Hospital advocate

When motorists see a blue and white hospital sign with an upper-case “H,” it means hope is nearby, former American Hospital Association President Richard Davidson maintains.

Davidson took the AHA's reins in 1991 and by the time his tenure ended in 2007, the AHA had developed into a unified voice that would better advocate on the behalf of hospitals. Among the lobbying groups stationed in the capital, Davidson says, hospital advocacy was unique and would frequently call hospitals “a very special interest group,” while stumping for them in front of lawmakers and regulators.

Davidson recalled an essay written in 1787 by James Madison urging the ratification of the Constitution. The Federalist No. 10 warned of how destructive factions could be to government. It's also the responsibility of hospitals to fight these factions to better represent their communities, Davidson reasoned.

“But Mr. Madison never imagined the breadth and strength of the special interests as we know them today, but the intent of the Founding Fathers was pretty clear,” Davidson says. “I like to say we need to continue to be a very special interest group because we do very special things that others can't do.”

Before being named to head the AHA, Davidson served as president of the Maryland Hospital Association for 22 years. His colleagues there and at the AHA recall Davidson's high expectations for hospitals. And that's shown through his opinions on what hospitals should represent to patients.

“When they show up there, it's caring, there's compassion,” the 75-year-old Davidson says. “We do what we do only for the purpose of curing, and we're an organization that does this in taking care of you with respect that's beyond reproach.”

Many accomplishments marked his career. The AHA's Institute for Diversity in Health Management represents one of Davidson's bigger ones, fueled by his interest in increasing member participation and representation. His successor, current AHA President and CEO Richard Umbdenstock, remembers another.

He's quick to call Davidson one of the founders of the Hospital Quality Alliance, a public-private collaboration that was established in 2002. The organization was instrumental in creation of the Hospital Compare website a year later.

The alliance's mission is to help the public make better medical decisions by releasing data to the public, through Hospital Compare, on the quality of care hospitals provide. Umbdenstock and others view its creation as a victory for transparency and quality improvement.

“For me that's been a terrific gift for the field, having an association so focused on quality and making that information released to the public,” Umbdenstock says.

Fostering better communications between members also was a priority. Before the Hospital Quality Alliance was formed, Davidson pushed for a meeting with officials to draft ideas on how to improve transparency. That initial sit-down featured government officials, members of the Joint Commission and other leaders. As attendees around the room were sharing their ideas and goals, Davidson began hearing similar reports.

“They didn't know they were doing the same thing,” he says.

By the end of that meeting, thanks in large part to Davidson, the group had a shared vision the led to the creation of the alliance, which includes the AHA, American Medical Association and the Joint Commission, among other organizations.

Davidson took a roundabout path toward a career in healthcare, as he started as a teacher, and that's where his leadership skills developed. He earned a scholarship playing football at State College in West Chester, Pa. He also served as a reservist in the Marine Corps from 1956 to 1962 while he taught at schools in New York and Delaware.

He earned a master's in education in 1962 from Temple University before beginning studies in higher education administration at the University of Delaware. It was while Davidson was in Delaware that his career changed course, leading him into the world of healthcare. He received that first healthcare job offer while on a Delaware hospital bed, recovering from a back injury in 1965.

An administrator at the hospital had heard about him from one of Davidson's professors at Delaware who wanted him to become director of education for the Maryland-District of Columbia-Delaware Hospital Association. Luck had it that Davidson was admitted to the administrator's hospital for a captive job interview while recovering from the effects of Demerol.

“I wasn't an expert in healthcare at all; I had was my tonsils out when I was 6 years old and some back surgery when I was in my 20s,” Davidson says. “Other then that, I didn't know much about healthcare.”

Davidson remained true to his teaching roots, Umbdenstock says. Davidson preferred to talk to his staff about plans and ideas before supplying them with documents. He felt that the papers would distract members, and he wanted to make sure he made his point and supply the proper context before they attempted to digest the plan by themselves.

“Dick really preferred the teaching mode … he never wanted to give you paper until he gave you the whole explanation; he was afraid you wouldn't be listening,” Umbdenstock says. “It's kind of classic teacher behavior ... He knew how to get a group's attention and hold their attention, and at the right time, let the discussion go.”

Davidson wasn't afraid of innovation, as about two years into his tenure at the Maryland Hospital Association, he helped establish the Maryland Health Services Cost Review Commission, after state lawmakers formally created the entity in 1971.

At the time, many state hospitals hovered on the brink of bankruptcy, suffering from various payment problems, including the rising cost of uncompensated care. Insurance companies provided the biggest opposition to the rate-payment model. They feared the proposed system would drive up costs, as all the payers would now have to pay that rising cost of uncompensated care.

Davidson and his colleagues pushed for a system in which hospitals could use a public forum to explain what resources they needed and how that would lead to improved performance. The MHA lobbied Maryland's General Assembly and the bill establishing the rate-setting model passed overwhelmingly. After a phase-in period, officials fully implemented the system in 1974.

Upon his appointment to lead the AHA, members were afraid Davidson wanted to take rate-setting nationally. Staffers based in Chicago also worried about their future, as Davidson became the first AHA president based out in Washington. But even though Davidson says the Chicago employees “were scared to death we were going to move everything to Washington,” he alleviated their fears. And he also reassured hospitals that he wasn't necessarily interested in pushing the Maryland rate-setting model onto the rest of the country.

“What we did in Maryland was our way to deal with problems,” Davidson says. “It didn't mean that it could work in other states.”

Davidson also encouraged gender and ethnic diversity, something Carmela Coyle, the current president and CEO of the Maryland association knows firsthand. She calls Davidson a mentor, having met him while working at the AHA.

“As a young executive, as a woman executive, being part of this team, he was not only fair and respectful, but he always made himself available for the extra time needed to help me, to coach me,” she says.

Former AHA board Chairman Gary Mecklenburg echoes Coyle's thoughts, saying that the need to do the right thing always guided Davidson.

“He is a great developer of people, and that was reflected in both the teams he assembled at the AHA as well as larger issues,” Mecklenburg says.

Davidson remained much more comfortable talking about the work of others, rather than his own accomplishments, Mecklenburg adds.

Coyle reflects on the early years of Davidson's leadership at the AHA, which led into President Bill Clinton's first term. Gearing the AHA into more of an advocacy role was important as the Clinton administration began sowing the seeds for its attempt at healthcare reform.

Davidson always kept an eye on the future, says Richard Wade, his former press liaison at the AHA. Davidson's push in the 1990s for community-care networks can be considered the forerunner to the developing accountable care model, Wade maintains.

Clinton's camp banked hard on healthcare reform when he campaigned for the 1992 presidential election, a year after Davidson joined the AHA. The Clinton health plan, which attempted its own version of universal coverage, famously flamed out in 1994 after an intense debate in Washington and across the country.

Wade recalled an event in Florida in the summer of 1993 when he and Davidson watched then-first lady Hillary Clinton addressing the crowd about healthcare reform. Her husband had appointed her to head the administration's task force on the push for reform. Many AHA members were nervous at the prospect of reform: “Nobody knew what that meant; it sounded pretty frightening to a lot of hospitals,” Wade says.

But Davidson helped alleviate those concerns and talked with members, persuading them to listen with open minds. Hillary Clinton's speech ended with a standing ovation.

“Dick set the stage for her,” Wade says.

One of Davidson's first steps at the Maryland Hospital Association was to expand the role of administrators, as he felt they didn't have enough input in the group's decisions. When Davidson joined the MHA, the board chairman was a banker. Not all hospital CEOs at the time were comfortable talking on a bigger stage to advocate on the behalf of the industry. The association's restructuring also required the board to be composed of hospital trustees.

It wasn't the most natural transition, but a necessary one, Davidson says, because hospital people often weren't very comfortable in meeting with elected officials. “Nobody every trained them for that,” he says.

It was Davidson's values that allowed him to succeed and to advance the role of hospitals and hospital leaders, Wade says.

“I think he understood … that hospitals were very human institutions, and that we were not successful because of the buildings and technology, but successful because of the people inside of them,” he says.

Davidson has three sons, Richard, Michael and Andy. He married his wife, Janet, in 1957.

Andy Davidson serves as president and CEO of the Oregon Association of Hospitals and Health Systems. Father and son may occasionally talk about the business, but Davidson says he never tried to pressure his sons to follow in his footsteps.

“We never pushed them toward healthcare,” Davidson says.