Richard Mark has the outsider's instinct to shake up the system.
Lest employees forget that financial troubles once threatened the future of St. Mary's Hospital of East St. Louis, Ill., Mr. Mark, its 39-year-old chief executive officer, set up a standing committee to remember hard times and seek new savings.
The committee recommended, for example, that giant rolls of toilet paper replace smaller rolls in public restrooms so visitors could no longer walk away with them-a $6,000 annual savings. It urged the hospital to convert to a lower concentration contrast agent with the same outcomes-a $75,000 annual savings.
"Sometimes, we look at this for the exercise," Mr. Mark said. "One of my goals is to maintain innovation when we're not desperate."
From the committee's start in May 1993 to this May, its recommendations added a critical $265,000 to the 135-bed hospital's bottom line. In the 1993 calendar year, St. Mary's made $1.4 million on revenues of $29 million.
"Part of Richard's philosophy is, if we operate every day like our worst scenario, we will never get fat, lazy or indifferent," said Sister Peter Altgilbers, vice president of mission effectiveness at St. Mary's.
That worst scenario could be glimpsed as recently as 1990, when executives expected St. Mary's to lose $7 million. Its sponsors, the Poor Handmaids of Jesus Christ, feared they someday would be forced to close the 104-year-old hospital. Then and now, the healthcare of about 90% of its patients is covered by the government or not at all.
Mr. Mark, hired from the county in May 1990 to head government affairs, vividly recalls a finance committee meeting he attended that month. St. Mary's was losing $600,000 a month.
"My first thought was to call my old boss to see if he filled my position," Mr. Mark said. "The thing that convinced me to stick it out was the dedication of the sisters. Without a hospital, the problems of East St. Louis would be compounded."
In June 1990, Mr. Mark became chief operating officer-a position for which he was being groomed-and began restructuring. He became CEO this March following the retirement of former CEO Charles Windsor.
By early 1991, St. Mary's had dropped its oncology program and hospice. It had cut total staffed beds to 110 from 140 and shrunk its work force to 484 employees from 584. It since has added 25 beds for substance-abuse treatment.
Change wasn't easy. Mr. Mark had never worked at a healthcare institution. Although he brought a fresh eye to practices at St. Mary's, his lack of healthcare experience didn't sit well with everyone.
"When I got in healthcare, if we needed new equipment, they'd go to the first supplier," Mr. Mark said. "My comment was, `Don't we get bids?'
"Then, some of the managers challenged us on the cuts. My comment was, `You guys have been running this place long enough, and we're in this trouble.' "
Neil Schmidt, director of pharmacy and ancillary services, is one of the managers who questioned Mr. Mark's plans. He read it as a sign of inexperience when Mr. Mark decided to cut staff, including two pharmacy employees, without managers' input. His skepticism turned to respect when managers were told to decide how to make the cuts.
"I used to be a traditionalist," Mr. Schmidt said. "You get the managers' input, you talk about staffing, etc. Richard just cut through it, but he made the department part of the process. He has a real strong vision."
A streak of defiance-the urge, perhaps, to upset the notions of others-runs through Mr. Mark's character.
The first in his family to attend college, he graduated in 1977 with a degree in early childhood education from Iowa State University. The 6-foot-1-inch Mr. Mark weighed 170 pounds when he entered college, but he played football on scholarship all four years "basically because people said I was too little to do it."
Mr. Mark returned to his hometown of Collinsville, Ill., as a special education teacher and married his college sweetheart, Melissa. He wastapped to coordinate the town's program for juvenile offenders and was drawn into politics. He has three children: Fontez, 21; Joseph, 12; and Megan, 4.
Compassion accompanies his strong will. Sister Altgilbers talked of Mr. Mark's emotion at the farewell for his mentor, Mr. Windsor; his devotion to his children; his love of flowers and the Japanese art of bonsai. "It was that (compassion) which got us where we are," she said. "I never worry about the mission here."