So many people wanted to hear what Edwin L. Crosby, M.D., had to say that 21 boxes were needed to store the 548 speeches he made over the course of his career as a medical researcher, hospital administrator, professor and international healthcare leader.
Nine additional boxes hold the letters and memos he left in his personal office files at the American Hospital Association, where he served as president from 1954 until his death at age 63 in 1972.
Yet another five boxes are full of his papers from home and reprints of more than 80 magazine and journal articles that he wrote for publications as varied as the Saturday Evening Post and New Zealand Hospitals magazine.
Though some of the papers may have yellowed and wrinkled with age, many of the ideas expressed in them could have been written last week.
In the August 1948 issue of Modern Hospital, the forerunner of Moder Healthcare, Crosby wrote an article predicting what challenges the healthcare administrator of 1998 would face.
Crosby foresaw the rise of integrated delivery systems, wellness programs and preventive medicine. Structured training for hospital executives, a growing emphasis on home care and outpatient centers, the necessity to redistribute hospital beds and experiments with capitation also were in Crosby's crystal ball.
These were the visions that Crosby tried to advance as one of the youngest directors of Johns Hopkins Hospital, the first director of what is now the Joint Commission on Accreditation of Healthcare Organizations and later as president of the AHA.
Committed to values. But while many of his ideas have come to fruition, they may not have played out quite the way he would have wanted.
"He understood that organizations needed money to survive, but he believed that making a profit shouldn't even be a secondary motive," said Donald Dunn, a retired president of the Iowa Hospital Association. "He would deplore the movement toward commercial values replacing the Hippocratic (oath) and social values found in healthcare through the first three quarters of the century. He was confident that the not-for-profit perspective was the best way to serve people."
Crosby's lifelong devotion to the Salvation Army and its teachings helps explain his disdain of the profit motive. Crosby was born on Aug. 18, 1908, in Rochester, N.Y. His parents were Salvation Army officers who emphasized the virtue of helping others meet their spiritual and physical needs.
In high school, Crosby met his future wife, Harriett O'Neil, whose parents also were members of the Salvation Army. They married in 1929 while Crosby was attending Albany Medical College and Harriett was training to be a nurse.
After graduation in 1933, the Crosbys fully intended to serve as medical missionaries in Africa. But the need to pay off medical school debts pointed them toward a more practical path, and Crosby decided to intern at Ellis Hospital in Schenectady, N.Y.
Among other duties, Crosby often drove the ambulance, which had tires in extremely poor condition. When the hospital refused to provide the money for new ones, Crosby lined up the bald tires in the administrator's office.
As a result, the ambulance got new tires and Crosby got the attention of the hospital's director. Crosby was named assistant superintendent of the hospital in 1934.
Crosby left Ellis a year later to train as an epidemiologist at the New York State Department of Health. Awarded a Rockfeller Foundation fellowship, he moved to Baltimore in 1936 and earned his master's and doctoral degrees in public health at Johns Hopkins University.
Crosby remained at Johns Hopkins as a biostatistician and a professor of preventive medicine. When the armed forces began issuing dog tags to GIs during World War II, Crosby traveled to London where he helped keep track of the number of servicemen with particular diseases.
After the war, the 37-year-old Crosby was named director of Johns Hopkins Hospital. He lived across the street from the hospital with his wife and three daughters.
As director, Crosby sought out innovations. As early as 1948 he supported the use of television as a teaching tool and brought cameras into operating rooms.
Crosby earned the reputation as someone who knew how to build a consensus and act on his vision. "He knew when certain things were ready for the field and when they were too far ahead," said Edward Weimer, a retired vice president for conventions and meetings at the AHA. "Politically, he was very sharp."
An ideal choice. These qualities made him an ideal choice for the first director of the Joint Commission on Accreditation of Hospitals. The Joint Commission was formed in 1951 to take over the hospital standardization program that had been run by the American College of Surgeons since 1916. The success of the new organization would depend on how well its top executive could bring together the various factions jockeying for influence over its scope and purpose.
Crosby accepted the challenge in 1952 and moved the family to Winnetka, a Chicago suburb. Crosby believed that the Joint Commission should strive to help physicians and hospitals meet what he called their "noncancellable obligation" to improve patient care. For two years, he worked to mold the Joint Commission into what he viewed as "one of the most powerful forces at work at the national level for the improvement of our hospitals."
In 1954, Crosby succeeded George Bugbee as head of the AHA. Reluctant to leave the Joint Commission so early, Crosby initially declined the offer. But AHA executives, eager to have a physician-administrator at the helm, pressed him to take the job.
Crosby's work for the association soon consumed him. He held meetings on plane flights and was often at his desk at 6: 30 a.m. "If anyone had a phone growing out of his ear it was Crosby," Weimer noted. "He called a lot of people to get their opinions and see what was going on."
At the same time Crosby was working on behalf of U.S. hospitals, he was traveling the globe as president of the International Hospital Federation from 1963 to 1967. He worked to improve public health in such places as South Vietnam and emphasized how much the United States could learn from other countries.
Even at home in Winnetka, Crosby kept a busy schedule. Every Sunday, he would detail his travels and activities in a letter to his family and close friends. Though he most passionately rooted for the New York Yankees, he liked to take his grandchildren to Wrigley Field for Chicago Cubs games.
At summer cookouts and family gatherings, he could be found leading his nine grandchildren, all tooting horns, as they paraded to an old barn behind his house.
Crosby always carried a slide rule in his pocket, and he could often be found tinkering in his workshop in the barn. A collection of electric trains and Salvation Army cornets also kept him occupied.
Crosby's unpretentious manner carried over into the workplace. He ran the AHA with a subtle sense of humor rather than boisterous or grand gestures. "He was the best one-on-one person I ever observed," said David Drake, who served as one of Crosby's special assistants at the AHA. "He would bring you into his office and start by asking you questions about your problems. He would end up getting his problems answered without ever letting you know what they were."
Crosby had a moon-shaped face and dressed like an old-fashioned doctor or banker, complete with vest and bow tie. Perhaps to remind himself of the days when he would make rounds at Ellis and Johns Hopkins, Crosby often would take off his suit jacket, don a lab coat and stop by people's offices.
Through Crosby's efforts, the AHA was transformed from primarily an educational organization to one equally focused on healthcare policy issues. "He put hospitals on the (political) map," Weimer said. "Hospitals matured under him. He helped people view hospital administration as a career and a body of knowledge, and he helped build state hospital associations."
The shift in the AHA from an education to a policymaking role is most evident in the work of the AHA's Special Committee on the Provision of Health Services. Crosby formed the committee in 1969 to address the issue of national health insurance.
The committee's final report, referred to as the "golden book," was the first unified statement by providers on a national healthcare policy that recognized the benefits of regional integrated delivery systems and capitation. "It was a radical statement," Drake said.
The report was introduced as legislation in Congress in 1972, just after Crosby's death, which followed a series of heart problems.
"Crosby got healthcare providers to say that we are willing in the greater good to sacrifice some autonomy in our cottage industry," Dunn aid. "To create a unified policy position now is much more difficult than a generation ago. Crosby's time was a window of opportunity."
The legislation failed to pass, however, and Dunn noted that "fate dealt us a bad blow by removing that visionary leadership at that particular time."
In the end, perhaps Crosby's secret was as simple as one of the items he kept in the AHA's trophy case: a toy ambulance, with the wheels removed.