Scarlet fever made Samuel J. Tibbitts.
Although it often leaves the afflicted blind or deaf, Tibbitts completely recovered from the disease when he contracted it at age 6. But his bout left him with a determination to make healthcare his career.
At first he was going to enter medical school, with sights on becoming an administrator. But his undergraduate professors at the University of California at Los Angeles spotted something unique in him. At their suggestion, he entered only the second class at the new graduate school of public health and hospital administration at Berkeley, Calif.
His professors were right. Though Tibbitts began his career humbly in 1950 as an administrative resident at California Hospital Medical Center in Los Angeles, he was the facility's administrator before the decade was over and he had turned 35. By the time Tibbitts passed away in his sleep in March 1994 at the age of 69, the hospital had named its new inpatient tower after him. It was one of the smaller-but numerous-examples of how he had left his personal stamp on both the not-for-profit and for-profit healthcare sectors in Southern California.
Caring deeply. "Sam was a great human being; that's the bottom line. He cared very deeply for the people who worked for him and with him. He was attached very much to the nonprofit and public side of healthcare," says Merlin K. Du Val, M.D., who nominated Tibbitts for the Health Care Hall of Fame. Du Val was president of American Healthcare Systems, now Premier, while Tibbitts chaired the corporation in the mid-1970s.
Indeed, his successes at not-for-profit California Hospital made Tibbitts' career. Three years after he was named its administrator, he became assistant secretary and chaired the management committee of its parent company, Lutheran Health Society of Southern California, later known as LHS Corp. In 1966, he was named Lutheran Health's president.
Tibbitts' larger career milestones-including his forays into for-profit ventures-came in the 1970s and 1980s. In 1975, through American Healthcare Systems, he co-founded the PPO Alliance. The Woodland Hills, Calif.-based company is now one of the largest PPOs in the country. In 1978, he co-founded a small subsidiary of Lutheran called PacifiCare Health Systems. Today, PacifiCare is among the largest and most profitable HMOs in the nation, and often tops the list of the most desirable employers.
"This was a company and a project that didn't need to happen," says Alan Hoops, PacifiCare's chief executive officer, who noted that Tibbitts always displayed tremendous perseverance and commitment to his visions. "(PacifiCare) really was an effort on Sam's part to stay ahead of the game, because he saw that HMOs had potential and opportunity, and this really was a product of his imagination."
Even though PacifiCare struggled in its first couple of years and could have easily failed, Tibbitts was willing to arrange $1.5 million in credit to keep it going, Hoops says.
Creating efficiency. Exactly 10 years after the PacifiCare launch, Tibbitts engineered a merger between Lutheran and HealthWest Foundation, creating UniHealth America. The merger saved the combined companies $11 million in the first 18 months of operation and created one of the largest not-for-profit hospital systems in the West.
Aside from forming all these corporate organizations, Tibbitts was an industry visionary. He was among the first managers in the hospital field to integrate business efficiencies with day-to-day operations, having noticed that technology growth was overwhelming the quaint charitable notions that then tended to mold hospital bottom lines.
"Sam was probably the perfect mixture of innovation and entrepreneurial skill, along with possessing a biting sense of what was right for the patient," says Stephen W. Gamble, retired chief executive of the Hospital Council of Southern California, now the Healthcare Association of Southern California. Gamble worked with Tibbitts for more than 35 years, with Tibbitts serving as the Hospital Council's president in the early 1960s and later as a longtime member of its research and planning committee.
"He seemed to see what needed to be done to make delivery more effective and efficient, and he devoted a huge amount of his personal time to move healthcare in the right direction," Gamble says.
For example, Tibbitts pushed for hiring more competent hospital staff at better wages at a time when hospitals were often considered, in Gamble's words, an "employer of last resort." In the 1960s, Tibbitts also spearheaded California's Commission on Administrative Service in Hospitals. CASH was devoted to charting the efficiency of hospital employees and operations.
"At first, most people were skeptical that you could improve the way a nurse could bring a bedpan to a patient. Now it's taken for granted," Gamble says.
In the late 1970s, while chairman of the American Hospital Association, Tibbitts was able to take his efficiency drive national. He persuaded the AHA, the American Medical Association and six other organizations to make a voluntary effort to cut medical costs. Tibbitts was co-chair of the project, called the National Steering Committee for the Voluntary Effort to Contain Health Care Costs. Within a year, the effort cut nationwide medical costs by 2.8%, a savings of nearly $1.5 billion.
Seeing the future. Later, in the 1980s, Tibbitts foresaw tough times ahead for his industry. In a Los Angeles Times article that outlined the merger between HealthWest and LHS, he observed that "the individual hospital, the freestanding hospital, is going to have trouble making it in the next two or three years."
The shakeout and the ascendancy of large for-profit operators created a decidedly different management attitude than the pro-patient stance embraced by Tibbitts, Gamble laments.
"My own personal feeling is much of that is lacking in what we now have in managed care," he says.
Aside from his work with the companies and councils already mentioned, Tibbitts also served as president and trustee of the California Hospital Association, a delegate to the White House Conference on Aging and a hospital industry consultant to the Social Security Administration. He was also a member of President Nixon's Cost of Living Council and chaired hospital administrators' campaign to elect Ronald Reagan president in 1980.
The personal price. But Tibbitts' monumental efforts often came at the cost of 14-hour workdays.
"He got up at 5: 30 in the morning and was out of the house by 6," recalls Audrey Tibbitts, his wife of 45 years.
One time, after groaning at hearing her husband was attending his fourth evening meeting in less than a week, Tibbitts relented and canceled. He spent the rest of the evening pacing the house.
"He told me, `I shouldn't have missed that meeting. Don't do that to me again,"' Audrey Tibbitts says.
Bluntness was another Tibbitts trademark, Du Val recalls.
"He was a man who held onto his principles extremely tightly, and in many regards was bordering on the too tough," he says. "But we respected the views that he held; we were not in any way ever offended."
"He was strong-willed but fun-loving. He was also very loyal to his people," says Gamble, who likened the camaraderie at LHS under Tibbitts' leadership to that of a football team. "They went to conventions and meetings together, stayed in the same hotels, dined together and were seen as a great working group."
Indeed, Audrey Tibbitts also remembers her husband having a great sense of humor and compassion. And his loyalty left behind a huge network of friends and associates. It was that group of people who helped her get more involved with healthcare after his death.
Audrey Tibbitts serves on a UCLA dean's advisory council for the Los Angeles Public Health Department, and on the board of California Medical Center's fund-raising foundation.
"It's fabulous. I thoroughly enjoy the work," she says.