Hepner: training top-flight health administrators

While he may be leaving as director, he won't be leaving the program. Hepner said he now looks forward to the rewards of full-time teaching.

"I wouldn't want to leave," he said. "This school has been so good to me for the last 31 years."

The program he has headed had its genesis in 1946, when the medical school developed its first curriculum to teach future hospital managers. The early program, which involved one year of courses and an internship, was known as hospital administration.

"That's what we did -- prepared students to run hospitals," Hepner said.

Today's students graduate into a much broader arena. The program, now known as health administration, still prepares students to run hospitals. But it also teaches students to direct physicians' group practices, manage hospices, oversee home health care delivery systems and even work for pharmaceutical companies and health benefits programs in Fortune 500 companies.

The expansion is due to managed care, which Hepner calls the single biggest change in health care services during his 31-year tenure. When Hepner was a student in the program --he graduated in 1959 -- doctors were motivated to order tests, schedule office visits and allow lengthy hospital stays.

"The more they did, the more they earned," he said.

But today's health care delivery systems work within an entirely different infrastructure. The economic incentive, Hepner said, has shifted 180 degrees. Now insurance companies pay health care providers a set annual fee for each patient. The leaner providers -- those who limit expensive tests and long hospital stays -- make more money.

"We used to teach students that hospitals measured success by how many beds were filled. Not anymore. Now the goal is to move patients out of the hospital and into ambulatory care settings," he said.

James O. Hepner, Ph.D. (left), and Walter F. Ballinger, M.D., combine managers' and physicians' perspectives in their health care administration course at the School of Medicine.

The shift in focus means Hepner has taught during a fascinating, even revolutionary era in health care administration. Still, he worries about the change.

"It's all become very bottom line," he said. "I just hope we don't lose sight of why we're all here, which is to help sick people."

For Hepner, a dedication to helping people is paramount and critical to the program's success. Prospective students must believe in seeing "beyond the bottom line," he said. "Our students have values and the desire to serve others."

When choosing students, Hepner looks for clues that the applicant feels a sense of responsibility toward the community. Many of the program's students are natural leaders: Eagle Scouts, veterans, volunteers, captains of school teams. So it comes as no surprise that the program's alumni go on to become leaders in health care administration as well. In fact, almost 35 percent of the program's graduates are chief executive officers or presidents of health care facilities.

"It's a phenomenal network," said 1972 graduate Larry Mathis.

Mathis is former chief executive officer of the Methodist Health Care System in Houston. He recently retired, meeting a longtime goal of leaving the daily workplace by age 55. Among other plans, he will busy himself serving on the search committee for Hepner's successor. He hopes the next director shares Hepner's dedication to selecting premiere students.

"He emphasizes selecting leaders," Mathis said. "It's self-reinforcing. Prospective students see the program's high-profile alumni and they say, 'I want to go there.'"

Hepner is proud that so many of the program's alumni are at the top of the field. But more than that, he's proud knowing so many of the field's top leaders are committed to serving.

"Our students see the field as not all business and not all social work, rather a balance between the two -- a balance between doing well and doing good."

Hepner's interest in hospital administration has deep roots. In high school, he worked as an orderly for a Cedar Rapids, Iowa, hospital, earning 50 cents an hour. While he was there, an administrator encouraged him to consider hospital management as a career option. He revisited that idea while serving as an officer in the Marine Corps during the Korean War. He had enlisted after earning a bachelor's degree in history from the University of Iowa. During his three-year military stint, Hepner served as an infantry platoon leader in North Carolina where he met fellow Marine officers who were considering post-discharge careers in hospital administration. The idea stuck.

After he was discharged, Hepner researched various health administration programs but was sold on Washington University.

"I definitely liked it here best," he said. "The program is in the medical school, and that made a big difference then -- and still does today."

Hepner went on to earn a Ph.D. from the University of Iowa and returned to Washington University to lead the master's in health administration program in 1967. Over the years, his professional expertise has reached far beyond the University. Hepner is a research grant reviewer for the U.S. Department of Health and Human Services and a consultant to the Air Force Surgeon General. In fact, he is the only civilian to have been awarded the Medical Service Corps' gold medal for excellence and leadership.

In another "first," Hepner was the first full-time academic to serve as board chairman of the American College of Healthcare Executives, a post normally held by health care administrators. The group presented him with one of its most distinguished honors, the Silver Medal Award of Excellence in Health Services Administration.

And when Mosby Year-Book recently developed a bi-monthly journal on health care management, the health publisher asked Hepner and Ballinger to serve as co-editors-in-chief. The two now share the helm of "Best Practices and Benchmarking in Healthcare: A Practical Journal for Client and Management Applications."

Building alliances with physicians has been a major component of Hepner's career and a strength of the program he's built. Many of the 68 accredited university graduate programs in the country are not housed in a medical school. To capitalize on the School of Medicine's uniqueness, Hepner developed the Capstone Program, which gives fourth-semester students practical experience solving real-life problems. BJC Health System administrators give teams of students actual problems and issues to solve. This semester, one team is analyzing what effects a nurses' union would have on the quality and cost of care for patients. Another is investigating different ways hospices operate throughout the country and how cost and care vary.

Hepner and Ballinger developed another course called the Physicians Executive Management Course for doctors interested in honing their leadership skills. What started as a one-day crash course has developed into a 10-session primer on building effective management skills. The program is tailored exclusively for BJC physicians and is so popular that Hepner is considering adding an advanced course as well.

Now that Hepner will return to full-time teaching, he may lead such a class, leaving the administrative duties of building courses to his successor.

So what does retirement hold after 31 years as director?

In addition to teaching, perhaps a little playtime, said Hepner, most likely with his two bulldogs, Chesty Puller -- named after a famous Marine -- and Minnie. Hepner also will relax with his wife, Lynn, a 1982 graduate of the program and vice president and general manager of Spectrum Emergency Care.

"I can't say it enough -- this school has been so good to me," Hepner said. "I've been here 31 years, and I just never wanted to work anyplace else."