The lore surrounding Parkland hospital’s legendary chief executive officer is nearly as extensive as the sprawling public-hospital system he leads. Dr. Ron Anderson has become synonymous with Parkland, it’s commonly said. But the day is edging closer when that no longer will be the case.
Now one of the country’s longest-tenured hospital bosses, Anderson actually rejected the job offer when he got it in 1982—three times. Soon after assuming the post, at age 35, he helped lead a crusade against patient “dumping,” the now-banned practice of transferring medically unstable—and uninsured—patients to another hospital. He’s won numerous awards over the years and, in 2009, appeared for the fifth consecutive year on Modern Healthcare magazine’s list of the country’s 50 most powerful physician executives.
Under his stewardship, Parkland Health & Hospital System has evolved into a multi-faceted complex, with a Level 1 trauma center, an extensive network of clinics, and a total volume of 1.14 million patient visits annually.
Anderson’s tenure hasn’t been without controversy. He recalls fielding death threats during the height of the patient-dumping battle. He and other officials receive hate mail—more typically e-mails these days—over Parkland’s ongoing and still controversial decision not to screen patients for U.S. residency status. Six years ago, Anderson says, he nearly lost his job during a board rift in which half the members quit. More recently, Parkland landed in the media spotlight as complaints surfaced about long emergency-room waits and a high percentage of patients leaving before getting care.
How has he managed to survive all of these years? “Ron has a good blend of political skills, compassion, and sharp elbows,” says Larry Gage, president and founder of the National Association of Public Hospitals and Health Systems, who first met Anderson in the early 1980s.
At this stage in their careers, many hospital executives might be taking their final laps. And yet, with his 64th birthday around the corner, Anderson is on the cusp of what may arguably be his longest-lasting legacy to Dallas. In 2008, voters approved $747 million in bond financing toward construction of a nearly $1.3 billion “replacement” hospital for Parkland Memorial. (The plan for the existing 685-bed building, where President John F. Kennedy was rushed in 1963, remained undecided as of this writing.) The new, 862-bed Parkland, to be built across the street, will be roughly twice the size of the existing facility.
Since the 2004 board flap, Anderson has built a new team of senior-level leaders he keeps busy. Jack Kowitt, the system’s chief information officer, jokes that he’s been at Parkland almost seven years, but some days it feels more like 40. “His passion is contagious—it’s chemical,” Kowitt says of Anderson. “You work for Ron and you want to do the right thing for him. And you want to do the right thing for Parkland.”
Anderson doesn’t plan to leave before 2014, when the first patient will roll through the new hospital’s doors. “I happen to come from a religious tradition that doesn’t believe in retirement,” he quips. But even the possibility of Anderson’s departure raises the question of succession: What happens to Parkland when Ron Anderson is no longer at the helm?
Money vs. Mission
Compared with the swank hotel-like lobbies of many hospitals today, Parkland’s main entrance could be considered almost sterile: an information desk and a few metal chairs near the gift shop. Beyond the entryway, patients and family members navigate a warren-like series of narrow hallways, a few leaning on braces, others in wheelchairs or congregated in groups, stacked up in front of the elevators.
It’s difficult to discuss the taxpayer-supported system without referencing its size and national profile. Parkland’s FY 2010 operating budget is $1 billion, including $450 million in projected tax revenue. Among its annual visitors, 130,000 come through the emergency room and more than 950,000 through Parkland’s system of 11 community health centers, along with school-based clinics, mobile health vans, and other outreach efforts. Parkland clinicians delivered nearly 16,300 babies in 2007, the most recent year for which statistics are available, second in the U.S. only to Atlanta’s Northside Hospital. It also serves as Dallas County’s “safety net”; roughly 355,000 residents get treatment through Parkland’s program for the uninsured.
Considering the limited longevity of many public hospital administrators, Anderson is practically on his ninth life. JPS Health Network in Fort Worth, for example, is being led by its third chief executive since 2000.
In Texas, public hospital administrators manage under a multi-layered system of bosses. They report directly to the board of managers, who in turn are appointed by the county commissioners. The commissioners also OK the budget and the tax rate. “You don’t have stockholders,” Anderson says, “but you’ve got a lot of publics that you’ve got to satisfy. You have these really highly charged moral issues to deal with, but you have to run [the system] like a business.”
Anderson’s leadership has been marked by an ongoing tug-of-war between available funding and patient-treatment needs. “No money, no mission,” Paul M. Bass Jr. recalls telling Anderson more than once. Bass, vice chairman of First Southwest Co., joined the Parkland board shortly after Anderson became CEO, and later became board chair. “The only times that Ron and I had conflicts,” he says, “were at times when the finances were strained.”
Bass, for example, was initially skeptical about developing community health centers, preferring to focus instead on hospital services. But Anderson convincingly made the case that preventive care in the clinics would keep people healthier and away from more costly emergency treatment. “I credit him for sticking to his guns,” Bass says. “And I yielded.”
Anderson “still wants to cure the world,” Bass says. But he’s developed a hefty dose of diplomatic savvy. Anderson concedes that his leadership style has mellowed over time. “When I first came to this job, I had a lot of vinegar,” he says. “I guess I had a kind of a cold anger about things that I saw as socially unjust.”
Anger, for instance, about the transfer of medically unstable patients from other hospitals to Parkland if the patient couldn’t pay the bill. Bass talks about patients getting a “pocket biopsy,” vetting their ability to pay prior to transfer. Anderson is credited with being one of the forces behind developing a local policy that quickly morphed into a state law—Texas was the first to pass a “patient-dumping” law—and, in 1986, a federal law as well. The result is that emergency departments nationwide can no longer turn away patients despite their inability to pay.
These days, the working relationship between Dallas hospitals is far more collegial, Anderson says. “Being strident is what was necessary then,” he says. “It’s not what’s necessary now.”
Anderson talks fast and fluidly, with relatively few of the platitudes and clichéd phrases commonly used by hospital administrators. His responses are direct and packed with nuggets of detail, and light on jargon and acronyms. It’s the style of a physician accustomed to leading rounds, which he has done for years. He just assumes that people will keep up.
He doesn’t highlight his long hours, though others do. Jennifer Coleman, senior vice president of consumer affairs at Baylor Health Care System, serves with Anderson on the Texas Health Institute board, one of his many leadership positions. “I don’t know how he does all that he does,” she says.
He’s also touted for mentoring and recruiting talent. Dr. Ruben Amarasingham, director of the Center for Clinical Innovation and Parkland’s associate chief of medicine services, first met Anderson as a medical student, when he approached Amarasingham about studying the medical issues and other characteristics of the Dallas homeless population. Walter Jones first crossed paths with Anderson when he led Parkland officials on a tour of the new women’s health center for Atlanta’s Northside Hospital. Jones had served as the associate architect in charge of that project; a few years later, he was hired as senior vice president of facilities and tasked with designing and constructing Parkland’s new hospital.
Anderson also doesn’t back down if he believes in something, Gage of the national hospitals association says. “He’s not afraid to say things to powerful people basically that need to be said,” he says. For his part, Anderson tells younger administrators to stand up for their value systems: “You have to be willing to lose your job in order to do your job.”
Anderson’s fans are effusive. Paige Flink, long-time executive director of The Family Place nonprofit, describes Anderson as “accessible and down to earth and sincere. He’s got a really critical role, and he takes that seriously.”
At this stage of his life, Anderson’s three children are adults, and his marriage has nearly reached its 35-year mark. (He met his wife, Sue Ann, while she was working as a nurse in the emergency room and Anderson was still a resident.) But it’s difficult to get a sense of his life beyond Parkland’s hallways. What would he do if a day off fell into his lap? Come into the office and catch up on his backlog of medical-journal reading, he says. Perhaps go hiking, he adds, when pressed.
If there’s any criticism of Anderson’s style, it’s that he should slow down, take better care of himself, that his managerial plate is a bit overloaded at times.
Dr. Lauren McDonald, the Parkland board chair, says the board has asked Anderson to dial back his daily-management duties, and focus more on strategic planning and promoting the needs of safety-net hospitals like Parkland. Anderson also has stopped making patient rounds for the time being to focus on fundraising. The goal: to raise $150 million for the new hospital through philanthropy; they have raised $87 million as of press time. (The rest of the $1.27 billion price tag after the public bonds are figured in—or some $350 million—will come from hospital funds.)
McDonald, who first met Anderson in the 1980s, says that years of management experience, and perhaps the passing years themselves, have made him “calmer, more peaceful.” She particularly noticed that shortly after 2000, when tensions with board members and the county commissioners heated up. “He was very serene,” she says.
On the Hot Seat
In recent years, Anderson has not only constructed new board relationships, but also rebuilt his team of senior managers. Tensions peaked in 2003 and 2004, when the commissioners assumed a closer oversight role in Parkland’s financial operations and a split developed in the board. The hard feelings spilled into public view one day in 2004, when more than 100 Parkland supporters filled the boardroom. Soon afterward four board members resigned, including chairwoman Cynthia Comparin, most citing frustration with the hospital’s management and financing.
One point of contention had been whether to move forward with the hiring of a consultant to develop a succession plan. Comparin, who didn’t respond to an interview request, said at the time that the intention wasn’t to force out Anderson, but to develop options if the hospital’s top managers abruptly left.
Reflecting back on that period, Anderson says it didn’t help that he was juggling several jobs besides his own. Parkland’s long-time chief operating officer, MacGregor Day, had died in 2001, taking with him a set of skills and institutional memory that were difficult to replicate.
Ultimately, though, Anderson cites politics. “When it came down to it, people saw me as more ‘liberal’ or wanting to care for everybody,” he says. “And costs were going up.”
During this stretch, plans to build a new hospital were tabled. The initially conceived hospital, Anderson says, was roughly the same size and cost as the one that will be built now. This time around, though, the financing is less reliant on taxpayer money. Under the original scenario, Anderson says, the tax rate likely would have been raised five or six cents, since the hospital would be contributing relatively little. (The rate is currently set at 25.4 cents per $100 in assessed property value, or $508 annually for a house valued at $200,000.) Because of Parkland’s larger contribution now, the tax increase will be around two cents or possibly less, in part due to the hospital’s bond rating, Anderson says. Parkland received a AAA rating prior to its 2009 bond sale.
So, what did Anderson learn from the experience of regrouping and “reselling” his hospital vision? “Persistence is more important probably than brilliance,” he says, pointing out that 82 percent of Dallas County voters approved the bond financing.
The development of a succession plan also was written into Anderson’s most recent contract. Signed in 2007, the pact includes several extensions that, with board approval, could employ Anderson through 2014. (Anderson earns $606,060 annually and up to 45 percent more in performance incentives, depending on how he meets patient-safety, financial, and other goals.)
Anderson stresses that it’s the board’s job to determine how broad a search to conduct once he retires, or, as he puts it, is “called upstairs.” But he lists three Parkland administrators who could step in at a moment’s notice: chief financial officer John Dragovits, chief operations officer John Haupert, and chief medical officer John Jay Shannon, M.D.
He’s also been striving to offload more management duties to these executives and others. At one point, 14 people reported directly to him, he says; now he’s down to 10. “I learned that from [MacGregor] Day—that was one of my biggest lessons in life,” referring to Day’s fatal heart attack in 2001. “If something happened to me, and I think this is what I owe my board, that they don’t miss a beat.”
Anderson acknowledges that the new hospital (see accompanying story, “Breaking New Ground”) will be “a capstone” to his long career. But he doesn’t view its construction as his most important accomplishment. Instead, he cites the patient-dumping legislation and the vital preventive role of the clinic system he’s developed. In fact, he worries that too much focus on “bricks and mortar” could divert attention from care already being provided in the community.
Anderson harbors other concerns, among them the potential for national health care reform to trigger unintended effects along with the good, such as reducing federal funding for needy patients while treatment gaps persist.
And, he’s already gazing beyond the ribbon-cutting for the new hospital. Depending on the shape of health reform, there may one day be a need for satellite hospital campuses, he says. He talks about the growing “suburbanization of poverty” in the United States, including northern Dallas county, and the loss of several hospitals in the county’s southern region.
Anderson, as he talks, sounds more like a canny diplomat than the frustrated young administrator he once was. “He’s realized that old saying, that you catch more bees with honey than you do with vinegar,” Paul Bass says. “He is much easier to work with, and can make a great case for what he thinks the mission should be.”
Clearly, the vision of this older, wiser, more mellow CEO extends beyond 2014—regardless whether he’s crisscrossing Parkland’s hallways at that point or not.
Ron J. Anderson, M.D.
TITLE: President and CEO, Parkland Health & Hospital System
TENURE: Since 1982.
BIRTHPLACE: Chickasaw, Okla.
EDUCATION: Southwestern State University of Oklahoma, pharmacy school, 1969. Oklahoma University Health Sciences Center, M.D., 1973.
ACTIVITIES: Member, executive committee of the State Task Force on Indigent Care. Co-chair, Attorney General’s Task Force to study not-for-profit hospitals and unsponsored charity care. Member, Texas Health Institute, Governor’s Health Policy Task Force. Past chairman, Dallas-Fort Worth Hospital Council, the Texas Board of Health, the National Association of Public Hospitals, and the Texas Hospital Association.
AWARDS: J. Erik Jonsson Award from The Cary M. Maguire Center for Ethics and Public Responsibility. American Hospital Association’s Award of Honor. Boone Powell Sr. Award of Excellence. John P. McGovern Award for Humanitarian Medicine and Lectureship from the Association of Academic Health Centers. Award for Excellence from the American Public Health Association.
Breaking New Ground
In Parkland Hospital’s existing neonatal intensive-care unit, rows of tiny incubators fill seven rooms, facing onto a long corridor. At full capacity, the unit cares for 80 critically ill babies and sometimes more. High-tech equipment may be paired with low-tech measures. When a baby requires additional infection-control protections, clinicians will mark the floor around the incubator with a strip of tape.
The new NICU, like many areas of the new Parkland hospital, will be expanded both to handle more patients and to meet existing codes and patient-safety standards. Semi-private rooms will become a relic of Parkland’s past. The new hospital, which is scheduled to break ground later this year, will provide all private rooms. And the hallways will be easier to navigate for patients, family members, and clinicians alike, hospital designer Walter Jones says.
The emergency department will be doubled in size and will incorporate workflow changes that have already helped reduce long waits. By August of 2009, just 5 percent of patients were leaving before getting treatment, and the wait time—just over 11 hours two years previously, on average—had declined to just under seven hours.
But the NICU expansion will be particularly notable, as much as eight times its current size. The unit will be able to treat as many as 120 babies in individual rooms, each 200 square feet. That design, increasingly popular among hospitals, helps guard against infection and allows for individualized lighting and other personalized care, Jones says.
As the new hospital’s design is being finalized, is Ron Anderson more interested in the nitty-gritty details or the top-level overview? “He actually does both,” designer Jones says immediately. “He really does.” —Charlotte Huff
PARKLAND BY THE NUMBERS
1894: year founded
130,000: annual emergency department visits
1.14 million: annual patient visits
16,300: babies delivered in 2007
$1 billion: annual operating budget
8,000: number of employees
2,300: registered nurses