When I began my medical internship at Massachusetts General Hospital, a porcelain figure on the desk of Walter Bauer, MD, department chair of medicine, caught my eye. He explained that the object — a young child squatting down as if to examine a speck on the ground – captured something critical for excellence in the practice of medicine: the unprejudiced curiosity of a child. I brought curiosity from Camden, New Jersey to Harvard College, to Harvard Medical School and then to internship at MGH. My first assignment was on the floor devoted to patients in iron lungs (treatment at the time for poliomyelitis victims whose muscles for breathing were paralyzed). Once the epidemic subsided, I moved to a general medical ward. These two posts made for an exciting opening of my career in the care of patients.

After a second year as resident physician in medicine, I spent two years at the National Institutes of Health in Bethesda, Maryland, focusing on thyroid disorders and genetic abnormalities. With my wife, Adrienne, we enjoyed museums and other opportunities of the Washington, DC area. After chief residency in medicine back at MGH, I joined its endocrine unit, headed by L. Hollingsworth (Holly) Smith, MD, a superb physician later to head medicine at the University of California in San Francisco. With Andrew Frantz, MD in the endocrine unit’s lab, we focused on disorders of the pituitary gland, especially dwarfism and gigantism, and developed the first radioimmunoassay of human growth hormone. Dr. Frantz later returned to Columbia, heading its endocrine unit, then as dean of admissions at its medical school.

As clinician and teacher at MGH, my future seemed clear. Surprisingly, I was invited to meet with trustee leadership of Boston’s Beth Israel Hospital (now, Beth Israel Deaconess Medical Center), another major teaching hospital affiliated with Harvard Medical School. They were seeking a new Chief Executive Officer. Out of courtesy I responded though with little intention of altering my career. I was struck with the thoughtfulness of these men committed to strengthening the hospital in ways that matched what my limited experience might have suggested. A vision of scholarship motivated them to build the best patient care in an academic environment of teaching, research and community service. They took a chance with this 35-year-old novice. My only experience in management had been as chief resident in medicine, hardly a reassuring background for the role. I took a chance, too, but felt that should I fail – and I would know in a year or two – I could return to MGH. Two good friends, Howard Frazier, MD and Daniel Federman, MD, pointed out that I would still be caring for patients, but in somewhat different a manner, through care of both an institution and its overall community.

Circumstances were favorable on my July 1966 arrival at BI as general director. As a Harvard Medical School faculty member, I knew some of the hospital’s physicians, particularly Howard Hiatt, MD, chair of medicine, and David Freiman, MD, chair of pathology. Arriving from the University of California was William Silen, MD as chair of surgery, and we bonded quickly. The experienced chief operating officer at BI, Jack Kasten, had voiced no interest in the CEO role; he stayed for several years, helping orient and educate me. I had a lot to learn. And there was the July 1966 advent of Medicare, enabling me to appear, it seemed, with a load of cash, helping the hospital to temper its losses from charity care and purchase equipment long needed. (Maybe everybody loves someone with a full carpet bag!)

A plethora of resources offered guidance -– a supportive board with broad business management experience, our medical and nursing staff, administrative managers and other employees, patients and their families, and colleagues at other hospitals. Consultants helped on occasion, constructively critical of my thinking on management and resulting decisions. Selected books and articles on organization management helped. Meetings with board leadership were bi-weekly. I alerted them soon after a major issue surfaced and over time matured, encouraging them to consider its evolution and my thinking. This was an approach better than announcing my decisions once made; board members learned both background and rational for the hospital’s major decisions – but each issue remained the purview of management. Their advice was increasingly perceptive as an issue matured. Meetings with the medical school deans were important. My perspective grew through membership on boards of the Duke University Hospital and the New York University School of Medicine. I gained insight from sessions of the Association of American Medical Colleges, ultimately serving the standard one-year tenure as chairman of its Council of Teaching Hospitals and later, that of the AAMC itself. And there was an informal group, Society of Medical Administrators. Most were physicians, all in leadership roles at major hospitals and medical schools. Knowledge and insights were shared at annual meetings and through occasional visits.

Following retirement, and reflecting on my two careers – clinical practice, teaching and research at one academic medical center, and then CEO at another, I thought about sharing my understanding of organizations and their management, developed over two careers. Pertinent not only to teaching hospitals, they are relevant for organizations of all sorts. Oddly, these insights are introduced through an observation from zoology.

Most mammals display group-specific behavior, typically for gathering food or self-defense. Through groups, they get something done that cannot be done better individually. For example, meerkats move out from their burrows assigning one member to monitor for predators while the others search above ground to gather food. Elephants confront a potential predator by close gathering, with the youngest in the center and large males on the periphery. Identical among widely separated groups of the same animal, such patterns of behavior seem to be species-specific and thus genetically programmed. Should humans be excluded from this common pattern of mammalian behavior, gathering in groups to achieve specific goals?

Think about it — Homo sapiens also forms organizations to reach specific goals, but their purposes do go beyond gathering food and self-defense to include goals that may be religious, scholarly, cultural, recreational, or others. While each organization’s specific goal may differ from that of another, the commonality is to get something done collectively that cannot be done as well, if at all, by the individual. That common, group-specific, human behavior includes organizations established to do business.

The education of physicians, whose practices focus on human health and disease, starts with basics – study of anatomy and physiology which, despite individual variation, are common to all humans. It then advances to pathology and medical practice. Similarly, should not education in, and exploration of, organizational management start with fundamentals, that is the generic anatomy and physiology of organizations? A basic understanding would enable any group to understand and move toward its goals, and then clarify how each part of the organization and its interrelations will work for effective and efficient performance.

The book opens by examining the generic anatomy and physiology of organizations, that is, their basic common nature. Next, roles and relationships among workers are defined. Examples are offered to show how this understanding can benefit managers, enabling them to achieve greater clarity of role and purpose, to address disfunction, and meet the accountability of each role, all in pursuit of the organization’s effectiveness.

I end with thoughts from management sage Peter Drucker: If someone (or a group) is not assigned to do specifically what is planned and given method and materials to do so plus standards of performance and time of completion, organizational effectiveness necessarily suffers. If there is a plan but it is not implemented, nothing is achieved beyond creation of an idea and its goals remain unfulfilled.

December 2021