John McMeekin's mentor, healthcare legend H. Robert Cathcart, taught him never to start a sentence with "I." It is a lesson McMeekin takes to heart both grammatically and philosophically.
McMeekin, 66, stepped down last month as president and chief executive officer of Crozer-Keystone Health System in Springfield, Pa. McMeekin was the chief architect of the system, which was created in 1989. It brought together two disparate hospitals in suburban Philadelphia: Delaware County Memorial Hospital, Drexel Hill, Pa., a 240-bed community hospital in a blue-collar neighborhood experiencing a demographic upheaval of new immigrants, and Crozer-Chester Medical Center, Upland, Pa., a 435-bed academic teaching hospital bordering Chester, the county's only city, with 40,000 residents.
McMeekin's retirement and the apparently seamless transition was nearly two and a half years in the making, but he confesses that he is leaving reluctantly, in complete denial and with only a very rough sketch as to what he will do next. But retirement isn't about him. It is a bitter pill he is forcing himself to swallow for the good of the system he helped build.
"This retirement is not going to be easy," says his longtime assistant, Jennifer Pedley. "Deep down he doesn't want to, but he's forcing himself to because he thinks it's the right thing to do. In his head, he thinks it's the right time even though his heart is not telling him that."
Then, Pedley adds: "Mr. McMeekin doesn't know much about relaxing and taking time out for himself."
Indeed, on the cusp of the Christmas holidays, McMeekin showed no signs of downshifting during one of his last workdays, which he shared with a Modern Healthcare reporter. He laid out a grueling schedule that both he and Pedley say was fairly typical. It began with dinner one Tuesday evening off-campus with the system's executive management group, then back to the corporate offices bright and early Wednesday morning for a standing 7: 30 senior staff meeting.
The next meeting reflected McMeekin's "live locally but think globally" approach to healthcare: a 10: 30 a.m. briefing in downtown Philadelphia at the offices of Philadelphia International Medicine, one of his many pet projects. In the program, Crozer-Keystone is teaming up with its toughest competitors to thrust Philadelphia into what they feel is its rightful place on the international healthcare scene, considering the vast number of teaching hospitals, medical schools and pharmaceutical companies in the area.
After the briefing, he retraced his steps south on Interstate 95 for a meeting with Crozer-Keystone board Chairman Robert Bruce at Widener University in Chester, Pa., where Bruce is president. They wanted to discuss yet another pet project, a Widener and Crozer-Keystone joint venture to build a technology park in Chester aimed at boosting the economy and ultimately lifting the emotional and physical well-being of the city's defeated population. There is no denying that the venture also could help boost the balance sheets of both Crozer-Keystone and Widener.
"A little self-interest never hurts in getting good deeds done," McMeekin says.
After Widener, he planned to go back to corporate offices to review a grant proposal for a Chester community technology center that will, if it comes to fruition, inevitably tie into University Technology Park. The idea is to train people for information-age positions, helping them leapfrog over dead-end entry-level jobs in the fast-food industry, he explains. And it will promote overall community health because if people earn more money, they eat better and are sick less often, McMeekin adds.
Someone casually said to him once that the kids in Chester "have no hope of getting out," McMeekin recalls incredulously. "I've never felt like that, except for maybe two years in the Army."
In retirement, McMeekin expects to stay involved in each of these ventures. The only difference appears to be that he would stop drawing his CEO's salary.
McMeekin insists that the only contrived event of the day will be lunch, where he has arranged to meet Cathcart, who was with Pennsylvania Hospital for 42 years, 39 of them as president and CEO, and who is a member of the Health Care Hall of Fame.
The past meets the future
In some ways, McMeekin is the embodiment of what happens when old-fashioned values meet forward-thinking ideas. He religiously follows up every meeting with a hand-written note, frowns on the idea of dress-down Fridays, and opens doors for women to the point of exhaustion. With his snow-white hair, perfect posture and crisply pressed suit, at 4 p.m., McMeekin gives hardly a hint that he had already spent eight and a half hours on the job and has hours more to go.
He is a passionate partisan for information and medical technology. He frequently mentions that Crozer-Keystone invests slightly more than 4% of its total expenses in information systems, nearly double the industry standard of 2.5%. But even that amount is woefully inadequate, he quickly adds.
Almost without exception, those who know him best-his staff, his chairman of the board, his colleagues-describe him first as a visionary.
"Jack is an innovator," says C. Thomas Smith, president and CEO of the Irving, Texas-based VHA hospital alliance, where McMeekin is on the board of directors. (McMeekin's long list of professional activities includes stints on the boards of the American Hospital Association and the Hospital Association of Pennsylvania.) "He's a guy who always seems to me to be willing to try new things, to take risks, a person whom I believe cares deeply about the reasons why not-for-profit hospitals exist," Smith says.
In the decade after McMeekin steered the Crozer side of Crozer-Keystone into the merger, the system acquired and resuscitated three failing hospitals. It also plunked $40 million into a 170,000-square-foot fitness center called the Healthplex. Crozer-Keystone also had the distinction of being one of the first systems to get into the HMO business as one of 12 HCFA-designated Medicare+
Choice demonstration programs. It also was one of the first to bail out of the HMO business.
"It was a great learning experience, but a financial disaster," the ever-pragmatic McMeekin says. "We're always prepared to cut our losses."
In good shape
With five acute-care hospitals (under two licenses), four skilled-nursing facilities, 6,800 employees and a physician network of 80 primary-care physicians and 60 specialists, Crozer-Keystone is Delaware County's largest employer, at the moment besting No. 2 Boeing Co. The system operated in the black since its inception, although it was alarmingly close to break-even for two of those years, most recently in 1999. In fiscal 2000, the system earned $1.3 million on net revenues of $519 million. Charity- and free-care expenses climbed to $32 million.
In short, Mc Mee-kin was as ready as he was ever going to be to turn it all over to his longtime second-in-command, Gerald Miller, who was appointed president and chief operating officer in July.
"Jack and I have been working together so long that I just see this as a natural step," Miller says. "It's a real honor to follow (him)."
McMeekin was long ago requisitioned locker No. 1 in the Healthplex, but he claims he never got a moment to take advantage of it in a recreational capacity. He says there were workout clothes hanging in the locker with price tags still attached. However, Miller wants him to stay involved with the business of running the fitness center, so he promises to begin using it.
"If I'm going to evangelize a wellness facility I don't use, there will be a little credibility problem," he admits.
Crozer-Keystone is headquartered on a rolling hillside in suburban Springfield, next to one of its more recent acquisitions, Springfield Hospital. Once an osteopathic hospital that was losing $2 million a year when it was taken over, the system downsized it to 40 beds and built the Healthplex, the corporate offices and 86,000 square feet of physician office space-all connected by pedestrian walkways.
The closest neighbors are an upscale 200-unit adult retirement community and St. Kevin's Church. As a condition for the Healthplex zoning permit, McMeekin explains with a smile, the seniors were given a free one-year membership, and the children at St. Kevin's march over regularly to play basketball on the regulation court. The baskets drop down in height to accommodate them.
Crozer-Keystone headquarters is the setting for the weekly 7: 30 a.m. senior staff meetings, held in the state-of-the-art conference room that staffers affectionately call "the board room that McMeekin built." With its polished wood U-shaped conference table and teleconferencing capabilities, it serves both as the site for high-powered computer-assisted presentations and United Way community meetings.
By mid-December, the meetings were already being led by Miller. This particular morning, each executive updates departmental progress on corporate goals for fiscal 2001. They discuss achievement of quality-performance measures, which includes a systemwide approach toward pain assessment; patient safety and reduction of medical errors; and a patient-satisfaction survey, to name a few.
There was no mention of profits, losses or bottom lines. Miller jokes that it was a luxury of running ahead of budget. McMeekin adds, "There is wide recognition (at Crozer-Keystone) that if all we do is focus on reducing costs, we are looking at the wrong thing."
The prior evening McMeekin had introduced each of the senior staff with praise for their professional abilities along with an ingratiating personal anecdote.
He compared them to a precise formation of geese flying south. He removed his coat to demonstrate. The senior staff had stared aghast.
"In 16 years I can count on one hand the number of times I've seen him without a jacket," Miller says.
Time to go
At lunch, Cathcart mentions he and his wife will be escorting McMeekin and his wife, Karen, to Thailand and Malaysia in the spring as a way of furthering the retiring CEO's adjustment to his new life. Cathcart grouses that he firmly instructed his friend that he is not allowed to bring a suit or tie, but McMeekin nevertheless insists he will bring a blazer.
Embarking on retirement with Cathcart at his side will in some ways bring McMeekin full circle. In 1965, McMeekin made his first foray into healthcare at Pennsylvania Hospital, where he was assistant vice president under Cathcart. McMeekin's three sons were all born at Pennsylvania Hospital, and Cathcart carried each one of them out to the car to go home.
Those were the heydays of President Johnson's Great Society, and Cathcart says he "turned Jack loose" on it, directing him to "scale the stone wall" that surrounded the hospital in both thought and deed-an "earth-shattering reorientation," Cathcart says.
That meant rather than make the community trek to them for care, they would begin delivering healthcare services out in the community. McMeekin set up South Philadelphia Health Action, establishing clinics and a delivery system that did just that. He remembers the time with relish because it was an era of change, he says.
Now what with the explosion in information technology and the mapping of the human genome, technological changes are rocking the healthcare industry. It drives him crazy that he is retiring in the midst of it.
"They are like keys to the closets we never opened," McMeekin says. "There is a frustration in being in a career that has these things going forward and you have to go."
But go he must, he adds.
"It is the right time and the right thing to do," McMeekin says. "An organization needs periodically to have new, fresh leadership. You have to move on and let someone else do it, move on or the organization is stymied. An organization is much bigger than a person's likes or dislikes."