Heritage Snapshot: Part 109

After Dr. David B. Hinshaw Sr. became president of Loma Linda University Medical Center in 1987, he addressed financial concerns he had foreseen earlier. Entitlement programs of the 1960s had changed the nature of the practice of medicine and the operation of hospitals. In effect the government created an environment which enhanced health benefits with incentives that encouraged institutional growth. Private insurance companies followed suit. For 20 years, the environment encouraged hospitals to enlarge, add programs, and hire more people. This development resulted in the cost of health care increasing more rapidly than inflation in general. But, there was a price to pay for it all. The rapid increase in costs impacted federal, state, and corporate budgets for health care benefits. Politicians, theorists, and futurists looked at what was happening and predicted big trouble. As storm clouds approached, health maintenance organizations emerged. Based on the fact that 60 to 65 percent of the cost of operating the Medical Center is wages, Hinshaw slowly started to reduce the Medical Center’s overhead by decreasing its work force. Most of the time it was a gradual process. At that time revenues hadn’t yet fallen substantially. Because managed care issues had not yet captured enough of the market, there was a little time to adjust. Hinshaw praises a very capable administrative staff for its support during this difficult time during which they reduced the Medical Center staff by 1,000 full-time equivalents (approximately $40 million annually). What made this response more challenging was the fact that, at the same time, as hospital financial gains dropped, managed care shortened hospital stays substantially and a larger percentage of hospital beds became critical or intensive care beds, a situation which required more nursing help. During this medical care revolution, at a time when more than half of California hospitals lost money, Hinshaw was able to help the Medical Center avoid financial disaster. Although the Children’s Hospital functioned essentially as a stand-alone facility, it was connected to and shared many of the services of the Medical Center—which reduced its cost of operations. Because children are a medium of great appeal, it has been very well received in the community and has benefited the Medical Center and School of Medicine. Because there is no competing children’s hospital in the region, it serves 1.3 million children in its four-county service area. The children’s hospital has helped tie the institution into the community intimately. Caring for abused and critically ill youngsters creates a relationship with the community at large that has a positive impact that otherwise would have been impossible. Mental health in a Christian setting also became one of Dr. Hinshaw’s serious concerns. He joined others in the Department of Psychiatry in developing a much-needed psychiatric hospital with an overtly Christian teaching track. He felt that such an emphasis was important for the institution, its sponsoring denomination, and Christianity in general. Even though the Medical Center addressed this need during a time when financial support for psychiatric facilities had just about collapsed, it was able to purchase an almost new, 89-bed proprietary psychiatric hospital in nearby Redlands for a very reasonable price. The School then recruited more psychiatry staff and developed a teaching emphasis that promoted Christian values as formal options, despite the fact that this unique approach flies in the face of traditional psychiatry. The Loma Linda University Behavioral Medicine Center serves men, women, and children—a more comprehensive cross-section of the regional community. Dr. Hinshaw promoted the endeavor because he believes that Christian ways of thinking complement good mental health. One of Dr. Hinshaw’s interesting observations over the years was the change he witnessed in the scientific community when what was once viewed as a religious prejudice regarding smoking became demonstrable clinical evidence: “I can remember people I used to know in outside surgery circles who smoked heavily in the 1950s. Most of those people are dead,” he said. “They died long ago. It’s interesting because most of them died from complications of vascular disease or they developed carcinoma of the lung. It was interesting to hear the remarks and see the eye rolling, because there was a time when you went to a medical meeting that you could cut the air with a knife, the smoke was so heavy. You could hardly survive in the room. But I lived to see that change with signs saying, “No Smoking.” I was there during the transition. You would see the same people who were once heavy smokers at these meetings when they became militant wanting to get rid of everybody who smoked. In a period of three or four years it sort of caught on. People who did smoke thought I was being a little puritanical. But to watch the same people change was very interesting.” In a metaphor, Dr. Hinshaw compares his leadership experiences to climbing a hill. On the way up, the horizon changes. A different perspective emerges because what was on the other side of the hill is unknown. Opening before him was a wide diversity of opportunities in directions that no one could have imagined. And regarding Loma Linda University, he believes that it is an institution of destiny. “There’s no place like it.” Regarding the future, Dr. Hinshaw believes that regardless of how the financing of medical care is structured, young physicians must realize that what they are doing is a calling…. “How physicians relate to patients can influence the patient’s life in a variety of ways, and they must remember that. It isn’t how much they get paid for their services or exactly how much control they necessarily have over the health care system, but rather the personal, hands-on contact and concern for the whole person, including the spiritual component. They are in a calling. The profession of medicine is an ancient and honorable profession. It’s based on the idea of service and commitment to that calling.” During the 2014 graduation ceremony for Loma Linda University School of Medicine, celebrating the 100th anniversary of its first graduation, David B. Hinshaw Sr., MD, will receive the institution’s Lifetime Achievement Award.