While Charles P. Cardwell Jr. was working for a short period as director of the department of buildings and grounds at the Medical College of Virginia Hospitals in Richmond, the story goes that he walked into the president's office one day and asked, “What's my budget?” The president's response: “What's a budget?”
Whether true or apocryphal, the story dates to a time—the 1940s—when hospitals typically were run by doctors or nurses and the field of health administration was but a twinkle in the eye of visionaries like the late Cardwell, who died in 1977.
Trained as an engineer, Cardwell rose to become director of the hospital division of the medical college in 1947 and was promoted to vice president and director of college hospitals in 1962. In 1949, he founded the college's School of Hospital Administration, and was appointed a professor there, teaching until 1969.
“After World War II, when the doctors came back from the front and new hospitals were being built … they didn't have anybody to run them,” says Thomas Barker, dean emeritus of allied health at the school Cardwell founded, which in 1968 became part of Virginia Commonwealth University. “They all turned to Charlie, and as he would be training people to help him in his hospital, the other hospitals (in the region) were looking to the people he trained and hiring them. That's how they got into the teaching business. That program in hospital administration at MCV is one of the original ones.”
Barker, who recalls Cardwell telling the story about the president who didn't know the meaning of the word budget, was hired in 1967 as director of the School of Hospital Administration. “He was a phenomenon. He won about every national recognition you could get for hospital administration,” Barker says. “He belongs in that Hall of Fame if anybody does. He's a classic.”
Stephen Mick, who chairs the department of health administration at Virginia Commonwealth, says training people specifically to run hospitals might seem like a no-brainer in 2007. “He had the foresight to see the need for more than just a cursory education in hospital administration,” Mick says. “It seems trivial now … but looking back, in the late '40s, it was quite an accomplishment. The idea that someone should be professionally trained to run a hospital was a radical idea.
“Mostly they (administrators) were doctors; they were nurses. They were people who had no particular understanding of accounting or management,” he adds. “With the rise of technology and specialization in medicine, it just became unwieldy for people who had no training to run these organizations.”
Cardwell was interviewed in 1970 by the American Hospital Association journal Hospitals, when he received the AHA's Distinguished Service Award. He recalled that when the medical college program began, “There was really no one in the southeastern part of the country who had a formal education in hospital administration. With the operation of hospitals taking on all sorts of additional dimensions and complexities, we felt we should at least give it a whirl.”
The school, now called the School of Health Administration, has some 2,000 alumni in all 50 states as well as 10 foreign countries, who have graduated from either of the two master's program in health administration or the doctoral program. Mick says the alumni have been instilled with the no-frills approach focused on the details of operational management that Cardwell stamped on the school.
“We still have that patina to us,” he says. “We are known as sort of a hard-headed, no-nonsense, hospital-oriented program that concentrates heavily on what we call institutional management. That comes directly from Mr. Cardwell, and it is, for us, our strength. We don't try to be all things to all people.”