Ray E. Brown Lectures, Messages, and Memoirs · ing Ray Brown's early years, while Ray attended...

. . . . . . . . . . . . . . . . . . . . . . Preface ix J. Alexander McMahon

... . . . . . . . . . Biographical Note: Ray Everett Brown XIII

Introduction . . . . . . . . . . . . . . . . . . . . . 3

Chapter One: The Turn of Mind of the . . . . . . . . . . . . . . Effective Administrator 9

. . . . . . . . Chapter Two: Administrative Strategies 31

. . . . . . . . . . Chapter Three: Favorite Brownisms 5'7

BART Two -Y E. BROW: THE DOER

. . . . . . . . . . . . . . . . . . . . Introduction 63 David M. Kinzer

Chapter Four: Ray E. Brown: Prototype . . . . . . . . . . . . . Hospital Administrator 65

Aaron Cohodes

Chapter Five: Ray E. Brown: . . . . . . . . . . . . . The Early Chicago Years '79

Richard L. Johnson

Chapter Six: Ray E. Brown: The Duke Years, . . . . . . . . . . . . . . . . . . . 1964-1974 91

Donald S. Smith

. . . . . . . . Chapter Seven: The Boston Perspective 109 Richard Wittrup

Ray E. Brown Lectures, Messages, and Memoirs

... vzzz Contents

Chapter Eight: Back to Chicago- Northwestern University . . . . . . . . . . . . . 121 Robat M. Cunningham, Jr.

Chapter Nine: Ray E. Brown and the American Hospital Association

Contributing to AHA . . . . . . . . . . . . . . 129 Geolp-ge Bugbee

Association Services . . . . . . . . . . . . . . . 132 James E. Hague

Chapter Ten: Input from Other Colleagues . . . . . . 139 David M. Kinzer

. . . . . . . . . . . . . Publications by Ray E. Brown 153

Copyright 2010 Foundation of the American College of Healthcare Executives Copying and distributing this content is prohibited without written permission. For permission, please contact Copyright Clearance Center at info@copyright.com or visit www.copyright.com

EDITED BY

MARY M. BLANKS WILLIAM E. CORLEU S. DOUGLAS SMITH

Health Administration Press 9 Ann Arbor, Michigan

Copyright O 1991 by the Foundation of the American College of Health- care Executives. Printed in the United States of America. All rights reserved. This book or parts thereof may not be reproduced in any form without written permission of the publisher. Opinions and views expressed in this book are those of the authors and do not necessarily reflect those of the Foundation of the American College of Healthcare Executives.

Library of Congress Cataloging-in-Publication Data

Ray E. Brown : lectures, messages, and memoirs / edited by Mary M. Blanks, William E. Corley, S. Douglas Smith; preface by J. Alexander McMahon. p. cm. Includes bibliographical references. ISBN 0-910701-68-7 (alk. paper) 1. Brown Ray E. 2. Hospital administrators-United States-

Biography. I. Brown, Ray E. 11. Blanks, Mary M. 111. Corley, William E. IV. Smith, S. Douglas.

[DNLM: 1. Brown, Ray E. 2. Hospital Administration- biography. WZ 100 B87941 RA971.BB5R39 1991 362.1'1'068-dc20 [B] DNLM/DLC for Library of Congress 90-15656 CIP

Health Administration Press A division of the Foundation of the

American College of Healthcare Executives 1021 East Huron Street Ann Arbor, Michigan 481049990 (313) 7641380

We dedicate this book in m e n 9 of RAY E. B R O W

There is no doubt that he has changed the lives of each of us who knew and studied under him. By the pages of this volume we, his students, hope that those who follow us, not having the privilege of being able to attend his classes, will nevertheless be able to acquaint themselves with the traditions for which he stood and profit as we have from his example.

This book is a result of love and admiration: love for a great teacher by former students at Duke; admiration for a faculty col- league, co-worker, and contemporary by a number of people who encouraged the former students in their efforts and added their own tribute to one of the giants of the field of hospital administration.

Ray Everett Brown was indeed, as David Kinzer describes him in Part Two, a "triple threat," combining "preeminence in teaching," "big league experience in institutional management," and "top level political leadership in his field."

Ray was a great teacher, not only in the classrooms at Chi- cago and Duke, but also through his writings. His former students, Mary Blanks, Bill Corley, and Doug Smith, have performed a great service by recording for administrative posterity mo of Ray's "three interwoven processes" of the practice of administration. He had recorded one in his book,Judpent in Administration, published in 1966; the other two, "turn of mind" and "administrative strategies," form the core of Part One of this book. Mary, Bill, and Doug explain the development of these three chapters in the Introduction to Part One.

Part Two describes his experiences in management and political leadership, seen through the eyes of some of his many admirers and close professional associates. With one exception, all of the contents of Part Two were written by request, as part of the design of a new book. The one exception is "Ray E. Brown: Prototype Hospital Administrator," written by Aaron Cohodes in 1962 when Ray had just arrived at one of his career peaks. It is still counted among the best articles about Ray ever written.

Ray was an excellent administrator, with varied experience at Chicago, Duke, Harvard, and Northwestern. His approaches to administration at the University of Chicago are chronicled in Chapters Four and Five. The Duke years, and the development of the master's degree program in hospital administration there,

x Preface

are covered in Chapter Six. The Harvard and Northwestern experiences are described in Chapters Seven and Eight.

Ray's political leadership is apparent in the positions to which his peers elected him. He served as the chief elected offi- cer of both the American Hospital Association and the American College of Hospital Administrators (now the American College of Healthcare Executives). There are now awards by both organizations given in his name. His American Hospital Association activities are described in Chapter Nine, and other evidence of his leadership is found in Chapter Ten, as told by a collection of people who worked with him over the years.

My own friendship with Ray began with his arrival at Duke in 1964. I was then Secretary-Treasurer of the North Carolina Association of County Commissioners, and since his first job was that of County Manager of Cleveland County, we had an imme- diate kinship. The counties of North Carolina had a substantial involvement in hospitals, so I was an invitee to the early Duke Forums which Ray began. The invitations, and the relationship, continued when I moved to Blue Cross and Blue Shield in North Carolina the following year. We met regularly during his Boston years, because he returned annually to the Duke Forums, and we became neighbors when I moved to Chicago and the American Hospital Association in late 1972.

Over the next year and a half, we visited occasionally, shared a couple of platforms, and traveled together once or twice. Our North Carolina background provided a bond, but it was strength- ened by Ray's willingness to accept yet another student for his teaching of administration and political leadership. He ap- proached administration as more art than science, an approach I found compatible with my own. Hence I encouraged the development of this book in its present form, particularly his former students' contribution in Part One. Yet, in my thinking, Part One needs the real life applications portrayed in Part Two, where one will find the teachings in action in administration and political leadership.

I think of Ray often. His picture graces the lobby of our health administration program offices and one of our students is aided by a scholarship named for him. To some readers, those who knew him, I hope this book is a reminder of a giant in the

Preface xi

field. To others who had not the privilege of knowing him, I hope it offers the lessons that his students and friends learned firsthand.

A word about the contributors. "Part One, Ray E. Brown: the Teacher," was compiled by three graduates of the Duke Pro- gram in Hospital Administration, students of Ray Brown in the 1960s. Mary M. Blanks until recently was Assistant Commissioner of the Department of Mental Health, State of Oklahoma, in Okla- homa City; William E. Corley is President, Community Hospitals of Indiana, Inc., Indianapolis, Indiana; and S. Douglas Smith is President, Quorum Health Resources, Inc., Nashville, Tennessee.

In addition to Aaron Cohodes, contributors to Part Two are Richard L.Johnson, President of Tribrook, Inc., Hospital Consul- tants, of Oak Brook, Illinois; Donald S. Smith, Assistant Professor of Health Administration, Duke University; Richard Wittrup, for many years a member of the consulting firm of Herman Smith and Associates, now working at the Henry Ford Hospital in De- troit; Robert Cunningham, former editor of Modern Hospital magazine and now an editorial consultant for the Blue Cross and Blue Shield Association, Chicago; George Bugbee, for many years the Chief Executive of the American Hospital Association and, later, professor and head of the graduate program in hospital administration at the University of Chicago; James E. Hague, for many years editor of Hospitals, the journal of the American Hospital Association; and the late David Kinzer, former president of the Massachusetts Hospital Association, who was a lecturer in the School of Public Health, Harvard University, and in the Depart- ment of Health Administration, Duke University.

Finally, a strong word of appreciation to Bob Cunningham and David Kinzer, both of whom helped edit the final product and brought it into publishable form.

J. Alexander McMahon Durham, North Carolina May 1989

Ray Everett Brown was born in Union, South Carolina, on Sep- tember 26, 1913, the son of the Reverend William Thomas and Fan Casey Brown. Rev. Brown was a Baptist minister who moved with his family from one community to another several times during Ray Brown's early years, while Ray attended country schools in the Carolinas. When he finished high school Ray enrolled at Gardner Webb College, a Southern Baptist preparatory school at Boiling Springs, North Carolina, and after two years there enrolled at the University of North Carolina at Chapel Hill, where he graduated in 1937 with a B.S. degree in accounting. This knowledge of accounting got him his first job as county manager of Cleveland County, North Carolina, and led to his appoint- ment as superintendent of the Shelby, North Carolina, Hospital in 1940. At Shelby, Ray was comfortable managing hospital fi- nances but aware that he lacked anything more than a superficial understanding of other phases of hospital operation. That lack of understanding prompted him to sign up for an institute or "short course" in hospital management at the University of Chicago. At the institute, Ray's searching questions drew the attention of Dr. Arthur C. Bachmeyer, superintendent of university hospitals and director of the graduate program in hospital administration, and a nationally recognized leader of the emerging profession.

xiv Biographical Note

They talked at length, and Dr. Bachmeyer told Ray that what he needed for a successful career in hospital administration was the thorough, all-around knowledge and understanding afforded by graduate study.

Ray was convinced. He returned to Shelby, loaded his family and their possessions into the car and drove to Chicago, where he finished a year's study and the required practicum in something less than the usual two years. He went back to North Carolina with an M.B.A. in hospital administration, and a job as superintendent of North Carolina Baptist Hospital at Winston- Salem.

In 1945 Dr. Bachmeyer invited Ray to come back as superintendent of the university's hospitals and clinics. He spent the next nineteen years at the University of Chicago as administrator of the university's general and special teaching hospitals, as assistant professor and then professor of hospital administration, assistant director and then director of the graduate program in hospital administration in the university's school of business and, as vice-president of the university, in charge of all its business operations. He didn't particularly enjoy the last assignment: it took him away from the hospital/medical environment that had been his life's interest for so many years, and that made every day an adventure to be relished. In addition, the university was growing, and a large part of Ray's time in the newjob as vice-president had to be spent negotiating for city property adjacent to the campus and dealing with contractors, as well as university departments, on details of building plans and costs.

When an opportunity came to get back to where he felt he belonged, Ray moved on to become a professor of administration and director of the graduate program in hospital administration at Duke University. Ray Brown might readily and happily have stayed at Duke until he retired. But an old friend whose appeal for help he could not refuse decided matters dif- ferently. This friend was Robert Ebert, M.D., who had been an assistant professor of medicine at the University of Chicago when Ray came to the hospitals. An extraordinary young man who had taken a degree in philosophy after he finished medical school, Dr. Ebert became professor of medicine and head of the department. He and Ray saw each other regularly for ten years and they

Ray Everett Brown xv

became good friends, their talks starting and ending with hospitals but roaming the expanse of human behavior. Ebert went on to Western Reserve and University Hospitals in Cleveland, and then to Harvard, where he was professor of medicine, dean of the medical school, and head of the department of medicine at Massachusetts General Hospital. In 196'7, when he called Ray Brown at Duke, the merger of teaching hospitals and the plan- ning of the new affiliated hospitals to replace the old Peter Bent Brigham Hospital had been seen as needed but remained to be accomplished. Plainly, Harvard needed a firm hand at the hospital helm, and Ebert was sure he knew where to get one. 'You'll have to come," he told Ray, and Ray came.

Some years later, he told a friend, "The best way to accom- plish a hospital merger would be to get the needed signatures on the documents that are legally required, and not tell anybody else until it was done." The more people who know about it in advance, the more trouble you'll have getting it done, he said, because they all think they may have something to lose. At Har- vard, in addition to the internal complexities, the neighborhood was up in arms. The plan for the new affiliated hospitals building meant that a row of old residences, many of them made over into rooming houses, had to come down, and public turmoil had re- sulted. This was in the late 1960s when the civil rights movement was at its apex, with leaders who knew how to make the most of a struggle that could be presented as "the establishment" against '"he people." The tensions were formidable. "There were days when Ray had to cross picket lines to get to his office," an assistant related.

The picket lines on Boston streets didn't trouble Ray Brown as much as the picket lines inside the heads of those who feared loss of identity in the contemplated merger. As he had in Chi- cago as vice-president for administration, Ray was spending too much of his time, as he saw it, resolving difficulties that had little to do with the consuming interest of his career, and when the right kind of occasion was presented, he responded and moved on. As executive vice president of the McGaw Medical Center at Northwestern University in Chicago he was among old friends, creating the organization to make an efficient operating entity of the five hospitals that were its principal components.

mi Biographical Note

Engaged as he had been with his responsibilities at the Uni- versity of Chicago and at Duke, Harvard, and Northwestern, Ray Brown always had time to write the papers he presented at meet- ings of state, regional, and national associations of hospital administrators, and to be an active participant in association affairs. Accountants are not invariably noted for the precision and clarity of their prose, but Ray was a notable exception; his contributions to the literature of his profession were widely sought after and ac- claimed. His active membership and participation in professional organizations is evident from his selection as president and board member of both the American Hospital Association (AHA) and the American College of Hospital Administrators. Moreover, both organizations honored him for outstanding professional contributions, the AHA with its Distinguished Service Award in 1963 and the College with the Gold Medal Award in 1969.

Ray Brown's counsel was valued in a wide range of professional and related activities. Thus he was a consultant to the Surgeon General of the Army and the Surgeon General of the Air Force, a member of the executive committee of the M i t e House Conference on Health in 1965 and the national advisory committee of the National Conference on the Costs of Medi- cal Care convened by President Lyndon Johnson in 196% he was member of the Joint Commission on the Accreditation of Hospitals, the National Commission on Nursing and Nursing Ed- ucation, the National Commission to Study Medical Education, and the National Task Force on Health Facilities. He was also active in community affairs beyond the boundaries of his interest in health, as a member of the Board of Directors of the Blue Cross Plan of Chicago, a member of the board and president of the University of Chicago Settlement, a trustee of the Home for Destitute Crippled Children, a director of the Chicago Welfare Council, a member of the executive committee of the Chicago Community Fund, and a director of the National Council on Philanthropy. Ray was a member of the board of directors of the American Sterilizer Corporation and Parke-Davis and Com- pany. He was an interested observer of business operations. As a friend who owned his own business remarked, "Ray's ideas were brilliant, and his advice was always sound; his impatience with the difficulties we encountered gaining acceptance of new ideas

Ray Everett Brown xvii

and selling products was consistent with the character that would have made him an outstanding success as a businessman."

Ray Brown suffered a coronary occlusion and died in May 19'74. He is still missed as the leading figure of his profession in his time, but his work goes on in the accomplishments of the hundreds who were his students and associates over the years.

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