next essential leadership characteristic and that is having a sense of "passion." The successful leader must have a passion for the vision and values of the organization. The leader's passion, or lack thereof, will be felt and it will provide a clear signal (one way or another) to those who have been asked to join in the battle. The ancient wisdom of the scriptures describes this need for clear, passionate commitment and clarity of purpose by asking the following question, "For if the trumpet give an uncertain sound, who shall prepare himself for battle?" You cannot lead with passion if your own passion is lacking or worn dangerously thin.

If, in your assignment, you do not feel aligned and inspired by the mission of your organization or its leadership, please do not linger on in passionless job security. Do not permit yourself to accept that kind of reduced self-respect. Even if it is painful to make a change, make it, when necessary, in order to gain the peace of mind that can only come from a full alignment of your values with the values of the organization you are asked to lead.

Further, on the subject of passion. I would encourage you to feel a passionate discontent about a compelling social issue that you feel must be addressed and resolved and then take every appropriate opportunity you can to address it, and help to resolve it.

You know, Tom, that for your dad the issue has been our country's unwillingness to provide access to health insurance coverage for all U.S. citizens. Ours is the only strong, developed nation left in the world unwilling to do so. Perhaps you remember my telling you of my Canadian experience in 1986 when I served as the elected chairman of the American Hospital Association. I was assigned to represent our association at the annual meeting of the Canadian Hospital Association held in Edmonton. During their banquet, I was placed at a table between the elected chairs of the Canadian Hospital Association and the Canadian Medical Association. In the course of our dinner conversation, the subject naturally turned to a comparison of our health care systems. The physician focused his full attention on me and asked this exact question. "As chairman of your national hospital association and as a citizen of the United States of America, how can you sleep at night knowing that 15 million (now 42 million) of your fellow citizens have no guaranteed access to health care, and you do?"

I responded with the expected explanations, noting that there are generous voluntary programs for charity care in the United States and that, in fact, many of the uninsured do receive care through such benevolence. But he knew, and I knew, that there were then and there are now, millions of Americans who simply do not know how to enter the health care system to receive the charity care that is available.

When my thoughts turn to this subject, I still feel a passionate discontent, and so here I am again today expressing my concerns.

You have a great deal of strength and ability within you to work hard to resolve a social issue that troubles you. Take a stand, be an advocate and work to correct the problem.

The last two essential characteristics of leadership mentioned by Steve Covey are discipline and sacrifice. Both are clearly needed in the pursuit of a successful health care career. Our work is not casual or frivolous. Our work is serious and it is essential that we do it well. It is, by definition, compelling and demanding and, therefore, it does require discipline and sacrifice. But there must be defined limits.

Our friend, Spencer Eccles, the chairman of the First Security Bank Corporation, recently gave this caution to a graduating M.B.A. class, born out of his long career of being pulled between the crises of the day at his corporation and the basic needs of his family at home. He said, "If it goes unchecked, your profession will suck the very life from you, and remember, it always robs the family first."

Spence also reminded the group that Pope John Paul II made the following observation about the need for balance. He said, "The first and fundamental structure for human ecology is the family, in which we receive our first ideas about truth and goodness and learn what it means to love and be loved, and thus, what it means to be a person."

And to further make the point, the late president of the Mormon Church, David O. McKay said, "No other success can compensate for failure in the home." These three wise observations identify the need to maintain balance so that things of higher importance are never sacrificed at the altar of things that are of less importance.

Now, with these basic principles of leadership success that I have mentioned and identified, I must admit to you that their positive application will never permanently immunize you from problems or disappointments. Harsh storms reach every sunny beach in time and those times can be filled with pain, disappointment and discouragement. They can also drain away self-confidence, health and overall happiness. Internal pressures build because you know that your colleagues are looking to you for strength and confidence when, in fact, you could use a little transfusion yourself. If this happens, the first thing I would recommend is that you quickly separate yourself from the "gloom and doomers." They can easily pull you down in their own overstated pessimism. Don't let them.

Next, turn to those you love and respect for reassurance, confirmation and perspective. That core group of collegial professional friends that I have previously referred to will come to your assistance with strength and needed perspective if you will let them. And in time, they may ask the same from you. On occasion, we all need strongly rooted trees to turn to for shelter. During these difficult times, there will usually be a small group of people eager to place blame and to criticize. They are usually very vocal and they seek out opportunities to voice their criticism widely‹often through the media. The resulting public news reports can sting and wound. This is not a new phenomenon. Shakespeare put these words into the mouth of Mercusio, "He jests at scars that never felt the wound."

During one of these difficult periods for me, several years ago, a friend sensing my need, sent me these words of wisdom given several centuries ago by Thomas Kempis, "Thou art none holier if thou art praised, Nor the viler if thou art reproached. Thou art what thou art."

Fortunately, after the storms pass, the sun always comes out again and we find ourselves back making decisions, organizing work and pressing on with our strategy to reach our goals. And then some opportunity comes along for the organization or for ourselves that is most compelling because it is perceived to have the potential to further the work of the organization or to further our own personal agenda. The only problem is that we are a little uncertain as to whether the opportunity really meets our own defined standard of acceptability on our personal ethics radar screen. When you face one of these uncertainties, and you will, my advice is to always lean toward the side of caution. Ask yourself, will this decision stand up under the scrutiny of a tough investigative reporter with a powerful magnifying glass? An even more compelling safety test is this--Will this decision meet the "Mom Test"? We both know what that means because of the great moms we both have. If you really think the decision will pass the "Mom Test" then go for it, because the chances are that you will be on very safe ground.

Well, Tom, the hour is getting late and it is time for me to close and so I will briefly mention just a few other observations about leadership with a condensed sentence or two for each. I hope that some of these ten distilled thoughts, gained through experience, might prove to be of some value.

1. Always remain teachable. An unfettered ego or sense of infallibility is a passport to self-destruction.
2. Never assume that intelligent people will always respond rationally. Try to cut them some slack and remember the virtue of patience and long suffering. The Golden Rule has full application in the field of health care leadership.
3. Helen Keller said, "No pessimist ever discovered the secrets of the stars or sailed an uncharted sea." Stay optimistic and encouraged so that you will maintain the desire to sail and soar.
4. Remember the power of the pen. It is a wonderful tool for good in your hands if you will use it regularly to write brief notes of appreciation to those who are working so hard to strengthen your organization.
5. Stay in good physical condition and stay away from anything that is potentially addictive. Your organization and your family need you over the long run and as a health care leader and as a father, it is important for you to try to set a personal example. Honor the body that was given to you through the providential miracle of creation.
6. Give of yourself to your religion and to other community organizations that are concerned about those who someone identified as being members of the "5-H Club". They are the homeless, the hungry, the hopeless, the helpless and the hugless.
7. Another thought about the pen and writing angry letters. I would recommend the following steps: Draft it carefully and say everything that you feel needs to be said. Next, put it on your desk at the end of the day for editing the next morning. Then when you get to the office the next day, edit it again with care and get it just the way you want it and then take it in your hands, squeeze it hard, squash it into a ball then toss it into the waste basket. Give yourself two points, not only for a slam-dunk, but also for having exercised great wisdom and common sense. By the way, E-mail is an even more dangerous weapon and it can be a self-destructive tool in the hands of someone who is inclined to quick emotional responses. Be very careful with the new technology.
8. Find humor in your own frailties. This will send a message of hope to those who model themselves after you‹and they do. They will take comfort in knowing that success does not require absolute perfection.
9. No one person can master all of the leadership skills required to successfully manage today's health care organization. Enjoy the satisfaction that comes from building a great team of leaders rather than personally trying to be the only "All American."
10. And finally, never forget the sacrifice, effort and pain that went into the creation of the organization you are now a part of. We have all been warmed by fires that we did not build and we have all quenched our thirst from wells we did not dig. Look for opportunities to make things better for those who will follow. And, always look for opportunities to make things better at home.

I ran across a Beatitude years ago, written by a thoughtful anonymous author. I had the quote framed and it is placed near my work area. It has served as a constant reminder over the years of the importance of my responsibilities as a leader and as a father. It states:

"Blessed is the man . . . .
In whom a clean conscience rests.
In whom a faithful woman trusts.
Who finds fulfillment in his work.
Through whom his children see God.
In whom good friends comfortably confide."

As I close today, I would like to add to the Beatitude one additional phrase:

"Blessed is the man . . .
who has a son who desires his counsel and,
Blessed is the man
Who has had the opportunity
To address a group of wonderful men and women,
Health care leaders who are all dedicated to the
Proposition of improving the human condition,
And following the example of our friends."