Arthur Porter, M.D., the new chief executive officer of Detroit Medical Center, considers himself "a sort of strange bird in the healthcare industry, because I'm not a traditional hospital administrator."
He added with a chuckle: "That makes everyone nervous."
Indeed, the 43-year-old cancer specialist, appointed May 18 to lead the seven-hospital system out of a withering financial crisis, has never managed a hospital. Born and educated abroad, Porter arrived in Detroit in 1991 to pursue an academic appointment. He is highly respected in patient-care and research circles, and was recently elected president of the American College of Radiation Oncology.
Porter has proven an effective leader, whose charisma and diplomacy are steering DMC's 18,600 employees and 3,000 physicians through a difficult turnaround.
He is not afraid to put himself in the line of fire, stepping in last year to settle a threatened boycott of the center by community physicians (Feb. 23, 1998, p. 59).
Unafraid of change. Since taking the helm, Porter eased out Robert Sokol, M.D., the Wayne State University medical school dean and DMC senior vice president of medical affairs. Sokol was seen by many as a barrier to reforming the system's financial relationship with Wayne State, DMC's academic partner.
Porter won the confidence of clinical staff by appointing the chiefs of staff of each DMC hospital-physicians elected by their peers-to his executive management team. He added a chief medical officer and a vice president of patient care to the senior staff.
"Most folks, if you're open and you tell them what you want to do, they're more than happy to work with you to improve the system," Porter said.
Fundamental change is already evident in patient care, said Agustin Arbulu, M.D., chief of staff at DMC's Harper Hospital in Detroit. After consulting with clinical leaders, Porter boosted the pay structure for nurses to increase nurse-patient ratios.
DMC Board Chairman Lloyd Semple called Porter a "natural choice" because of his good reputation at the medical center and at Wayne State, physician status and business experience as a principal in a firm that implements cancer treatment protocols.
Porter also brings an international perspective. His father was a lawyer and university vice chancellor, and his family lived in several countries during his youth. Porter said he's treated several heads of state but declines to name them. While professing that no healthcare system is perfect, he said he admires the speed at which the U.S. brings new technology to the patient's bedside.
During a recent interview, Porter didn't talk much about managed care, Medicaid shortfalls or woes inflicted by the Balanced Budget Act of 1997-all significant forces weighing on his system. Instead, he discussed a commitment to quality, rattling off the clinical achievements of DMC hospitals as if bragging about his children.
If the system is to survive, it must increase its attractiveness to paying patients, observers say. DMC is critical to southeast Michigan's healthcare system, providing the vast majority of uncompensated care-$177 million worth in 1998. It is also the largest private employer in the city and provides 20% of inpatient care in Macomb, Oakland and Wayne counties. DMC officials declined to provide a financial projection for 1999, saying only that they hope to achieve profitability by year-end.
Focus on quality. Porter said he wants to create a "community jewel," which physicians and patients will identify with top quality.
"Some folks might say that I'm overly optimistic," he said. "But maybe that's why I'm a cancer physician."
DMC has taken plenty of knocks. It posted a $106 million loss on revenues of $1.7 billion in 1998, and since Jan. 1 laid off 1,800 employees and closed one hospital, Sinai, which was merged with Grace Hospital at the Grace campus.
Lonnie Joe Jr., M.D., president of the Detroit Medical Society, which supported the threatened boycott of DMC last year, said Porter will create a leaner, more inclusive system. But he believes the DMC board must add new blood and reduce its bloated size of 43 members.
"I think (Porter) is going to have trouble convincing the old guard that the ways of the last 15 to 20 years in healthcare management don't work anymore," Joe said.
DMC plans to modify its centralized governance structure, implemented in 1996, which was meant to transform the cumbersome giant into a nimble, integrated system. Separate boards to govern regions and clinical service lines left no one fully accountable, Porter said, and most decisionmaking authority is being returned to local hospitals.
DMC is undoing an effort begun in the early 1990s to market its hospitals as one system. It's raising the profiles of individual facilities and rethinking a decision, made in 1997, to merge Detroit's venerable Hutzel Hospital for women with other facilities on its main campus. A determination on the fate of Hutzel is expected this month.
DMC has reduced its staff of employed primary-care physicians to 180 from 300 and is outsourcing information systems. Still on this year's to-do list: Shrink corporate overhead, cut staff at the newly merged Sinai-Grace Hospital on Detroit's northwest side and negotiate a new financial arrangement with Wayne State, which will include trimming academic programs.
Adding talent. To fill in acknowledged gaps in his experience, Porter is surrounding himself with top talent. Last week, he announced an executive team that includes recently retired Michigan Supreme Court Justice Conrad Mallett Jr. as the system's chief administrative and legal officer. Mallett will be in charge of key areas such as government relations, legal affairs and strategic planning.
Porter has embarked on national searches for a chief operating officer and chief financial officer, while continuing to rely on guidance from a turnaround firm, St. Petersburg, Fla.-based Hunter Group.
Hunter Group consultant Thomas Honan was named last week to serve as an interim COO, while DMC Controller Nickolas Vitale was elevated to interim CFO.
Porter is taking steps to mend the system's relations with community organizations, which want more contracts for minority and women vendors, among other things. Of Porter's five senior staff members, three are African-Americans and two are women.
But Porter said his appointments, while inclusive, won't be dictated by race or gender. "Naturally, in a city such as Detroit it's important we have a racial and gender makeup that reflects the city. I have taken special attention to look out for blacks and women, but that's not what I'm making my decisions on," he said.
Porter said he was drawn to medicine by the opportunity to develop new knowledge and see it applied to patient care. On his office wall hangs a caricature of himself in a white clinical coat and signature bow tie-a gift from a patient.
Porter continues to see patients a half day a week, saying it keeps him in touch with the system. But he has basically left research and patient care, perhaps for good. "As we come into the new millennium, it is important that physicians play an increasing role," he said. "I thought it was important that we step to the plate."