Gary Kaplan, M.D., chairman and CEO at 289-bed Virginia Mason, Seattle, recalls meeting Ross for the first time as an internal medicine resident and finding him approachable and humble. “He is very respectful and very inclusive,” Kaplan says. “Although learned and wise, he saw the unique attributes of every individual. He made you feel valued and appreciated the ideas that each individual brought forward.”
Ross was named CEO of Virginia Mason Hospital in 1968 and held the top job at the medical center from 1977 until his retirement in 1991.
Ross, 80, recalls the 1987 financial merger of not-for-profit Virginia Mason Hospital and the for-profit Mason Clinic—which had always been joined in a “Siamese-twinlike” arrangement at the executive management level—as the most significant achievement during his time there, although he's quick to stress that “it's not due just to me.”
The former partners in the clinic had to vote to give up their equity interest, which all but one did—and that person “told me later he didn't think doctors should ever totally agree on anything,” Ross recalls with a chuckle. “I've felt for a long time that hospitals and doctors needed to get on the same side of the ledger. The docs had to be the ones that led the decision, ultimately.”
Ross had a deep understanding of the need for doctors and administrators to work together out of mutual respect in the patients' best interests, says Kaplan, who also values Ross' leadership in founding a not-for-profit health services consortium that linked about 14 small, rural hospitals with Virginia Mason and one another.
“He had a vision for integrated care, for what the Virginia Mason group practice and Mason hospital would become, and how he could impact the region through his health services consortium,” Kaplan says. “How do we share knowledge, share continuing medical education?”
In that vein, Ross built ties with primary-care community clinics in Seattle and throughout the region, to which Virginia Mason provided “thousands upon thousands of referrals, and made a contribution in reducing health disparities and improving access for low-income people,” says Mark Secord, former assistant administrator at Virginia Mason. “He pushed the envelope. That was Austin's trademark.”
Ross credits Virginia Mason's board with the foresight to acquire enough property to allow for expansion, blooming from 26 doctors and about 200 beds when Ross first arrived at the organization in 1955 as an administrative assistant to 400 doctors and 280 beds when he retired more than three decades later.
“You couldn't do that on the old property,” Ross says. “It's the outpatient, ambulatory side that was really grown.”
Another achievement about which Ross remains proud is Virginia Mason's decision to step up and save the Bailey-Boushay House, established in June 1992 in Seattle to provide care for HIV and AIDS patients, when the agency that had planned to run it backed out. The decision carried financial risks as well as the stigma that AIDS still held two decades ago.
“It was a pretty controversial thing. Medical staff people and others didn't want to get too involved,” Ross says. “The key to it was getting the smart-thinking physicians to take the leadership in it. … Everybody looked at AIDS as bad stuff.”
“Virginia Mason's taking over the operations of Bailey-Boushay House wouldn't have happened without him,” Secord says. “What made sense to Austin was simply the community need for someone to step up and do a competent job. There certainly was a considerable amount of fear about AIDS and homophobia within every organization, including Virginia Mason. … The bigger issue was the financial risk.”
Ross enjoyed a second career as a professor of public health after his retirement from Virginia Mason. He says he values the academic chapter of his career greatly, both for the opportunity to work with young people and to publish even more frequently than he had done as an administrator. “I loved teaching. I feel it's so important to mentor people,” says Ross, who retired from teaching in 1999.
“He helped to both create and to honor and make visible the body of knowledge that made one a healthcare executive,” Kaplan says. “His textbooks are legendary. He's one of the greatest, if not the greatest thinker, among healthcare executives.”
Of his six books and more than 50 articles, Ross' most celebrated work is likely a textbook that he co-authored, Ambulatory Care Management, first published in 1984 and most recently updated in 1998, that's still used in universities across the country.
William Dowling, past chairman of the Health Services Department at the University of Washington, appreciated Ross' open door to taking interns at Virginia Mason from UW in addition to his alma mater, the University of California at Berkeley. “He said, ‘Fair's fair. This is the MHA program in the state of Washington,' ” Dowling recalls. “He was always very supportive in a guest lecture role, mentoring our students, or finding field work projects they could do at Virginia Mason.”
When Ross joined as a full professor upon leaving Virginia Mason after several years on the clinical faculty, some in the department sniffed that Ross hadn't paid his dues on the research side, “from the narrow perspective, I would say, of academia,” and Dowling answered: “Look at his C.V. He has published more than most of you have, even running an organization like Virginia Mason.”
Ross led the design of a certificate program in medical management aimed at physicians and then later built off that to lead the creation of a yearlong graduate-level executive management master's degree program.
“He felt very strongly that just because you had ‘M.D.' after your name didn't mean you were particularly adept at managing budgets,” Dowling says. The programs are “not designed exclusively for physicians and other clinicians, but they attract a pretty high proportion of them.”
Ross kept one foot on both the hospital and ambulatory-care sides of the field by participating in and eventually leading the boards of both the Medical Group Management Association (as president from 1976 to 1977) and the American College of Healthcare Executives (as chairman from 1984 to 1985); he is the only person to win both groups' top awards for industry achievement, the MGMA's Harry J. Harwick Lifetime Achievement Award in 1983 and the ACHE's Gold Medal Award in 1989. Ross is also the only person to lead both boards. “I must have been crazy,” he says with a laugh.
William Jessee, M.D., president and CEO of the MGMA, says Ross' ambulatory-care textbook is one of the association's all-time best-sellers. “So many people who run group practices now, it's their bible,” Jessee says. “He was one of the pioneers of the integrated delivery system movement, back before we knew what those were.”
Dowling says Ross' ability to lead the ACHE and MGMA makes him a different sort of pioneer. “Very few people are that ambidextrous,” he says. Before Ross' work on the ambulatory-care side, “Very few MHAs went anywhere other than into big hospitals. He established ambulatory-care management as an equally worthy area of healthcare management.”
Ross describes his leadership style as “participatory, trusting without judging, giving people opportunities to expand and grow, and to allow people to make mistakes and not crucify them. … If they won't take risks, your whole system begins to bog down. It's a soft style. I did not believe in taking a highly visible role.”
“He doesn't need to be in front; it's a subtle way of doing business,” says Dennis Pointer, the Austin Ross professor of healthcare management at the University of Washington's School of Public Health. “You run across some pretty big egos. Austin's not one of them. It's not an issue with him.”
“He's a very thoughtful person,” Secord adds. “When people think about Austin, you'll hear a lot of people that will look at him as a mentor, as somebody who offers sage advice—and that would embarrass the heck out of him.”
Pointer figures Ross is very proud but also “wincing” at his induction into the Hall of Fame. When Pointer sent out an e-mail informing colleagues about Ross' induction alongside the late Sen. Edward Kennedy, he added that “Sen. Kennedy's in good company.”
Ross shot back a kidding note that said: “Thanks for sending this out. I feel embarrassed.”
Ross credits his wife, Annette, for being supportive of his career by taking the lead day-to-day in raising their four children; they now have 10 grandchildren, three great-grandchildren and have been married for nearly six decades.
He's proud to say that two of his sons have followed his footsteps into the healthcare field: Randall is vice president of ancillary services at Sutter Health's Sacramento Sierra Region, based in Sacramento, Calif., and Austin T. is vice president of medical supplier Health Resource Services in Seattle.
“Family is the No. 1 priority,” Ross says.
Ed Finkel is a freelance writer for Modern Physician based in Evanston, Ill. He can be reached at [email protected].
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