By JEFF GOLDSMITH

Like birds of a feather, talent in healthcare management often gathers in flocks. The University of Minnesota, University of Michigan and University of Iowa healthcare management programs are all justly famous for graduating, over many decades, an exceptional number of future transformative healthcare leaders. But sometimes, talent comes from the “street”- challenging healthcare turnarounds that attract risk-taking leaders who, in turn, gather young talent around them. The University of Chicago’s urban academic health center has been one of these places.

The U of C was (and remains) the largest care provider on Chicago’s troubled South Side, a vast urban landscape that struggled economically and socially for more than seventy years with intractable poverty and violence. Like other major teaching hospitals in challenging neighborhoods–the Bronx’s Montefiore and Harlem’s Columbia-Presbyterian come to mind–all the management challenges of running complex academic health center are magnified by coping with huge flows of Medicaid and uninsured urban poor. 

In 1973, President Edward Levi appointed Daniel Tosteson, who was then Chair of Pharmacology and Physiological Sciences at Duke University, to be Dean of the Pritzker School of Medicine and Vice President for the University of Chicago’s troubled Medical Center. Tosteson was a charismatic basic scientist with no prior experience running a 700-bed urban teaching hospital.  He arrived in the middle of a severe Illinois’ fiscal crisis, and a horrendous Medicaid funding challenge (31% of the Chicago’s patients were Medicaid recipients). Chicago’s clinical chairs who led the recruitment of Tosteson also played a crucial role in the subsequent turnaround–notably Dr David Skinner, Chair of Surgery and Dr. Al Tarlov, Chair of Medicine, and Dr. Daniel X Freedman, Chair of Psychiatry. 

To renew the Medical Center, Tosteson recruited an experienced clinical manager, Dr. Henry Russe from competitor Rush Presbyterian St-Lukes, as his Chief Clinician. But Tosteson went off the reservation and hired a 34 year old economist named David Bray, who was Executive Associate Director of the White House Office of Management and Budget (responsible for the national security and intelligence agencies) as his Chief Financial Officer. He also named John Piva, formerly of Johns Hopkins,  his Chief Development Officer. To revitalize Chicago’s principal affiliate, Michael Reese Hospital, he recruited as its President, Dr. J. Robert Buchanan, then Dean of Cornell Medical College.  And he recruited me, at age 27, from the Illinois Governor’s Office, as his government affairs lead and special assistant.