A Heart to Serve

by Bill Frist

  Dad made a practice of entering the hospitals through the kitchen, greeting each worker as he passed as if he or she was the person most instrumental to the operation of the hospital. He always ate lunch in the hospital cafeterias alongside the employees, avoiding boardrooms and executive dining rooms. Such was Dad’s commonsense, simple approach to life and work, the same one he’d followed since growing up as a kid brother without a father, listening respectfully to everyone else at the dinner table sharing their life stories. It was pretty basic. And pretty powerful.

  HCA grew rapidly, revolutionizing the way hospitals operated—nonprofit and for-profit facilities alike. It was listed on the New York Stock Exchange in 1970 and became the first NYSE business to achieve $1 billion in revenues in its first decade of operation.

  For more than twenty years, with Tommy guiding the company, HCA experienced phenomenal growth and became the largest and most respected hospital management company in the world, with over three hundred hospitals in ten countries. Tommy instinctively knew how to engage change; he believed that successful companies needed to transform—actually radically reinvent—themselves every decade or so. When the hospital company grew too large and unwieldy in the late 1980s, Tommy and the company’s management took it private, paying all the public shareholders for their shares, so they could retool and prepare the company for the challenges and opportunities that they would face over the next twenty years. They went back to basics. They sold assets of the company that were not in their core expertise of acute, domestic hospital care, refocused the company on their original long-standing mission, and then after a few years went back to the marketplace to take the company public again. Dad, throughout these years, remained the icon of company values. The consistency of his integrity, compassion, and caring permeated the company. He stood for quality and caring.

  The motto of HCA, which is repeated on a plaque in the lobby of every HCA hospital in the country, is captured in the founding words of Dr. Thomas Frist Sr.: “It’s not bricks and mortar and equipment that make a hospital. It is the warmth and compassion and attitude of good employees that leads to quality care.” He knew that the bottom line would take care of itself.

  In 1994, it seemed the time came to pass the baton to the next generation of leaders. Tommy and the board thought they had found the perfect new leadership, and Tommy stepped back from day-to-day operations with the expectation that the same principles and values would be continued. The company changed names and became Columbia Hospitals system. Profits, not patients, became the guiding mantra.

  Unfortunately, in changing generations, the company lost its founding values and vision. The new leadership didn’t have the same heart as Dad and Tommy, and before long, it began to show. The company stumbled; legal problems ensued. The company that Jack Massey, Dr. Frist Sr., and Dr. Frist Jr. had started, cultivated, and carefully nurtured over almost three decades had lost sight of the principles and values that had made it great.

  By 1997, my brother Tommy could no longer stomach the downward direction the company was taking. He had written the CEO of his seven concerns about the direction of the company and never received a response. Through a series of events that could fill a separate book, Tommy was asked by the board of directors to resume active leadership. Acting with board support, he engineered a broad coup and brought back his old, trusted management team. HCA was taken back to its former self, and over the next decade it continued to grow and prosper. Dad died in 1998, having seen the values of HCA flourish once again under the stewardship of his son.

  I never worked for HCA or in an HCA hospital, nor did I ever serve on the company’s board. However, I’m humbled and honored to have been an active observer of the company’s proud history. I’ve learned a lot over the years by watching what Tommy and Dad were able to build at HCA. They combined private enterprise with public service and, most important, true concern for patients and their well-being, creating in the process one of the finest organizations in American health care. They knew how to serve. They invented a new industry, built on service and on values of heart. It all started with a young man’s dream, a pursuit of his passions, a father-and-son relationship, a commitment to hard work and basic values, and a refusal to ever accept defeat.

  3

  A Family Like No Other

  If Dad was the heart of our family, Mom was its soul. Dorothy Cate Frist was a strongly opinionated, brilliant woman who in a different time would have made a tremendous political candidate. Well-read and articulate, she loved debating controversial ideas. My sister Mary, six years older than me, went to Vanderbilt, so her college friends often stopped by our house, sometimes to see Mary, but just as often to converse with my always welcoming mother. The friends felt free to drop in at our home on Bowling day or night, and Mom loved sitting around our large yellow linoleum-topped kitchen table bandying about ideas with them. In the process, she taught me early on to see both sides of an issue before making a decision.

  Mom was politically liberal, to the left of everyone else in the family. In the earliest days of the civil rights movement, it was Mom who was the outspoken advocate for racial integration. Later, in the sixties, she just as adamantly opposed the Vietnam War, outraging many of the prominent conservative businessmen and women in Nashville with her strong, vocal arguments against our country’s involvement in the war.

  With Dad maintaining office hours all day long, even on Saturdays, and making house calls and late rounds at the hospital seven days a week, he had little time for keeping up with current events. Mother read both newspapers from cover to cover daily, the more liberal morning Tennessean and the more conservative afternoon Nashville Banner. She devoured Time and Newsweek and then each evening passed along the information and ideas to Dad regarding the stories she deemed important. Dad laughed heartily whenever he felt Mom’s not-so-subtle attempts to influence his thinking. Though he always listened to her and respected her views highly, Dad remained staunchly conservative throughout his life. Perhaps not surprisingly, Mom and Dad rarely discussed politics unless in the presence of others.

  Mom’s social activism was more than mere rhetoric. She modeled a genuine compassion, caring especially deeply for the needy people of our community. Her numerous gestures of generosity to people who did not have the wherewithal to repay her were legendary in Nashville. Almost always in obscurity, with as little fanfare as possible, Mom moved to meet needs wherever she found them. I never knew her once to go to a charity gala, but I’ve heard hundreds of stories about her helping individuals who were down and out and had no one speaking on their behalf. If she saw someone on the street begging for money, Mom never passed by without making a contribution. Around the time of the annual Girl Scouts’ cookie sales, a steady stream of green-uniformed Scouts would visit the Bowling home for a week or more.

  My wife, Karyn, inadvertently discovered one of my mother’s exceptional acts of charity when she went to H. H. Gregg, an appliance store then on Thompson Lane, to purchase a television during a stretch of unusually hot summer weather our first year back in Nashville. While she presented her credit card to pay for the television, the clerk recognized the name and said, “Oh, Mrs. Frist. We’re so glad to see you. And by the way, we just wanted you to know that we delivered those eighty air conditioners to the orphanage yesterday.”

  Karyn looked back at the salesman quizzically. “Eighty air conditioners?”

  “Aren’t you the Mrs. Frist who ordered…?” The salesman’s face dropped as he realized his mistake. Had it not been for the salesman’s gaffe, we would never have known about Mom’s anonymous, simple, yet generous act of charity, especially since Mom had specifically instructed the salesman, “Deliver the air conditioners, but don’t tell anybody that I’m doing this—and especially not my husband!” Dad, the spendthrift, believed in helping people, too, but Mom had raised giving to an art form. Mom didn’t make a fuss about her benevolence. Quietly and out of sight, she just did it.

  We
almost never went out to dinner, and I can’t remember going to a really fine restaurant as my siblings and I were growing up. For the most part we ate every meal at home. Occasionally on a Sunday afternoon, we’d go to lunch as a family; Mother and Dad’s favorite was Morrison’s Cafeteria in the local strip shopping center. If we were not at Morrison’s, we might be at the B&W, another family-style cafeteria in the neighborhood, or over at Allen’s Hotel, a modest family-run hotel off West End Avenue where the treat for the family was peppermint ice cream with hot fudge sauce. It was simple dining, certainly not fancy, and it was inexpensive for feeding five kids. My parents did not drink alcohol (though Dad would prescribe a glass of red wine to all patients who had heart disease); Dad even avoided coffee, though Mother would usually have a cup after she got him off to work every morning.

  Nor did they actively participate in the Nashville social networking scene, though they were always invited because of the positions of respect that both had earned in their own ways, Dad in taking care of so many within the Middle Tennessee community and Mother in personally helping the underserved in so many charitable ways.

  Mom’s number-one priority was her five children. Nothing was more important to her, and I think that is why, in part, that she did not take formal leadership roles in social events. She had taught school after she and Dad were married, but when Tommy was born, Dad insisted she not work so she could focus on raising their child. Tommy, the eldest of my four siblings, was born in 1938, fourteen years before me; Dottie was eleven years older than me, Bobby ten, and Mary six.

  As I was growing up, the broad age span of my siblings meant that my impressionable early years around the house were spent primarily with Mary, and to a lesser extent Bobby and Dottie. Being the “baby” of the family afforded me the opportunity to sit back and listen and learn through the experiences of others.

  Our home in Nashville was the place where all the kids in the neighborhood would come to play. Part of the reason was that Mom’s kitchen was always filled with tantalizing smells of delicious homemade food. Another inviting factor was that we had a big yard and an assortment of animals and pets—not merely dogs and cats, but, over the years, rabbits, white turkeys, a billy goat, occasional chickens, and even horses. As a young child, and until I was about ten (when the city limits were moved to include our house and there was an ordinance: “No horses in the city”), we had three horses on the two acres behind our house. The white barn and hayloft was the site of many Halloween parties, seemingly a world away from the realities of the main house.

  Sunday afternoons the front side yard would be the site of an all-family touch football game. The teams would grow as people driving by stopped in, soon to be recruited to the team most desperate for able players. Both Bobby and Tommy had quarterbacked their high school football teams, so they were relegated to being receivers, just to keep the game more fair. Dad and my siblings always made a position for the youngest, making sure I wasn’t left out of the fun.

  Today, Dad would be considered a workaholic. He would be home for dinner every night, but afterward, without exception, he went back to the hospital to make rounds, or he’d make house calls. But we never felt neglected, realizing that he was helping other people every second he was not with us. And I think the Ping-Pong game squeezed in after dinner and before Dad’s rounds almost every night made his separation a little less noticeable. And the fact that it was hard to walk around town without someone pulling you aside to confide how thankful he or she was that Dad had taken care of him or her through the night left little room for us to complain about his absences.

  Mom wasn’t actively involved in Dad’s medical practice, at least not in a traditional sense. But it was Dorothy Frist whom patients would call at home, knowing that “Dr. Tommy” would be busy, to solicit medical advice on how to treat their upset stomach, heartburn, headache, or aggravated arthritis. Mom was so loved and trusted, and had such a good relationship with the pharmacist Dr. Moon over at Moon’s Drug Store, that she’d quite frequently call in prescriptions for patients, and the pharmacist would fill them! “I’ll let Tommy know tonight,” she’d reassure Dr. Moon. She was the ultimate doctor’s wife—patient, tolerant, empathetic, and frequently physician in absentia!

  Mom allowed me enormous freedom as a boy growing up in Nashville. For instance, before I was eight years old, to the astonishment of other parents, Mom permitted me to take the city bus downtown to go to the YMCA every day with my neighborhood buddies, John Gibson and Tommy Nesbitt, without parents or other adult supervision. Of course, Nashville was a much smaller city then, but Mom just didn’t want me to be afraid to do anything. She figured that’s the best way to learn your way in the world. And, of course, I was the last child of five, so she’d seen it all anyway.

  Like most mothers, Mom’s goal was my success; she wanted her children to learn the value of contributing and being successful and winning. She went out of her way to see that each of her children developed a positive self-image and approached life with confidence. When Woodmont Grammar School, my elementary school, held its annual paper drive to raise funds, Mom not only encouraged us to participate but spurred us on to help our class win the contest. It was my mother who drove her blue and white station wagon, afternoon after afternoon, from house to house, so we could run in and pick up discarded newspapers. If we were selling raffle tickets for the annual school carnival, she helped make lists of people we could go see, and yes, if we hadn’t sold the last two dollars of our raffle book, she would buy them herself.

  But self-initiative can occasionally get you in a bind. One day in the fourth grade, when the teachers were recruiting students for the school talent show, I inadvertently (and probably wishfully) gave the impression to my teacher that I could play the banjo.

  “Wonderful, Billy,” the teacher said. “We’ll put you on the program.”

  The only problem was that I didn’t even own a banjo, much less know how to play one. But I was too embarrassed to confess in front of the class. That afternoon, I ashamedly explained my predicament to Mother. Without missing a beat, she saw another lesson to be learned. “It looks like you are going to have to learn to play the banjo!”

  For the next three weeks, Mother sat me down every day and taught me how to play a single song on the newly purchased banjo. I got through one rendition of “Home on the Range” in the school talent show, having learned my lesson about not overstating one’s abilities in the exuberance of the moment—or else. Having a mother who would step up and support her son, even when he made a mistake, was a blessing.

  Was I spoiled? Oh, probably (my siblings would say most definitely). But Mom had a different method of building my self-esteem. While she knew the value of learning from mistakes and recognized how important it was for me to know how to lose as well as win, and how to overcome failure and other pressures, she built my self-confidence by helping me to succeed more often than not.

  Dad’s genuine love for people, his deep interest in getting to know them as individuals, and his natural ability to listen intently to what folks said left an indelible impression on my heart and mind. Within minutes of meeting someone, he made them feel significant; he affirmed their dignity. And it was real. Dad was an experienced and, probably more important, an instinctive diagnostician, but he never confined his fascination with folks to his medical practice or his business dealings. At dinners, at social events, at church, when we ran down to the store, when we took a trip, he was always taking time to talk to someone, usually someone others might not notice, much less recognize—the boy working at the gas station, waitresses and road construction workers, the receptionist behind the desk, and even vaguely familiar faces.

  The Frist family members were spiritual people and attended church regularly. As a boy, Dad had a string of Sunday school pins for perfect attendance. As a family we attended Westminster Presbyterian Church on West End Avenue. Dad was a deacon and then elder in the church. He never preached at anyone, nor did
he wear his religion on his sleeve; he simply lived out his faith on a daily basis. When my siblings and I were younger and Dad had come in early from his nightly rounds, he’d come into our rooms and have us get out of bed for evening prayers. When we balked at kneeling beside our beds or questioned why we couldn’t pray from our pillows, Dad replied, “The Lord doesn’t answer a lazy man’s prayers.” So we dutifully pulled out of bed and got down on our knees to pray along with Dad.

  Mom’s faith ran deep as well. Whereas Dad’s was based on action and service to others and thanksgiving, Mother’s was rooted in a strict Methodist upbringing, with deeply religious parents who made her memorize Bible verses and taught her that frivolous activities such as dancing were sinful. (When I was a very young boy, my out-of-town cousins were discouraged by my grandmother from spending the night with us because we played music and had a pool table.) Young Dorothy Cate had a mischievous side to her that left her a little suspicious of those who held such rigid beliefs. But all of the Sundays and Wednesdays she spent growing up in church left her with a complete repertoire of great old hymns that she loved singing with the family, especially in her later years.

  Throughout my childhood, the telephone was a constant reminder of Dad’s instinctive response to human need and his accessibility to his patients. Often as I was growing up, I’d awaken in the middle of the night to the telephone’s ring, followed by the sound of Dad’s car pulling out of the driveway in response to someone’s call for help. It was hard on the family at times, but we children never felt cheated. We knew Dad was busy helping other people to get well, often saving lives with his knowledge and skills. And he prevented us from feeling hostile toward his career by making life around our home so complete. He never missed one of our baseball, basketball, or football games. When Dad was at home, he gave us his undivided attention…until the telephone rang again.