See also Vignette

JAMES H. ROSS
President, Pitt County Memorial Hospital
and Chief Operating Officer,
University Health Systems of Eastern Carolina

October 10, 2000

Interviewer: Marion Blackburn

Marion Blackburn: Do you have any thoughts about where the medical center is and where it is headed?

Jim Ross: A lot of the immediate future is going to really require us to continue the fundamentals that have been put in place by a lot of the early leaders. The Jack Richardsons, the Dr. Laupus, and the Dave McRaes and the Dr. Hallocks, a lot of our private physician leaderships like Frank Longino. A lot of those early leaders really set a course for us that is about how we move forward; things like the continued development of the school of medicine. There are huge educational needs in eastern North Carolina and we may be doing it in different sorts of ways perhaps, but really continuing on that major move that was made in the seventies. Dr. Monroe, and the list of folks that were huge in getting that started but no matter how we move forward it has to be with that kind of relationship growing and expanding. We are talking about things not just in medical education but in allied health and in nursing as they work with this campus and this center but how we work in this region; the needs in the labor force for eastern North Carolina and health delivery in our core of businesses are phenomenal. So, those relationships are really huge for us.

Taking advantage of some of the technologies about and that not everything has to be done in Greenville. A lot about distance learning, using technologies to better support that education. The same thing is about our service part of our mission; it is not about bigger is better; it is easy to say but it is a huge, huge point. The point of this whole system is about how to deliver care to those who need it in the right place at the right time and that the quality is always improving. So, that service piece that was laid in place a long time ago it differentiates PCMH and now University Health Systems in Eastern Carolina is huge.

The other part of our mission continues too and you probably talk less about research but that's a big deal. Talking about research, Dr. Hallock and the medical school faculty are better to speak to this point but we are not like every other medical school and every other campus. We do some advance research in the basic sciences and that's important, but so much of our research has to do with delivery of care, what works, what does not work, what's effective in eastern North Carolina, given the circumstances and the needs we find ourselves with. Those are fundamental tenants of what we are here to do in the first place and those things really continue to grow and expand in the future. All that says is that we have to be economically balanced. It is not about how much bottom line can you generate for the sake of size. It's not whether you invest that or spend that, but it is more a matter of what you are doing with that to further this mission. Sometimes that means growing reserves to be able to access the capital markets at better rates, but it is really more about how you invest and what your return is to further that mission and those components that I was talking about of education, service and research. We have to be economically balanced and that means we have to keep taking care of all comers here in eastern North Carolina for that reason and being able to do that whether it's in our home health businesses or our surgi-centers or in our hospitals or in our doctors; we have to be able to match that up.

It is also about continuing to build and expand on relationships. Dave has been one of the masters that I have ever been around about building the relationships. That's a long-time event. It's not a short-time phenomenon. You don't meet once and things are fine, it's about building relationships in a step wise fashion. It's not about University Health Systems owning or controlling everything about health care in eastern North Carolina. It's how we work with other hospitals that are either affiliates of ours or just good friends with our physicians and us. It is how we manage those relationships to still get our mission accomplished here. It's about how we do that with public health and Dave always leads us down that path with how to do that, but it's about other types of relationships whether it's education now or things that are important to eastern North Carolina but how you manage and build and grow those relationships; how you build win-win partnerships not that somebody can win if somebody else loses. This place has a great culture for that positive attitude for that approach. I know it sounds pretty much like a PR statement but I am telling you that after ten years around this place that is true; that is a real neat cultural phenomenon at a time when forces in most competitive marketplaces would have you in absolute cut throat fights over market share and somehow Dave has been able to keep us on the high road in managing our relationships in win-win opportunities.

Marion Blackburn: That was a great answer to my question. Something that I always enjoy hearing people talk about which is the hospital's mission, issues such as delivery of health care, of which are the specific health care needs of this area and the mission of serving the area and educating doctors to serve the area.

Jim Ross: You know, just like in Jack Richardson's time, it's about the patient. We talk about how big and complicated it has become and again, like Jack Richardson, I have heard him say it myself, I have worked in four or five different hospitals and I have never left this place because it always grows so. Well, it is still that way. In my ten years here we have gone from PCMH only to a six-hospital system with all these different other components of the health delivery system, but no matter how different it is, no matter how the bigness seems to get the attention, get the public eye sometimes, it is still about taking care of the patient whether it is in the home setting or the doctor's office setting or in the hospital or in the emergency department. It's about taking care of that patient and creating the right environment to do that. Do you have the right staff? Do they have the right educational opportunities? Do they have the right equipment? Do they have the right facilities, and have we made those appropriate balanced investments to do that the right way? In that sense it is the same as Jack Richardson or even maybe Mr. Ward to some extent, it is always a struggle economically to balance those forces in health care. They are a very dynamic set of economic times. I have been doing this a long time and some of these big changes that came through I kept thinking it was the end of us and somehow we found a way that it wasn't and we were able to get the job done. A lot of it is very different than in Mr. Richardson's days and Dave's early days but a lot of it is the same about those kind of struggles, that kind of reward in work.

Marion Blackburn: I would like to return a little bit to the sense of mission because I hear a lot of people talk about it but I also see an organization, University Health Systems, as an institution that actually pursues this mission. It's not a mission statement on the wall; it's a real thing. Can you speak a little bit about how this institution has been so successful in pursuing the mission and how it can continue to be successful?

Jim Ross: Good question. How in the world do we not let this great advantage we have ever slip away or ever become smaller? You know, it starts at the very top. Our Board of Trustees is where that begins and they really think about the mission. If you ask our twenty member Board what the mission was they will know. It is not just something you do for Joint Commission times and I think that Board really knows and they might say it in their own words but I think they understand the core concepts of what we are here to do. Regardless of the size or complexity of the issue in front of them, they don't forget that mission point. They all come at it from different points of view, that's why you have a community Board is they all bring their own perspectives from their lives but they remember that mission and help out. So you can say that is where it really starts. Then folks like Dave as the Chief Executive Officer whenever we are making a decision, he has to surround himself with a team of folks administratively that look at an issue from a variety of standpoints but has to have the whole group also understand that even within those viewpoints you have to think about the mission.

We have a financial officer here in Jack Holsten who is the consummate businessman. I have never seen better business judgment on a transaction or in accounting or just good sense and that is Jack. But, it has to be balanced with what the heck we are here to do in the first place. It isn't just about generating of profit; it's about how you do that within the scope of this mission. Debbie Davis is as strong operationally about running a business in understanding the detail of that as anybody I have ever been around but can't forget what the heck we are here to do in the first place. Therefore, you do some things that are not economically advantageous to you that others may shy away from. I think the word for it used to be culture and what is the culture of the organization. Well it is to believe and to understand that mission. Everybody needs to be able to articulate that maybe in your own life but everybody needs to be able to live by those principles and not deviate from those things, so it starts at the very top. When we do our planning activities and one of the other core values of our organization is our planning culture. We have a great system for looking way out into the future and then matching up every year is a step in that process but how it gets you to that longer term vision.

This is a good year when we are starting to relook at our Strategic Plan for the next five years, so it is really fresh with us. In that long-range planning process to keep all of that going every year we start off that whole process with that one slide that we use every year at our budget workshop for our Board and it starts with the mission. We really do talk about that and remember what we are here to do and then from that kind of what was our vision of how we wanted to get it done and then we look at our organizational structure. We look at our facilities plans and we look at our financial plans, our information systems and human resource plans and our clinical plan now to how those things really match up to the strategies that we want to go to and how they relate back to that mission.

Every year the Board gets a good dose of that thinking and they ask for it, they want to do that in these retreats. Every Board chairman since I have been here has built upon that, expanded upon that and along with the Board leadership and Dave and really think about those retreats. They are not just tossed together, I mean they are set up to really get out some of the core issues and a revisiting of some of those things. That keeps the mission very vibrant, very much alive. I guess one other part that is on my mind about that and I could go forever, is that we are different than a lot of other places and this is what I kind of know best from what I have spent all my time but we are not like some places trying to be in twenty-nine states, we are trying to be in twenty-nine counties and so we have a focus about our region and about what we are here to do that may be different than some others.

When I worked in Houston by way of an example, we were a huge hospital, the Texas Heart Institute, and it was a big deal and we did tremendous quality of work, very high tech kind of work, very, very advanced with the women and children and surgical diseases and those kind of things. We were in a city of three million people. Our population that we served came from not just the Houston, Harris County and surrounding county areas but internationally. It was all hard to identify outside of our own walls and part of the mission of this place is so great because it goes outside the areas of just PCMH. It's grown over the time about that but in Houston it was so hospital-focused and I have been gone over ten years and it may be very different now but at the time it was really built on that episodic care that you saw in a hospital and the mission here is a lot more than that. That's a great thing, it's a great opportunity and it is not about "save the world" it is more about let's save the twenty-nine counties of eastern North Carolina first and let's focus on health issues. We can't solve every societal ill or every social issue but we can have a good impact on what we are here to do about health care.

Marion Blackburn: You talked a little bit about your experience in Houston and I was reading Wayne's book to get a little bit of information about your background and I thought that was also fascinating and if you don't mind, maybe talk a little bit about, I guess I am trying to say how you got here from there. You were already in quite a big institution there and then you came to this big swamp we call eastern North Carolina.

Jim Ross: I had been in Houston for about five years and it was a 950 bed hospital, The Texas Heart Institute with Dr. Cooley and his team who were world renowned and there was a huge orthopedic surgery group there and Dr. Sifton and other folks were extremely well-know and highly thought of and there were some great pioneers. The Neurology Service there was one of the leaders in the world with Dr. Brantley Scott and a lot of really top board kind of folks. I had been there about five years as I said and I got a call from Bill Lowderman who was in a search firm, runs his own firm, and I had met Bill somewhere about a year before at some conference and just knew the fellow. So he called me and asked me if I was interested in looking at another job. I told him that I felt I had gone as far as I could at St. Luke's up the administrative ladder and I was not looking particularly but I asked him what he had in mind. He told me that Pitt County Memorial Hospital and I asked him where was that and he told me Greenville, North Carolina and I again asked him where that was. Being in Houston and Dallas before that I didn't know a whole lot about the rest of the country. The only time I had spent in North Carolina was in the mountains and he told me it was in the eastern part and all. We chatted for a while and he told me he wanted to send me some information on it and so he sent me a packet of things that he had worked on with Dave and the team here and they were recruiting for a chief operating officer at the time. He sent me the information and I looked at it and we talked again and I told him that it looked pretty interesting and that I was still not sure or anything but it was pretty interesting.

He told me that was great and he said that we should meet and talk about and I met with him for a while and he submitted my name to Dave for the list of other candidates and Dave did the screening and they picked a small set of candidates to bring in for interviews. I flew out of Houston into Charlotte and then caught one of the planes over here and I remember flying in and looked out the window as we flew over and there was this great air view of Pitt County Memorial Hospital. Remember this is before the North Tower and a lot of the expansion, and the Support Building and the West End Building and all that sort of stuff. I thought that wow this was a big deal. You have to understand that in Houston rather than being spread out like we are here, all on one or two floors or something, in Houston we had a twenty-nine story bed tower that went straight up. Our office building was like thirty stories and went straight up and I am looking at this place and it is spread out all over everywhere and I thought wow that this was really something.

The thing that really impressed me here, I mean these buildings were really something to see, of course, but it was the people. From the minute you got here the folks were just great. I mean they were super and I immediately hit it off with Dave, I mean what a great relationship, it was a good feeling just from the very beginning. I remember going home and telling Doris that this has really got some possibilities. Doris hadn't come with me on the first visit. I told her this had some real interesting opportunities; big place, academic medical center and there were really some tough issues looking down the barrel and I thought that professionally this looked pretty cool. So, I was invited back for a second interview and Doris came with me and we really were impressed again with the folks and we got treated great. Dave had introduced me to some of the Board leadership and the Medical leadership, Walter Pories and a number of the folks at the time that were here and I was really taken with this. I got back to Houston and told my boss that we were really impressed and if they make the offer I really wanted to take that. He was really supportive and pleased for me and encouraged me with it. He is one of my great mentors and he is a superb leader in his own right but he really helped coach me with some of that and made sure I had my eyes wide open about stuff.

Sure enough they made the offer and we moved here. We couldn't wait to get here. I had a great start with Dave and he has been a great person to work with. A funny story to finish that out is we had been here, I guess, maybe somewhere between three and six months and a couple of my buddies from Houston came to visit from a city of three million, I mean it never sleeps, there is something going on all the time, I mean a huge complex place to live and all that sort of stuff. The city of Greenville was maybe fifty thousand people and maybe a hundred thousand in the county or something like that. They said leaving a city of three million and coming to a city of fifty thousand or whatever and they said help us understand this and I told them to look that there were some things that they hadn't caught on to in Greenville yet and that they needed to stick around for a while. I told them that last week we had two cars stolen in the same day and it made the newspaper. I told them that had about one hundred twenty-five a week and you couldn't even get the police to make a report. I told them there was a quality of life here that is just wonderful. I mean we are not crime free and don't get me wrong, it is not that everything is perfect in Camelot and all but there is a quality of life here that in some cities you don't get to enjoy and yet professionally, look at this place from a health career, wow, you can't beat this with a stick.

This huge academic medical center, just on the size of it, but the things we are doing are so cutting edge and they have been. Everybody is thinking about robots and those kind of things but you look back over the history of this place, not just from the administrative side, but medical successes this place has done, the first this place has done in eastern North Carolina. That is what got me interested were the folks who live here and I
thought that was the cool piece, it comes alive. This place resonated a lot with me was one of my early parts of my job. When I lived in Dallas we had bought a hospital out in one of the suburban parts of Dallas and my boss put me out there. I was twenty-seven or twenty-eight years old or something. The neat part is the parallel here is you live in that part of town and you work in that part of town as administrator of that hospital and you go to the grocery store and you see people that you knew had been in your hospital and you knew you made a difference in your own community. I mean it is not the same in a lot of respects and the analogy breaks down after a while, but the part of that job that was so much fun was that you knew you were making a difference for your community and you were adding something by the services that you were doing there that here to for that had to leave the community to go get and in a way you have that chance here. I mean people can still leave if that is their druthers but you give them a shot at not having to do that and there are some people that can't leave, either economically or otherwise and so our ability to impact that access question is huge and that is really important.

Marion Blackburn: You have touched on the definitely important issues like just then you raised another one which is unthinkable in a lot of areas which is that a lot of people in the area we serve don't have a car. Nobody in their family has a car; they walk everywhere or maybe somebody has a bicycle and under those circumstances if somebody needs to come to Greenville two or three times a week for chemotherapy this is a real burden and a general complication for them.

Jim Ross: You have talked to Buck Sitterson in your travels, I am sure, and Buck taught me a really important lesson. He talks about it and I guess Buck's way of saying it, he tells a lot of colorful stories, he said there are two-car families, one-car families, and no-car families. The two-car families they go get health care any time they need it and the one-car families they go get health care but it is usually leaving after Dad gets home from work with the car. Then there are no-car families and you kind of have to go to them because they don't have much of a way to get to you. Maybe in Greenville that is a bit different but in some of the rural communities we are serving that is true and that is why you see us doing a lot of the things we are doing. You can talk to Diane about a lot of our community services where we are doing pediatric stuff where we go out to folks. We go to schools and you go to the different plants or the different companies and do things. It's like you in your business, you have to communicate in a variety of different ways and some people get it in writing, some people get it in TV but getting it is the point. It is that way in health care too, you have to do it in multiple locations and eventually you catch as many as you can that way.

Marion Blackburn: In other words, making health care more universal.

Jim Ross: Our point about access and all comers is definitely down that line. It is trying to help create a healthier lifestyle is a big part of us and you have heard us talk about it. It is not about just providing health care although that is a huge piece of it, but helping our physicians and our allied health folks who are really the providers, work on more healthier lifestyle. We are encouraging folks to that end. You have to go and see the new ViQuest Center, just go and take the tour and anybody will show you around over there. It is really something to see. The neat part of ViQuest to me is that they are not just about fitness, they are about health improvement sessions. I go there and they are not just pushing me about how much weight I am lifting or whatever, it is about what was my improvement, did you really reduce on your cholesterol, did you really reduce on your heart rate, what is your blood pressure doing with all this stuff and making me go through this rigorous check and I am healthier for that. They want to know if I am getting the right nutrition and stuff, I mean they are counseling me on all these things and that's pretty cool. If somebody didn't push me at it, I probably wouldn't have. If I am that way, gosh I am not any better than "Joe Average", I can imagine it is like that for everybody. I think that healthier lifestyle is a very important thing. One of the things that we heard a speaker at one of our Hospital Association meetings, who said that changing health care is generational. Well, if you don't start now then your kids won't be any different. They will do a little bit better then you want the next generation to do a little bit better; the same thing with education and health, you want to give them those tools to have the next generation be better and stronger and not have to face the same issues we do.

Marion Blackburn: Of course in eastern North Carolina when you talk about trying to have healthier lifestyles we can have a series of interviews on that on the need and in health. Greenville is fairly sophisticated compared to what it used to be but if you step outside and you go in Martin County or you go in Washington County, just things like farm accidents, occupational injuries, not to mention the foods they are eating and the smoking that is going on.

Jim Ross: Yes, that's a big issue but I don't know, Marion, if I go to the big city, if I go back to Houston, the smoking rate looks awfully high to me, the traffic accidents, the crime rates, I think of all the excellent opportunities there are there too. Another neat person to talk to about all of this kind of stuff is Dr. Herb Garrison with the Injury Prevention stuff that he has been doing. Whether he is dealing on the farm setting or whether he is dealing on the waterways with jet skis and all this sort of thing, Herb does a lot of really important work with injury prevention and that is huge for us in eastern North Carolina.

This trauma system that Dr. Rotundo has put together. When I point out medical advances before, these are some of the things that are huge about eastern North Carolina, they are not administrative, and they are medical jumps. Paul Cunningham led us into this Trauma Center and did a superb job, I mean what a neat program we have and now Mike Rotundo is picking up the ball and going the next step. The tangible side is we a second helicopter but that's not all about trauma but Mike is really providing some medical direction to carry our trauma programs to the next.

When you think about the Children's Hospital, wow, ninety-five beds for children's care here. Jon Tingelstad did a miraculous job of pulling that thing together. What a super human effort to go from ground zero with that. Look at it now, the NeoNatal unit is coming out of the ground and Ron Perkin is the new Chair of Pediatrics for the school of medicine and he can't wait and when he gets his feet on the ground to see how we go the next step.

Nick Benson in Emergency Medicine; Jack Allison was a great Chair, got us started and now we are running an ED that seeing probably fifty-five to sixty thousand people a year in something that was designed for about forty or forty-five and so now we have this need for a $25 million ED that will be wonderful. It will have levels of care within it that we heretofore have not been able to have. It will really help us get at that level and go to the next and Nick Benson is leading us to the next level.

You know, it's like Ranny Chitwood was with surgery, his heart program speaks for itself. But look at all of general surgery.

Another fellow, Phil Bryant, he is the Chairman of Physical Medicine and Rehabilitation. Phil is a real soft-spoken kind of fellow but let me tell you, you want to listen when he talks, he has really got us up to the next level. There are huge developments in our outpatient rehabilitation medicine and we are now into the pool in a big sort of way here. Now helping us with Heritage and its rehabilitation programs. The Residency Program is wonderfully accepted which we terrible need, Physical Medicine in eastern North Carolina.

I can look around at all these medical jumps forward in cancer. The bone marrow transplant unit, talk to Dr. Como, what a neat guy with a superb program put together. Women's Services with Ed Newton. Darnell Jones got us started with this and the private physicians in OB/GYN have played a huge role and the groups have really come together to do a great job. Look at it now with the invitro fertilization, I mean some of the really high tech stuff and the high-risk sorts of work that they do is absolutely incredible. The Residency Program is one of the most highly regarded in the State, they always fall in the upper end of the match and it is always a great indicator of a appreciation for what you are able to do here.

All of our big programs have had these great jumps forward in my times and Dave has really set the course for that. These medical leaders really weigh into moving us along with that. I could go on about every specialty from Radiology, Pathology, Anesthesiology, but you know they have all made quantum moves forward over time. Great leadership in the beginning and they moved along. You had Tom Norris in Pathology and then Peter Kragle. Peter has brought the labs together between the school of medicine and the hospital. You look at the Radiology Department, I knew Dr. McConnell and I understand Dr. Taylor before that, but McConnell was here in my time. Now Mike Weaver is the Chief of that service. Eastern Radiologists branched outside of PCMH not only running a lot more CT scanners and high tech processes here, but they are now providing radiology services for all of our regional hospitals and then some of our affiliates. There has been a huge expansion under Mike's leadership to do those kinds of things.

Marion Blackburn: I even saw Mike when we were working on the Annual Report, we went and I can't remember where it was, Bertie County, we went to that hospital and there was Mike Weaver and it kind of gave me the feeling of you know, Beth Nelson has this expression when she talks about where the rubber meets the road, and when you see your Chairman of the service and he is in Windsor and his working area was in a little corner of the hall and you know, this is someone who is a very well respected and I guess professional position, and gee, you have a very small space in a hall with very little working room and I just had this feeling that this was the reality, you can talk about what people are doing and you can talk about how successful it has been, but then you see somebody actually doing it, and that's what it translates into.

Jim Ross: Well, you have got to see the new hospital at Bertie. It is really coming along and I have been out there a couple of times in the last few weeks. You still have to wear a hard hat and all but man it is really taking physical shape where you can tell that this is going to be Radiology, this is going to be the Emergency Room and this is going to be the front entrance and stuff and it is really impressive, it's really, really impressive. It is all that medical leadership component that is just absolutely carrying us to the next level in taking care of patients. We are really doing what we were put here to do.

Marion Blackburn: If I may, I want to just return to something that I think is very interesting and I had no idea. I knew that you had already done quite a lot before you even got here which I guess was in about 1990 when you came here. Before that, of course, you were in Houston and before that Dallas, and it sounds like from what you were saying that you were twenty-eight years old and running a hospital. I just want to sort of ask you a little bit about maybe your personal experience and how you were managing a hospital at twenty-eight and how you had gotten there and so rapidly.

Jim Ross: Well, when I was in graduate school I went to do my residency at Methodist Hospital in Dallas. My preceptor was a fellow by the name of Bill Parassi and Bill was one of these very charismatic leaders and a ball of fire and he had just a great attitude. He could inspire you to do things you never dreamed you had the capacity to do. Bill had moved me around to two or three different roles within the Methodist system. This is kind of a funny story, he called me up and told me that we were going to buy this hospital out in the Southeastern part of Dallas and he told me to go with him and so we went down and actually bought this thing. It was a hospital that had gone bankrupt in the southeastern part of Dallas and it was a 170-bed frame I think and they sure weren't running anything close to that. We bought it and it is usually competitive and so we bought this thing and Methodist was becoming a system of hospitals at the time and I thought that was pretty cool. He asked me to go out there and run it and it was one of the most fun things, the most challenging things I have ever done. I don't think I have ever worked as hard but felt as good about it. The problems were just coming ninety miles an hour from a bankrupt hospital. The employees were absolutely terrified about what was going to happen with them regardless if you ended up as the owner of the hospital and they were terrified and the medical staff was all torn asunder and I mean it was in some ways it was just the worst of times you can possibly imagine.

The Board of that small hospital was absolutely steadfast and that Board held that thing together. The Chairman of the Board, I mean it essentially cost him his job. He was having to sign checks personally; delivery trucks wouldn't leave without notarized stuff. We were bankrupt and they weren't going to get paid so you couldn't get a loaf of bread without cash. It was just the worst of times. We organized that place drawing on the strengths of the system from Methodist. It wasn't me personally, it was that Methodist system that did all that stuff. Some of my closest friends of my life to this very day are from those times. Not just Board members, but I mean employees. We exchange letters throughout the year and Christmas cards every year and some of my closest friends are from that time and we really bonded together pulling that thing around and getting it to the quality level we wanted it to be and really the contribution in the community we wanted it to be.

Probably the hardest decision I have ever had in my life was to leave there. It was an incredible experience. I slow down every time I think about it and I mean it was just one of those hugely hard pieces of work in life that there was nothing more rewarding or meaningful in life than doing that. It clearly wasn't about the money but it was about the mission or the point of it all that really possessed you. In a smaller hospital you knew all the employees and they knew you. You knew about their families and it was a close knit group and there wasn't but just so many of us. We knew about hard times and we knew
about good times and we knew when to celebrate a victory and sometimes small things were big victories. There were some incredible turn-around moments for us but you got some great new medical staff folks but drawing on that Methodist system we recruited guys who were residents in those programs from Methodist and they came out to practice, a lot of subspecialists came out to practice, and so you built up this cadre of really incredibly powerfully good doctors that won confidences in that community where the people would come back there. When we first went out there even the fire department wouldn't stop; they would drive twenty miles uptown to another hospital. In some ways it is kind of like what Steve Lawler has done with Bertie Memorial. I see so many parallels in that where the employees and physicians and the community just felt beat down, almost like they were victims and how you can just through hard work and perseverance and showing up every day begin to turn that. It is slow hard work, it is not one meeting or one event it's just showing up and working it through and boy, Steve has done a tremendous job at Bertie with that very thing. You talk to the folks in the town up there and they have been through a number of owners in that hospital and part of our mission was to help them get access to medical care and that didn't necessarily mean full-blown fifty-bed hospital. Steve has done a dynamite job of turning that. It feels really good to see it when it is really working well. We are not done yet, knock on wood, but it is kind of cool to see it when the plan kind of works like you want it. I say that and something will blow up but the good part is you have got the team on the field and it is the right group and you will sort it out. They will come up with an answer of a way to deal with it.

Boy, people around here sure did when Floyd came. Those were some of the worst of the times and they never let it get them down. They just stayed right with it and that is a hallmark of how Dave has put an organization together. It is about personal leadership even in the worst of times, even when the message is hard and not one you want to deliver, when it's not good news, it's the truth and Dave has really led us to how you do that. He has set that expectation bar and boy that is huge. It sounds so trite maybe but it is not.

Marion Blackburn: I just had the opportunity to learn about his story and his personal commitment and it has made a dramatic difference and, of course, all the leadership has as you put it. There has just been a lot of really good leadership. Let me go back, you mentioned your residency, where did you get your undergraduate and graduate degrees?

Jim Ross: I got my undergraduate degree from Memphis State University. Yes, I know it's Memphis University now or something like that or University of Memphis, my diploma just says Memphis State and they didn't ask me about it and they just asked me to send my check to the alumni association so it is still Memphis State. I got my graduate degree at Washington University School of Medicine in St. Louis.

Marion Blackburn: I almost went to graduate school there. Writing programs are just tremendously difficult to get accepted into and that was one of the ones that I at one point had wanted to go to. These programs only accept maybe three people, the better writing programs, and this was many years ago but I may reconsider it one day because they just do so many things so well.

Jim Ross: I didn't know that, I saw a lot of the School of Medicine side and the hospital leadership side and a good part of the business school and I took a couple of electives over at the Law School even, but the rest of the university I didn't very much of but it was a great educational experience, it was superb. I went from there to Dallas to do my residency. At that time the Residency was required to get your Masters Degree conferred and now I think they have got it differently where it is either optional or after the degree is conferred but at that time it was part of the degree so you had to in essence pass your Residency.

Marion Blackburn: I guess this would be for Health Care Administration?

Jim Ross: Yes, Health Administration.

Marion Blackburn: Almost I guess like they require of the doctors or whatever.

Jim Ross: Yes, it was modeled a lot after that, of course, not as most residencies for physicians are much longer than one year. It was modeled pretty much after that.

Marion Blackburn: Well, I could very easily ask you questions all afternoon and continue to ask you about, I mean it is fascinating to me, your grasp of so many elements of what goes on here. I guess my final line of questions would be we have talked about the future and that was good, I guess I have to be curious about possible challenges and I have to say pitfalls that lie ahead because I am sure there is plenty of them. Do you have any of those you would like to mention, and maybe you have a plan to address them?

Jim Ross: Well, of course, the good part about working with Dave is you always have lots of eyes and energy on that future. I am sure he has shared with you what he sees coming down the pike, things to look for. I am trying to think how to give you quick answers to something that I could go on all day about. How do you summarize some of that? In a lot of ways, Marion, we can't rest on our laurels but the many, many successes we have got we have a legacy to continue to grow this place, not just be complacent in it. When I say grow, I don't mean just bigger, a lot of the growth I have talked about in medical programs, then what is the next step-emergency medicine or in heart surgery or in cancer or in children or in rehabilitation or the next service, but how do we stay on the front edge of that wave and not let ourselves get complacent on past achievements in a way.

How we take better care of the people in eastern North Carolina who are looking to us for health care services. One of the big questions right now is how do you balance all of these economics at times when those insurers and payers do not want to pay you more but technology and labor and demands more. So, how do you balance that and no let it get too far one way or the other. How do we manage public expectations while improving healthy lifestyles and healthy choices - big deal? How do you convince kids to choose health careers? Eastern North Carolina is the solution to eastern North Carolina. Whatever problems we have got we are also the best answers. You have guys like me you can import from Texas but by large it is eastern North Carolina answers to eastern North Carolina problems and so how do you encourage kids to pick health careers. How do you compete for those kids to want to do that when everything you look at is either in great sports and big bucks or the dot.coms of the world and you will be facing that soon enough. How do you advise kids about what to do with that stuff and how do you deal with that? That is a big issue for us in eastern North Carolina.

I look at some of our rural communities who face even more different kinds of issues and they are much more articulate in speaking about these issues but how do you convince kids that it is a cool thing to live in those communities. There is a lot of out migration or whatever the right technical word is, people are just leaving there but you also have got people moving back. How do you do that?

I think some of the challenges for us too is continuing to build these relationships that we were talking about; the school of medicine relationships-a lot of our physician group relationships-a lot of the public health relationships. How do we partner, not only control, but how do we partner up to get this job done; how do we create this win-win relationship that Dave and Jack and others were so instrumental in setting this course. How do you not let that get away at a time when all the economic forces, all the insurance forces, all the governmental forces are trying to set you up in a competitive beat your brains out sort of attitude. How do you maintain these relationships, how do you not drop down to that low road, are huge problems for us.

I get to feel a lot of those, Marion, is kind an umbrella over so many of the other more specific kinds of issues but how do you do that and not lose your roots, not lose your mission, not take your past successes for granted. How do you build on that, it is really a big challenge? I think the answer to that is it's about the patient, don't ever forget what we are here to do and if you keep your eye on that ball and if you create the right team, board, medical, administrative, employee, community, if you have got the right team then that team will help keep it balanced.

It doesn't mean it won't change; it doesn't mean it won't have its left and right rocking moments but it will keep it on the center key and that key of how you balance the right folks and the right leadership style and how you keep building that consensus, that's the answer to most of those problems. It sounds awfully generic but I am trying not to be too doggoned detailed about it but if I jump back to the really big picture that would be a lot of the challenges and that would be probably the thing to watch the most to make sure you are doing it. That way it is not about whether it is I or Deborah Davis or this person or that person, it's about the collective unit. You get the benefit of all the different brains as opposed to the one.

We talk about Dave or we talk about Jack or we talk about Dr. Laupus or Dr. Hallock or Ed Monroe, you know the folks who have lived the history who are huge leaders here and while they carried the lightening rod and the thunderstorm in a lot of this process, there were teams of folks around them that they surrounded themselves with that are also a part of this history here. The Buck Sittersons or the Rick Gilstraps or the Diane Pooles, you have met and interviewed a lot of these folks and you know what I am talking about. It was those teams that surrounded the Jacks, the Daves, the Chairs that surrounded Bill Laupus in the beginning and now surrounding Jim Hallock, it's about that team on the field that keeps this place centered.

Moving forward and I don't mean it won't have its moments where we jump around and have our disagreements, but that to me is how you take on whether the role changes or not, that is how you do it.