Let's hear it for middle management.
Matt Van Vranken does, and it has served him well.
In mid-May, the 37-year-old settled in as executive vice president at Brigham and Women's Hospital, taking "an opportunity I just couldn't pass up" at one of the nation's 100 top hospitals four years running (Dec. 4, 1996, p. 52).
The road leading to Boston was a 14-year itinerary of stops as a hospital operations executive reinventing duties of workers with more experience in the field than he had.
Vested with executive authority at an early age-and unfamiliar with many of the tasks performed in a hospital-Van Vranken says his early relationships with front-line managers helped establish a light hand on the operational helm and a heavy reliance on the good instincts of others.
"It's the middle managers that are about the business of making it happen day in and day out," he says.
An assistant to the president of Christian Hospital Northeast-Northwest in St. Louis at the age of 24, "I had people working for me who were older than my parents at the time," Van Vranken remembers.
The position was created for him right out of graduate school in 1983 by hospital President Fred Brown. "Matt was an energetic quick study who truly understood what we were doing," says Brown, who has since helped create and lead the giant BJC Health System. "We were building an early prototype of an integrated delivery system. As an assistant administrator, he was a valuable asset and team player."
Van Vranken skipped right over the middle-manager arena himself, eventually getting operational responsibility for nine departments at Christian.
In December 1987, he left to oversee development and construction of a freestanding radiology center in St. Louis as its chief operating officer. In May 1990, he moved to Connecticut for a seven-year stint as top operations executive at 500-bed Hospital of Saint Raphael in New Haven.
The facility launched several ambitious projects under his watch, including an integrated clinical information system and a redesign of patient-care services. One of his moves was to put a veteran patient-care manager, Mary Kuncas-Day, in charge of first the information systems effort and then the redesign as vice president of patient services.
"It was my first experience in reporting to someone younger than me, but it never was a problem," says Kuncas-Day, who's now been with the hospital 17 years. "He believed in letting you pretty much steer the way but was always there when you needed help."
In the redesign, where centralized services such as heart monitoring, phlebotomy and dietary were decentralized to nursing units, "the centralized departments had to give up what they always thought would be their turf." Van Vranken delegated authority and responsibility to her as needed but "had to do a lot of smoothing the way for this," she says.
Van Vranken says his job was to "step back and try to understand ways in which senior managers could be better enablers."
In a two-year process, the hospital was able to brainstorm and pilot the project internally without the guidance-and expense-of outside consultants. Total expenses outside the payroll of the organization amounted to a mere $80,000, including team-building retreats, Kuncas-Day says.
Van Vranken describes the project as "more bottom-up than top-down," starting with one pilot unit and comparing different approaches during a six-month period.
Although the project asked a lot from employees already doing a full day's work, "doing it at a deliberate pace was the key to our success," Van Vranken says.
The pace may quicken at Brigham and Women's, where already "the honeymoon pictures are on the shelf, and I'm looking at them fondly," he notes. Married and the father of a 3-year-old girl, Van Vranken says he'll spend whatever free time can get with his family, including parents who retired at a relatively young age.
His mother was an operating-room supervisor at a hospital in Utica, N.Y., while his father held down an accountant's job. The product of both, Van Vranken tells people he was "genetically programmed" to be a hospital executive.