Interviewee: Richard Kimball

Interviewer: Mary Marshall Clark

Session 1, Part 3

March 9, 2004

New York, New York





Q: Could you talk for us for a minute or two about the potential of Chaplaincy to take a leadership role in education, maybe in a broader sense that just with the seminaries, because, after all, we’re in this unique age where the secular and the sacred are meeting head-on. So, do you see any role for it in the universities, medical schools, and so on?



Kimball: Well, you would like to see such a role. As I said earlier, one of the areas that we did a lot of funding in was nursing education. One would have hoped we would have made more progress in nursing education than we did, and we were not in the medical education business at all. But I’m realistic enough to know that when you’re talking about seminaries, and when you’re talking about medical schools, and when you’re talking about nursing schools, you’re talking about guilds.

Nobody is going to give up any turf. Nobody is going to give up control of the curriculum. There are relatively few places in this world where the docs at the medical school and the nurses in the nursing school talk to each other. There may be a few, but there aren’t many of them. I see it; it’s a cultural thing. It’s a societal thing. If you’re dealing with problems, unfortunate accidents in hospitals, you have—I wouldn’t exaggerate this, but you still have a cultural thing where even though the nurse knows what the doc is doing is wrong, she’s very reluctant to speak up. Now, part of that’s a male-female thing that will dissipate over time, not because there’ll be more male nurses, but because there’ll be more female physicians. But that’s a long, slow process.

Nursing education has its own particular problems. It has the same problems as the seminary, but worse than that. It’s a profession—it claims to be a profession, when in reality, it’s a trade, and very low expectations of its graduates.

I sat on a—American Association of Colleges of Nursing had think-tank session a few years ago where they invited non-nurses from various fields, including American Hospital Association and myself, and some people that were not nurses and were not—one of them was a physician, I think—to talk about the future of nursing. One of the points we made was that nursing education—I’m not talking about Columbia or Yale or those places, but generally nursing education in the country, you know, I said, “You’re not asking enough of your people. You’re wondering why—you say to Susie when she enrolls, ‘You know, Susie, you get through this program, and when you get out, you’ll have a job here in Columbus General Hospital.’ If Susie’s brother comes along and says, ‘I’m not going to be a nurse, but I want to be a lawyer,’ do you say to him, ‘Well, do your work and take these courses, and when you get out we can get you a job as a paralegal’?

“Or Phyllis, her younger sister, who wants to be an architect. Then you say to her, ‘Well, do all your work and draw beautifully, and learn how to use the CADD system, and when you get out you can be a draftsman’? Think about that. One of the reasons you’ve got the problems you’ve got is you’ve got very, very low expectations of the people you educate. And you’re reaping that. You don’t have enough faculty to go into the modern world because you haven’t trained them.”

Now, in that environment, you know, I don’t see a role, say, for nursing in this educational—oh, I think you could go up to Mary Mundiger [phonetic] at Columbia and hook in somewhere just fine, and do the same thing at Yale and a few other places. But I don’t see you doing it in the general thing, because I think it, frankly, would be beyond them.

The docs will guard the turf every time. I love them. I know a lot of them. We get along very well. But they’re still—it’s the rare person that sees a role, I think. Part of the problem, and Walter and I have talked a little bit about this; not as much; I’ve done it from the other side. There’s some question as to whether, as you know, whether what you hope is the synergism, or the two plus two equals five, the spiritual component of care, it’s very hard to document that, in fact, that’s the case. We all want it to be the case. We all, in some personal level, believe it is the case. But I think until there’s some really good science that says it is the case, it’s going to be a fairly hard sell to the docs.

The president of St. Luke’s Roosevelt, who’s a physician, sent me a note last week that they’d unearthed in the archives of St. Luke’s Roosevelt—this was a copy of a note he’d sent to the medical board. They’d come across a letter from Sir William Osler, who by then was in England, encouraging a fourth-year medical student—they don’t know who the student is; his name is Burley [phonetic]; that, presumably, is his last name, because it was written to Dear Burley—in which Osler says, “Keep a hard head and a soft heart.”

He’d sent this to his medical board, saying, “You know, that’s not the worst advice that you could give to a medical student.” But I don’t—you know, I’m not close enough to it to know whether outside of individual kinds of experiences in cases, whether there’s a two plus two equals five. There will be for some people. But whether there is from an educational standpoint, or chaplaincy services, I don’t know.



Q: Speaking as a person who’s in charge of quality issues in several different levels at St. Luke’s, and have thought about quality for many years, could you describe the quality of what the chaplain delivers at the bedside?



Kimball: I can’t speak to that. I haven’t experienced it. I used to say, “If I get real sick, I think I want Sister Elaine Goodell at my bedside, because I think I’ll get better doing that.” But knock on wood, I haven’t been sick, and have only been in a hospital once, very briefly, and that was in White Plains—I mean Mt. Kisco, not in New York. So I can’t really speak to that, because at the level I’m dealing with it, we’re dealing with systemic issues, and how you measure; how do you measure quality, rather than the actual delivery of care. How do you measure the quality of the delivery of care? What are the things you have to assemble, which are required by the regulators and which we require ourselves as a way of trying to measure?

But it’s very much on a systemic basis, even at St. Luke’s Roosevelt, where we have people, staff people. It’s basically a staff committee with a few trustees on it, including Hope. But to continuum level, it’s really talking about systemic issues. We only hear the horror tales, and we only listen to the horror tales from the standpoint of trying to figure out whether there’s some kind of systemic issue that needs addressing. We don’t really—in that context, I wouldn’t know what people on any given floor might experience as a result of the Chaplaincy.



Q: You have a very unique kind of inside-outside role for the Chaplaincy, as a midwife.



Kimball: Yes. I don’t have to take any responsibility for anything. I just talk.



Q: But you have a very unique intimacy there. You’ve alluded to the qualities of leadership of the Twinames and Father Smith. Could you elaborate a little more?



Kimball: Well, let’s start about leadership. We all know, don’t we, that leadership starts with the board. It doesn’t start with the CEO. When John and Carolyn headed this organization, it started with John and Carolyn. Then they had to have a board, and they got good people on the board, and so forth. But it basically started with them. It long since outgrew that one.

The board has the responsibility now, and the board—of course, the management has the responsibility of getting things framed in a way that the board can deal with, but the leadership to move an organization ahead has to come from the board.

I have recently—I’m on the board of two colleges. One, as I told you, is in Memphis. The other is in Billings, Montana, both of which are going through these kinds of issues now, one with a formal strategic plan and one leading up to a strategic plan. For both those boards, this is a task that I don’t think they’re really prepared for and really understand. They have the best will in the world. They just don’t quite know how to go about it.

So it’s got to be a reflection. You’ve got to start with what you—well, I say—this is one man’s opinion, and hard to deal with—I always say you can’t get there, wherever that there is, you can’t get there from here. You can only get here from there.

You have to start by saying, five, ten years down the road, what is this organization? What do you want it to be? What do you want it to do? What kind of allocation of its assets do you want? How big do you want it? Where’s it going? And then work back from there to where you are today, and say, what is it that we have to do today that’s going to lead to help us get where we want?

That’s a hard process, because it tends not to be—not everybody can think that far in advance. Part of it is that whenever you get into that kind of rigorous process, the tendency is for people to get off on tangents, because it’s more comfortable to talk about tangents than it is about that end goal.

Perhaps this might have a relationship. I was invited by a college here in the Northeast that we’d given money to, to attend a trustees’ meeting and talk about the future, try to get the board thinking about something other than incremental steps. That’s what happens when your planning process starts from where you are and projects. You’re going to get a trajectory that almost always is going to be too—the slope is going to be too low to get you where you want to go by the time you want to get there. That’s one of the great pluses of starting there and working back, because extrapolation is not the most imaginative way of planning.

But in this particular college, which had two things that I knew about—one, it had a president who was very able, and a tendency on the part of the board to assume that whatever it was, she’d do it. They were headed for a capital campaign. It was perfectly clear to her and it was perfectly clear to me that they didn’t have their heads around what it was going to take, what kind of money it was going to take. And fortunately, the former chairman, but still on the board, was a very old friend of mine, and very, very close friend of my brother’s. So I knew him for all his idiosyncrasies, of which were many, and very entertaining, but he was a guy you could really deal with.

So I was invited to the board meeting, and I said as follows. “It’s ten years from today, and there’s been a transformation in this institution. Phyllis, that president you had some years ago, retired, and she was succeeded by Henry. And Henry’s getting ready to retire now, but there’s that—in that course of time, the institution has been transformed.

“And the, say, Philadelphia Enquirer, which has a long history of bashing small colleges, the Philadelphia Enquirer has noticed this, and they’ve asked to come on campus and talk to people. So we’ve given them a list of the trustees, and they’re going to come around and talk to you as a trustee, because you were here during all that process. And you’re free to talk to them. What are you going to tell them?

“They’re going to say, ‘I’ve noticed this change and transformation. How come? What made it happen?’”

That’s sort of a gimmick, but it’s a way of doing some focusing, which those trustees, at the meeting at least, felt totally unable to answer. Though one of them, the retired board chair—not my friend, but the other—no, I guess it was the current board chair called me later and said, “You know, that’s the way we have to look at it, and none of us was looking at it that way.”

And I would say the same thing pertains here. You have to go out there and work back, and be able to articulate how you think, today, you’re going to get from here to there, by working back. But if the board can’t do that, then one can’t expect an enormous degree of clarity from anybody else. And it will answer the not-Walter question, too, because that’s what you’re going to hire against. I don’t know whether that answers what you wanted, but—



Q: Anything I haven’t asked that you want to ask?



Bjornson: I would love it if you—you said that the economics surrounding hospice are totally different from those on—



Kimball: Yes. Hospice—I’ve just gone on the board of the Jacob Perlow Hospice, a continuum hospice. So I don’t have a clear idea of the economics. But hospice, unlike hospitals, makes money. And they have different protocols and different regimes. I mean, I’m not saying all hospice makes money, but you can make money in hospice which you can’t make as a teaching hospital. I mean, I don’t think there’s a teaching hospital in this country that makes money. And if it does, then it would be something like a Mayo, which basically has its own staff and, you know, a lot of full payers from abroad, and things of that kind.

There’s probably a market for hospice. I’m almost sure there’s a market for hospice. That’s a cultural thing. We are now doing some things that make a market for hospice easier than it was.

I had a board chair at Teagle, of whom I’m very, very fond. I worked for him at Exxon as well as at Teagle. I once broached the question as to whether the foundation ought to get into the funding of hospice, because I saw some intersection between theological and nursing educations, if nothing else. He didn’t want to touch it with a ten-foot pole. And he’s a very devout chap, so I had to come to the conclusion that he just—anything to do with dying, as many people, most people aren’t very comfortable with.

I used to—it’s getting much better. But in my early days at St. Luke’s—well, no, when I’d been there a while, long enough not to make an awful pest of myself, I used to ask at board meetings, how many people sitting around the table, both trustees and staff, did not have advanced directives, did not have powers-of-attorney and living wills. And it was amazing the number of hands that went up, including, the first time I asked it, the chairman of the board and the president of the hospital.

I periodically ask that question at meetings, and now the number of hands that go up are much smaller, much smaller, much smaller. I think that’s a reflection of some societal things. The fact that people are living—well, it’s the same kind of thing that has made the long-term-care insurance business so profitable. People are having to face up to it, whether they wanted to or not, and that’s going to continue. So people are going to have some consciousness about what happens at the end of life.

For that reason, I think hospice is a much more acceptable notion. I’m just using it as a concept rather than an actual delivery of care. And I think that will increase as people live longer and more and more are faced with that end of life, fairly sure. That’s where the insurance companies make the money, is the perception that you’re buying this care for—you’re buying the right to care for a long period of time, when in reality, the numbers will tell you that the payoff from the insurance company is for very short periods of time. So it’s a big business for them.

I was once in a—many, many—a number of years ago, on the board of an insurance, from New York State, insurance company that went into that business very early, and it just was staggering, the amount of money they were making on it. Now, it was bought by General Electric and I left that board at the time. But I think that’s going to be—I think that landscape is changing. Whether HealthCare Chaplaincy ought to get in the hospice business, I’m not about to say. That’s a strategic decision that people need to look at. It’s one of the logical things it should get into.

I would—and whether it can get into things that are fallouts of the medical education business, I think is more questionable. I’m not sure how you do it, for the reasons that I have said. But hospice is clearly—the hospice market is clearly out there and growing, and the Chaplaincy has the requisite skills to get into that sort of thing, and then some. It’s basically what it’s doing now. I don’t know whether that answered the question.



Bjornson: One piece of it. Is there an element, either for or against, our multifaith mission and commitment that is antithetical or supported by the general approach of hospice?



Q: Just for the sake of the transcriber, the question was whether or not the multifaith, multifocal configuration of the Chaplaincy would work against the idea of the hospice, which I guess you’re assuming people who want to go to their institution of choice.



Bjornson: I would think that one turns to one’s particular religion, rather than thinking of the more basic religionless elements of—



Kimball: Well, I think that people who are in—I’d think certainly in New York City, and I would guess in any urban area, with the exception of certain obvious issues, the denominational history of the institution is not connected to the people served by the institution. I mean, we’ve had discussions about a kosher kitchen at Beth Israel, and the fact of the matter is, a tiny fraction of the patients at Beth Israel keep kosher; but there are an awful lot of Chinese from the Lower East Side. And I doubt that that’s different anywhere else, and I’m not sure why it should necessarily be different for hospice. There may be—yes, I really don’t know. I wouldn’t think it would be.

This is a polyglot community. It’s going to remain a polyglot community, and these things are going to exist, perhaps more as history, and then I think with—you know, obviously, they get into reproductive issues in a Catholic system. That’s a different issue, but that’s not what we’re talking about.



Q: I’m mindful of the crew’s time, so I’d like now, if you’re good with where we are, to stop this tape.



Kimball: You have to be good with where I am.



Bjornson: I’m good.



Q: Okay. We’ll stop this tape and then do another—