H. Robert Cathcart is coming home.
With his induction into the Health Care Hall of Fame, Cathcart, 72, takes a permanent place of honor at the Hall of Fame housed within Philadelphia's Pennsylvania Hospital, where he served as an administrator for 43 years.
A tireless worker and unapologetic perfectionist, Cathcart left an indelible mark both on historic Pennsylvania Hospital-founded in 1751 as the country's first major hospital-and on healthcare nationally. As a local and industry leader, he put patients first-regardless of their ability to pay. And throughout his career, Cathcart devoted himself to realizing a vision of hospitals as grand instruments for community service.
"I tried to make it respectable to remind people of our social mission," says Cathcart, who retired as hospital president in 1991. "When I left, I hoped I'd be remembered more as a social worker than a businessman."
For Cathcart, though, running a tight financial ship ensured services would be there for all who needed them. "We blended the two pretty well, and I don't think we ever turned a patient away for economic reasons," he says.
From surviving to thriving. Fresh from a fellowship with the W.K. Kellogg Foundation, Cathcart joined Pennsylvania Hospital as administrative assistant in 1949, when only 30 or so of more than 400 beds were occupied by paying patients.
Cost shifting from those wealthy patients' bills and a sizable endowment failed to keep pace with the cost of running the hospital's swelling charity wards. "We needed to get a substantial base of patients who could pay," he says.
Soon enough, an unlikely savior came along in the form of Blue Cross. Cathcart moved to revamp the hospital to appeal to the rapidly growing insurance plan.
"They wanted two-bed rooms, but all we had were 40-bed wards" and a few private rooms, recalls Cathcart, who had become the hospital's chief executive in 1952. In response, he had a new pavilion built that featured two-bed rooms, including full bathrooms complete with showers and wash basins. That struck his board as slightly extravagant, but the shared rooms suited Blue Cross' patients just fine. They streamed in and Pennsylvania Hospital's fortunes looked up.
At the time, specialty care, such as urological and orthopedic surgery, was all but unheard of at Pennsylvania Hospital. That, too, had to change. So Cathcart wooed physician specialists in part by upgrading basic and clinical research programs with funding from the John Hartford Foundation and the federal government. Pennsylvania Hospital under Cathcart also offered teaching physicians a bountiful supply of extraordinary interns who clamored for its prized appointments.
Cathcart, a champion for nursing, also boosted nursing teaching programs within the hospital, attracting more and better nurses, which in turn made it easier to lure top-flight doctors.
Those doctors were given the freedom to work without the restrictions of a mandatory faculty practice. Making sure physician practices thrived was a cornerstone of Cathcart's approach. "The richer they became, the better we did," he says.
Taken together, the measures succeeded in winning the loyalty of top-notch specialists, despite competition from eight area hospitals with their own medical schools.
Concern for the community. With a sound financial base thus assured, Cathcart during the 1960s pushed clinical services into the community beyond the imposing brick wall that surrounds the hospital. He established community health centers and outreach programs that were ahead of their time.
A Cathcart protege, John McMeekin, chief executive of Crozer-Keystone Health System, Media, Pa., recalls that his mentor didn't let community unrest dissuade him. During the racially volatile 1960s, Cathcart, who traveled by bicycle whenever possible, was pelted with stones while riding home one evening from a meeting in a rough south Philadelphia neighborhood, McMeekin remembers. But Cathcart neither complained nor sought retribution, McMeekin says: "He figured that just went with the turf."
At all times, Cathcart subscribed to a civic version of the Golden Rule. "If you do well by your community, then they won't let you falter," he says. "They'll support you and carry you through."
Out of Iowa. Modest, almost to a fault, Cathcart seems to hold tight to his Iowa farm boy roots. World War II interrupted his college education begun at Drake University in 1941. After serving in the Army in the Pacific, he finished college at the University of Iowa in 1947. Then thanks to the G.I. Bill and a stipend from the Kellogg Foundation, Cathcart went on to the University of Toronto to study hospital administration, a career he had read about in the local newspaper.
"I applied every place I could," he says. "They were the only place that would take me."
True to form, he downplays his enormous contributions on the national scene. He chaired numerous American Hospital Association committees grappling with nursing education policy and care for the poor. He led the search for an AHA president in 1985. He served as AHA chairman in 1976 and speaker of the House of Delegates in 1977, and received the association's distinguished service award in 1983.
"My (hospital) board thought of that as demeaning trade association work, but it got me out of town and got me the kicks I needed," Cathcart says. "As long as the work at home got done, they didn't object."
His peers assessed Cathcart's professional accomplishments a bit differently.
"Every time I turned around in the last 40 years and there was a tough job to be done, he was either leading or intimately involved in seeking a solution," says D. Kirk Oglesby Jr., a Cathcart contemporary and president of Anderson (S.C.) Area Medical Center. "If you look at the AHA, much of the transition it's had to make over the last half of the 20th century has Bob Cathcart's fingerprints all over it."
Mr. Hospital. Throughout it all, though, he never lost sight of the little things that make a hospital hum. Putting in yeoman's hours, he usually worked seven days a week, often returning after dinner to walk the wards to comfort patients and chat with staff.
"The hospital was his neighborhood, his family and his job," says Wendy Cody, vice president for support services at Pennsylvania Hospital. Actually Cathcart is married and has a daughter.
As a graduate student at Columbia University, Cody sought out an administrative internship under Cathcart in 1979, even though New York abounded with opportunities. Cody never left.
"He was spoken of, even in New York, as Mr. Hospital," she says.
Cody, like others who worked for Cathcart, sought desperately to please him, motivated by his example more often than direct orders.
Even today, Cody says, she can hardly pick up litter or a stray piece of paper without remembering how Cathcart would tidy up the hospital premises while on his rounds.
A formal, restrained man, Cathcart surprised Cody one day while they shared an elevator on their way to a meeting. Without warning, he jumped onto the handrail inside the elevator car and began fishing out rubbish someone had stuck inside the overhead light fixture.
"He believed everyone should make Pennsylvania Hospital better," Cody says.
For almost all of the more than four decades he worked at Pennsylvania Hospital, Cathcart lived in a house located on the grounds, on one occasion even holding a staff meeting in his bedroom while recovering from a back ailment. But in keeping with his buttoned-down style, Cathcart managed to wear a business shirt and tie along with his bed covers.
Even after his ascendancy on the national scene, Cathcart kept his eye on the details close to home. "He was always there," recalls Howard Newman, professor at New York University's Graduate School of Public Service, former HCFA administrator under Jimmy Carter and an assistant administrator to Cathcart during the 1960s.
When Newman joined the hospital in 1965, he asked about the on-duty rotation for administrators to handle emergencies. He learned it was very simple: Cathcart would take the calls. Only if he needed help or was otherwise busy would the junior administrators get involved.
"To be chairman of the AHA and the guy on first call may seem contradictory," Newman says, "but he was accessible because of the totality of his commitment."