William Streck, November 16, 2014

Title

William Streck, November 16, 2014

Subject

Bassett Healthcare Network
CEO
Doctor

Description

Dr. William F. Streck served as President and CEO of the Bassett Healthcare Network from 1984-2014. Born in Parsons, Kansas, Streck grew up in Oklahoma City in a family that valued both faith and education. After graduating from the University of Missouri, where he met his wife Karen, Dr. Streck completed his internship and residency in internal medicine and a fellowship in endocrinology and metabolism at the University of Rochester. In 1978, Dr. Streck came to Bassett as the institution’s first board certified endocrinologist and by 1984 was serving as the President and CEO. Dr. Streck was instrumental in the creation of the Bassett Healthcare Network, an integrated healthcare delivery system, which employs more than 400 providers and serves eight counties across Central New York.
The Bassett Medical Center (formally known as the Mary Imogene Bassett Hospital) located in Cooperstown, NY was opened in 1922. Since the 1920s, Bassett has utilized an employed physician model with a commitment to both research and education. Bassett Medical Center is a teaching hospital with postgraduate medical programs offered through an affiliation with the Columbia University College of Physicians and Surgeons. During the course of Dr. Streck’s career, Bassett has grown from a single hospital to a large regional network of providers and continues to lead the field in rural healthcare.
I interviewed Dr. Streck at the Cooperstown Graduate Program building in Cooperstown, NY. In July of this year, Dr. Streck retired after a thirty-year tenure as CEO. In the interview, Dr. Streck discusses his medical training and his experiences at Bassett as both a practicing physician and President and CEO of the institution. He also provides insight on how the healthcare system has changed over time, as well as the political nature of the field.
I have attempted to capture the flow and emphasis of Dr. Streck’s narration. However, for readability I have made some editorial decisions such as eliminating many words such as “so,” “and,” “kind of,” and “but,” as well as shorting sentences. I recommend listening to the audio tracks for a more nuanced and accurate experience.

Creator

Victoria Lee

Publisher

Cooperstown Graduate Program, State University of New York-College at Oneonta

Date

2014-11-16

Rights

New York State Historical Association Library, Cooperstown, NY

Format

audio/mpeg
28.8mB
audio/mpeg
25.6mB
image/jpeg
2080 x 1996 pixels
image/jpeg
1717 x 2619 pixels

Language

en-US

Type

Sound
Image

Identifier

14-035

Coverage

Upstate New York
1940-2014
Cooperstown, NY

Interviewer

Victoria Lee

Interviewee

Dr. William Streck

Location

5838 State Route 80
Cooperstown, NY

Transcription

VL = Victoria Lee
WS = William Streck

[START OF TRACK 1, 0:00]

VL:
This is the November 16th, 2014 interview of Dr. William Streck by Victoria Lee for the Cooperstown Graduate Program’s Research and Fieldwork course recorded at the Cooperstown Graduate building in Cooperstown, NY. Can you tell me a little bit about where you grew up?
WS:
I was born in Parsons, Kansas, in a small community in Kansas where myself, my brother, and my two sisters lived until I was 8. Then we moved to Oklahoma City, Oklahoma, and that’s where I grew up was in Oklahoma City. So I consider myself an Oklahoman culturally, or at least I did. All my family really was based in the Midwest in Kansas and in Oklahoma.
VL:
What’s a cultural Oklahoman versus an upstate New Yorker culture?
WS:
Well, if we’re looking at it in the socio-cultural phenomena of today, I would say that Oklahoma culture has become progressively more conservative, and I think that’s less so in New York and the Northeast, part of the political-cultural divide we’re experiencing now in the United States. I’m fond of Oklahoma, but its politics I find very difficult.
VL:
What did your parents do?
WS:
My father, for many years, he was a salesman in building materials in that region of Oklahoma. It was a very difficult and, I’d say, ethically complicated area for individuals. He was a rock of integrity and stood out in that field. Highly regarded, highly respected, but very hardworking in a way a lot early on in our lives I recognize only in retrospect. He and my mother were very strong parents, set very high standards for all of us. We were a very Catholic family in a state that had very few Catholics, so there was a lot of emphasis on us getting a Catholic education, which we did at Catholic grade schools and Catholic high schools. That was a large part of our family dynamic. We were never bordering on affluent ever. We lived in a small home. I shared a room with my brother. My sisters shared a bedroom. But [we] never really viewed ourselves as deprived in any way. There was an emphasis on education, manners, and faith; I would say [those things] were a large part of growing up there. After I left high school I went away to college. I was the first in our family to go to college and of our extended family it was only that generation, my cousins and myself from my mother’s large family and my dad who was an orphan, who had two siblings but had not gone to school. So I was the first, but then all of my siblings have gone on to at least master’s degrees. I left to go to college in Kansas City, a Jesuit college in Kansas City, Missouri, so I was the first in the family. It was awkward when I was expelled at the end of my first semester for having beer in my room, which was a major catastrophe for us it seems, so I had to then return to Oklahoma. I was admitted to Oklahoma State University after some perturbations about whether I had been allowed to withdraw and other technical considerations. So, I finished my degree at Oklahoma State. I was very politically active at Oklahoma State University, became very close to being expelled. This was in the ‘60s, late ’67, ’68 during the Vietnam War. I got a lottery draft number that would have easily moved me into the queue for Vietnam, but had been accepted into medical school a month before, so I got a deferral to get into medical school. Went to medical school at the University of Missouri, and when I was at the University of Missouri met my wife Karen. So, we were there, the war was still going on and there was always this fear that one could be drafted out into the war, but I always managed to be about one year ahead of that. We had a child when I was in medical school that gave me another reason for deferral, so in the end I was able to complete medical school. The University of Missouri, at that time, was characterized by a number of very accomplished deans who had gone to the University of Rochester. They had always wanted, this small cabal of deans there, had always wanted someone from Missouri to go to Rochester, the University of Rochester, because it was a good program. When I traveled for my internship from Missouri, where Karen and I had lived for those four years, I started in Atlanta and worked my way up, went to Vermont and had never been to New York before, but came here. I remember distinctly in September driving down from Vermont through upstate New York and thinking, “My goodness, this is not one’s image of New York,” particularly if you grow up in Oklahoma. I think even after Karen and I had been here for years my parents thought that there was Manhattan, a large parking lot, Cooperstown, and Buffalo, Niagara Falls where they had honeymooned and that was the perception. As it turned out, the University of Rochester was a great place. I went there to do my internship and residency in internal medicine, had just a great experience there. I ended up spending five years there going through my residency. I was the chief resident, and then I did a fellowship there in endocrinology and metabolism. That became my subspecialty. There were two things that happened. One, my chief resident from Rochester came to Bassett to be a physician, so he was constantly telling me it was a great place. Then a young woman who was an extern, that is a medical student from Hopkins, was on the first service I was on at the University of Rochester as an intern, and we became good friends. She happened to be the daughter of A. McGehee Harvey, who was the very distinguished former Chief of Medicine at Johns Hopkins. A. McGehee Harvey and James Bordley, who was the third Director at Bassett, had been close friends at Hopkins for many years. Through a different series of events, Harvey became Chief at Hopkins and when he got that job, Bordley, who was a very distinguished man himself, didn’t get the job. Stephen C. Clark Sr. came from Cooperstown to recruit Bordley to be the Director at Bassett and brought him here in 1946, so he was the Director of Bassett from ’46 until ’67. Harvey, his friend, bought a home here so that his daughter Joan, as we follow this story, who was my extern, got married here [laughs]. We, Karen and I, came to Joan’s wedding. It was here at the north end of the lake, at the golf course there, and that was our first exposure to Cooperstown, and we loved Cooperstown. Then we could go back and assess. I had a chief resident who knew the program. Bassett had what I wanted, which was an opportunity to teach and take care of patients. And it had what Karen had always wanted, she was a St. Louis girl, and that was a small town, a nice small town in which to grow up. That brought us here in 1978, and because of that you and I are here in 2014.
VL:
Fabulous!
WS:
[Laughs] How’s that for a summary?
VL:
That is a fantastic summary! What was it like practicing, and you said teaching, in Cooperstown?
WS:
Well, Bassett is a unique place; it’s had a unique history. It’s always been a hospital after Mary Imogene Bassett died and the first iteration of Bassett after that that really took hold was an employed physician model, and so that’s been part of the model from the 1920s. The history of Bassett and the Clark family really relates to one of the five Clark brothers being very supportive of her and actually building the hospital when she asks for a lab, built a nice fieldstone hospital. But the nature of Bassett was really founded by George Miner Mackenzie, who became the Director after some political perturbations in 1927. He wrote a paper in the 1940s called “The Social Responsibility of the Modern Hospital,” and I always have felt that was a good blueprint for Bassett. It basically said that hospitals and physicians needed to be working together and they needed to be focusing on the social aspects and the medical aspects of healthcare and taking care of communities. He was very forward-looking in that regard. That was one of the appeals for me coming here. I had not read that article, but I saw in Bassett the best model of the employee physician, plenty of time to teach, time to take care of patients. When I came that was very true, there was more than enough time to teach because it was a very idyllic little place in the 1970s. There were not a lot of demands to build your schedule and become very busy quickly, but there was an expectation that you would teach, so I really threw myself into the teaching. At that time you took a month at a time on the in-patient service, so you would run with the house staff, the residents; you’d take care of patients for a month at a time. It was just a much more relaxed time. People could stay in the hospital until they felt better as opposed to today where you’re in and you’re out as soon as you can possibly get out. There was time to talk with the residents. There were rounds and time to do things. I was writing a textbook in endocrinology when I first came. It was a very sweet time; one lost now to the expediencies of healthcare and society and any number of demands.
VL:
What was it like raising a family in Cooperstown?
WS:
It was very nice. I’d have to turn to Karen to ask her more of the details because I worked, and I worked probably, in retrospect, I put in more hours than I should have. I should have just gone home, but there was a need on my part to be successful so that I could take care of the family. But we had a wonderful time with our children growing up here. The freedom they had; that you could let an eight year old walk downtown with friends. We made a decision to always live within the village, which we did. We had three homes that were probably separated by one mile over our thirty years here. The children did well in school; they had great teachers and blessed with great friends. Then, I got the job I could only have imagined when I was very young, so it worked very well for all of us. So I had the job I liked, Karen was very active in the community, and our kids have a very good feeling about having grown up here.
[TRACK 1, 13:55]
VL:
What are some of the difficulties or benefits of practicing medicine in a more rural area?
WS:
Well, it’s somewhat different to be in what America would say a rural area and to be in a rural area like Cooperstown. The truth is that Cooperstown is somewhat of a socio-economic oasis in a region that is socio-economically disadvantaged on the whole. I mean just statistically the average income, the opportunities; though it’s a wonderful region we have two colleges. In aggregate it has a lower mean income than most of New York State and a higher proportion of elderly. So that part is fairly characteristic. What’s different is Bassett. I mean Bassett is an academic health center connected with Columbia. You’re recruiting people nationally and you’re bringing into the community a broader contingent of people. It’s interesting that when I first began as the President and CEO of Bassett I don’t think it was fully appreciated how distinct that was because there are many hospitals within this region, Bassett was one hospital. Bassett was respected and Bassett got referrals from other knowledgeable physicians within the region. But to build an academic program to make sure you saw enough patients with enough variety to teach other doctors to be good doctors, it’s both an attraction and a demand. I mean it attracts people to want to come here, but it’s also a demand on the organization to really be good. As the healthcare system changed then Bassett had to change, and that really was my career was changing that part of Bassett because we had to build a delivery system that took care of a larger reach, in essence. It had to be a system where we had enough influence by either providing care or having relationships with others who provide the care [so] that we would not suddenly find ourselves one day waking up and having a large proportion of people with whom we were working say, “Well we’re going to go somewhere else and you’ll just have to make it on your own.” So that’s really what has been my life’s work at Bassett since 1984 when I took over as the Director and subsequently, they then changed the nomenclature to the corporate President and the CEO, was to build a network of care where we could maintain standards and bring enough business, in that sense, to Bassett and through the region to ensure that the ideals of Bassett could be pursued.
VL:
Could you talk a little more about your transition from practicing at Bassett to becoming…?
WS:
Well it was an interesting transition. I had a wonderful practice; I just had wonderful people that I got to meet at my practice. I always tell people that the thing about medicine that you can never forget is the remarkable privilege and intimacy that you gain with people because you talk to them about things that are very important to them; they trust you to help. It’s an extraordinary privilege. I’ve always maintained that and even in leading Bassett, I think my colleagues knew I understood that part of the game and that I was trying to protect them and that part of the game. I had been politically active at Bassett early on. When I first came I had been there I think three months, and I wrote my Chief, the Chief of Medicine, and I wrote him and I said, “I really like Bassett, but who’s planning for the future?” It’s a little bold for a thirty-two year old who just finished his training and never ever had to make a decision other than where to go train his whole life. The Chief of Medicine at the time, a really marvelous guy named Joe Lunn, said, “Yeah, that’s a good question. I’m going to appoint you chair of a committee. I’m going to put on all these senior doctors and you can chair this committee and try and figure this out.” We had a group of maybe five or six of us, and we met twice a week, Monday mornings and Saturday mornings for a year. We did not miss those meetings. We’d meet early Monday morning, 7:30 to 9:30, and Saturday 8 to 10. We studied ourselves for a full year and then we wrote this report about Bassett and about the way things were changing. The report was accepted by Dr. Lunn, but I think Joe was a senior and he saw the changes and he accepted it, and for a number of reasons thought he would go on and do something else. But then Dr. Walter Frank took over as Chief of Medicine, and we started implementing that report. So from the beginning I was engaged in, how are we were going to make this work? When Dr. Ashley, who was the Director at the time, stepped down in 1984, for reasons that were not clear to me I was asked to serve as the interim Director. I must say the reasons were unclear to many people in the organization; I was pretty young. But I mean I had been at least politically active. I would have probably been in the “young Turk” category trying to lead the place from the back benches of the Parliament. I was appointed the acting Director, which was tolerated. I was still continuing my practice then, but I was doing that part. I embraced that very immediately. I said, “Well okay, I’m going to be acting Director, but I’m not going to sit on my hands,” so I made a number of changes and started changing things. Then next year I got appointed to be the full-time Director, I learned subsequently by a two to one vote of the search committee. Although the Trustee who was the one negative vote told me a few years later he would change his vote [laughs]. I found that somewhat reassuring. So then I became the CEO, and I tried to maintain my practice for about two years while being the President or Director, I forget when we changed to the corporate names. But I came back from a meeting where I had been traveling, because I was increasingly traveling in the job, and I came back one day to my desk and I had about six pink notes, which was what my executive assistant Donna used to send me messages. There were about six notes there from patients I should have called that day, and that was the moment I said, “Okay, I can’t do both.” I was sad because I had really collected a wonderful group of patients both by seeing new patients and then as some of the senior physicians left it seemed that I had always gotten their most eccentric patients. So I just had a just wonderful group of people. It was like giving gifts to my other colleagues when I started having to transfer the practice. It was like these unique gifts I would give because some of them were so quirky, every day was an event when they came in. It was a joy to be a part of all that. So I did give that up, and when once that was given up it was just full bore in the other game.
VL:
You talked about the intimacy of practicing. How did you consider that or think about that as you went further in your career?
WS:
I think I considered it the price. It wasn’t like I was doing something I didn’t enjoy because I did enjoy the leadership and the administration, and I did have ideas and I wanted to test things and I had a vision of Bassett. I truly had a vision of Bassett in 1985. I told someone as I went through my seemingly relentless farewell events here this year for my retirement, Bassett in 2014 is about as close to that vision as I could imagine, and it’s immensely gratifying. I thought I would probably have seven years; it just took thirty [laughs]. Well it’s true. I thought well, you know, seven years I’d get this done, not so. I felt very privileged to be in the job I was in and I could do that job. I mean everyone has their own abilities, and I could do that job. And I got better as the years went on.
[TRACK 1, 24:11]
VL:
What was your vision for Bassett? And did it change over time?
WS:
It underwent evolution in the way we might do things, but it was always that we would have an excellent hospital with a very good medical staff, but a regional system that would support these activities. And that we would have this cadre of employed physicians and a workforce that understood that our role was to be innovative and to try new things and to constantly be looking at the realities of the healthcare system and adapting. I think that’s what we did. And we had to grow, that was the other thing. It was very clear to me, even in my nascent little beginning as a CEO, that we were just too small; we had to get bigger. Now, didn’t mean we wanted to become, you know, Mayo Clinic, but we had to get bigger. You had to have depth and breadth and mass; you had to have some mass as an organization as things moved on. Over time we accrued that, and I think we did it in a way that won the respect of a lot of people, even those who were our critics saw the way we did things and we did them well, and we honored our obligations. We took over a large, failing hospital. We said were going to do A, B, C, and D, and we did A, B, C, and D. It might take longer than they thought, but we did what we said would do all these years. We were never disingenuous or dishonest in our approach. We were tenacious though, and so that was how Bassett grew over this period of time.
VL:
You mentioned you had some critics. What were some of the other challenges you faced?
WS:
Well, not everyone bought the vision. I think part of what’s it’s been at Bassett is that I was very fortunate in that I had a sense of where we could go. I had the good fortune of having a very smart Board of Trustees, and the leadership of the organization, both physician leadership and administrative leadership, were very capable people who were willing to listen and critique and ensure that we would not go off the track. We built plans that had no guaranteed outcome. I’d say that’s one thing about Bassett in 2014 is… I’m very proud of where Bassett is right now and everybody assumes that since Bassett is a well-recognized place, it’s doing very well, that that’s the way it always was and it’s not. I mean we had to prove ourselves again and again when we tried new ideas. We introduced the first HMO in the region in 1986. People thought we were crazy. It was an incremental process. The young physicians we recruit now, they assume this is the way it’s been. It’d be like the graduate program. The graduate program hasn’t always been at the top level it is now. It took time and effort to build and to have people go out and be there for you to talk to, to learn about. It’s just that incrementalism that requires commitment and tenacity and an ability to tolerate criticism.
VL:
You mentioned students. Did you continue teaching once you transitioned?
WS:
I did continue teaching through the transition. I think I did that from the time I started in the CEO role, I think I continued that for about ten years. I just felt that, first of all it had changed. The way you had to deliver in-patient care was much more intense, much more focused. There was much less time to sit down and talk or to teach the way I had as more of a classicist teacher. Things had changed in that regard. So I just felt like I wasn’t really the best model, and I wasn’t current in many of the things. I’ve never felt uncomfortable, even now, talking to a patient and having a sense of what’s going on, but to walk out of the room and know what drug is the most modern drug. I had lost all that. So it was okay with the residents for a while, but after a while I thought, “I can’t ask them all the new drugs every day.” In that sense I had to be more current to be credible, so I stopped that.
VL:
Why is the academic component of Bassett important?
WS:
Well, it’s important because it attracts very good doctors. Bassett, as I have said, is a very good place, and it’s now known as a healthcare delivery system, but the soul of Bassett, I’ve always said, is its education,
[START TRACK 2, 0:00]
the willingness to teach, to have that be such a big part of the commitment. That’s really what brings the physicians to Bassett that make Bassett as good as it is. It’s just an undeniable attractor to a certain group of physicians, and they are the physicians you want. They want to teach, they want to learn, they’re thoughtful. That’s really the characteristic of Bassett. The Bassett physician group historically has not been characterized by entrepreneurial physicians, individuals who go out and set up a private practice and want to build their own business. It’s a career decision to come to a place where you’re employed and there are expectations, but then there are benefits to that. So you have to weigh those, and the Bassett model attracts that group. The truth is that now in America there are more and more physicians in that model, but Bassett was always ahead of that since its origins in the ’20s, but now it’s much more common.
VL:
Can you talk a little more about the creation of the Healthcare Network? You talked a little bit about it.
WS:
Yeah, I’ve thought about that as my tenure ended here. It was a big lift. It was not anything anybody necessarily had even envisioned in 1984. It basically, I would say the first three or four years, consisted of my driving on roads at night talking to various hospitals and going to meetings, talking to people about how the fact that there had to be some better way, we needed to work together, and constantly being rebuffed. I mean it was like Sisyphus. I’d go out, go to the meeting, talk, and then come home. But in ’86 we had a physician group join us, a private practicing group joined us. As they came on board to Bassett as a practicing physician group in Walton, NY, a very good group, and they joined Bassett, which was nothing anybody had ever seen before, this particular model. And in joining us then, we had to do their billing. They really joined; it wasn’t like we’ll just kind of be a part of it. They became on the payroll. They were members of Bassett. Later that year another excellent group from Cobleskill did the same thing. That just set a new tone for Bassett too, because the Bassett Board had to get this through their head that it wasn’t just Cooperstown all of a sudden. There were very influential members of the Bassett Board who thought this was really crazy. They were not in favor of it, but the board as a whole said okay. So we brought that group on and this other group on, and that started shifting dynamics a little bit. The hospitals in the region still were all very independent, but I had personally, and mostly by myself, just been driving to these meetings again and again with nothing happening. Then in 1988, the hospital in Delhi, the O’Conner Hospital, had encountered some difficulties with the State. I would say in parallel with all this other stuff I had really tried to start building credentials with the State, because they control the whole rate setting system at that time and I made a decision I was going to have to master that part of the game. So I had begun to have some influence in the State. We had sponsored a Rural Health Consortium, trying to build a little credibility there, and indirectly because of that the State called and said, “Can you take over this hospital?” And I said, “Certainly.” I didn’t really know what that meant. Then, we took over the O’Conner Hospital, and that was the first. Now we had the O’Conner Hospital, these very good practices, and then it just started building. Then we went to Herkimer, where a physician wanted to join us in another very complex story, but in the end we got we got a clinic there. In ’88 O’Conner joined. In ’93 the Cobleskill Hospital went bankrupt, but we had the best practice there, so we went over and negotiated a very complex deal with Medicare to get them out of bankruptcy and brought that hospital on board. And so it was just year by year. A practice in Norwich. Hamilton, NY a group wanted to join us. So we began to accrue these practices that truly joined Bassett and became part of the thinking at Bassett. Then in the early ’90s there was really a very significant event when one of the leaders of a practice in Cobleskill was elected the President of the medical staff of Bassett. To me, that was a very symbolic transition in that it showed that the Cooperstown campus, which had historically been a specialty campus, recognized what was happening and our need to have physicians within the region who were working with us. We just gradually built on all of this and now we have very nice clinics in multiple communities with doctors who are linked electronically, so we all have the same electronic medical records. But more than that we have a commonality of interests and purpose and recognition that all the physicians are very interdependent. Then the hospitals, as they have come on it’s been much the same. So O’Conner in ’88, Cobleskill in ’94, actually Valley Health Services in ’85, that was a nursing home. So then O’Conner, Cobleskill, Little Falls joined in 2005, Fox in 2010, and then Sidney. The Sidney Hospital was actually closed by the State because of economic failure, and we reopened it, which was considered an impossible task, but we did that. We had to leverage the skills to convince the State to do a lot of these things, and then our credibility continued to grow because these things worked [laugher]. That’s the other thing, it did improve things. It was just work, a lot of work.
VL:
Is there anything, now that you’re reaching the end of your tenure, that you would tell yourself when you first started pushing your vision of Bassett?
WS:
That’s a good question. No, I think being buffered by naiveté is a good way to start [laughter]. I truly mean that. I was very naïve. I just said, “I think we can do this,” and that’s probably driven me the whole way. “I think we can do this.” I have enough scars to be more savvy now, but I think that’s one of the great advantages was just to be naïve and unwarned by wiser and more experienced voices, at least at that point. [Laughter]
[TRACK 2, 8:25]
VL:
This is kind of a strange question, but did you have any great failures that you had or learned from?
WS:
Well yeah, I think there are failures that are very telling. One of the most significant that really changed a lot of my approach was in the early ’90s we built a Bassett clinic, which is the building that continues to be our primary out-patient facility. That was a major political task to get it approved. Just to get it approved by the Village was as hard as it was getting it approved by the State. It was because we were running out of space. We had been in the old fieldstone building for years. The ENT [Ear, Nose, and Throat] Clinic was down the hall from the Eye Clinic. We just had chairs in the hallways in these narrow halls. I used to tell people that the blind had to traverse the deaf to get to their appointments. So we needed space and we built a clinic. We had this elaborate plan. “It’s a whole new ballgame.” We had little pins made up for the organization. We’re going to move. Everything’s going to be better. And we moved and we lost a million dollars a month for the first six months. Every month we lost one million dollars. We had transferred every bad habit, and unbeknownst to me everyone had decided they would really cut back on business until they got used to it [chuckles]. They might have gotten used to it, but I was getting used to some real angst. Yeah, that was very sobering. It was unclear how we were going to get out of it, but the Board was calm, and I did devise some strategies that by March of the next year we were back on track. In that December, in the midst of this crisis, there was a telling moment in my career where I called together the physician leaders of the organization and I remember saying, “Well we’ve gotten ourselves into this and now we have to get ourselves out of this.” And one of the more distinguished leaders looked up and said, “I didn’t get us into this.” [Laughter] I thought, I’m going to have to learn from this. What I learned from that was that I was no longer going to be the coach, because I’d always seen myself as a CEO as the coach of a team of talented players, and that my role was to make sure that each player got what was needed. After that experience, I decided to become an executive and a captain as it were. If the ship went down I would not go down as the coach on the ship [laughter]; I was going to go down as the captain. So it changed my approach and it was indeed a failure, one we recovered from and one that changed things. I don’t know if I would characterize them all as failures, but my premise was that there was not a cul-de-sac into which we would not sail to explore an opportunity. We spent a lot of time trying things that didn’t work, but I didn’t necessarily consider them failures it was just, they didn’t work. But we at least had really explored them. We spent a lot of time before the Cobleskill Hospital went bankrupt, we spent a lot of time working with them trying to build a nursing home and figure out how to help them, and it failed. It just failed. For the better in the long run because it failed for good reasons, but we were always trying. That was always one of my strong feelings, is we would explore any opportunity and it might cost us to spend time and resources unsuccessfully, but I never considered those failures although they were, in a sense, a failed effort. They guided us and we learned.
[TRACK 2, 13:14]
VL:
How did you balance navigating the politics of the field with your own beliefs, or your philosophy about healthcare?
WS:
That’s a good question, Tori; I like that question. Well, it’s interesting because fortunately when I began there was a leader of the State, Dr. David Axelrod was the Health Commissioner then and set a new tone as a very powerful Health Commissioner. He was very socialistic in his views. It just drove him crazy that people weren’t getting care or that somehow all this money was being spent on x when y should be addressed. So I really felt very comfortable working with him, and as I said a little earlier I made a decision that I had to master the New York State system. By that, I mean I would try to get on all these groups. Then under Axelrod there were committees and meetings and all this where policies were set and you could argue. I learned arcane reimbursement technicalities so I could talk to the staff, and I worked really hard meeting staff and working hard in those roles. By doing that, my views which were most concerned that we would get this care set up, that we have to make these changes, which were not inconsistent with the government’s views at that time, found a lot of synergy. So that I could both pursue what I believed in, because largely the government at that time believed in it. From about, I’d say ’84 when we had the first rural conference in ’85, ’87 we had the second one, and then they formed the Rural Health Council largely because of us starting this initiative and that continues. There was a stretch of time where we were all in sync over our purposes. So it was easier then. I would say in the mid-90s there was a shift in administration and regulation went away, which was the way everything was being driven, which wasn’t necessary bad because the regulatory process had gotten a little over the top. Then you had to figure out how to advance your cause politically. But it was a different sort of politically. It wasn’t politically by working with ideas and everything. It was politically like making contributions to politicians and knowing whom to know. We had people in the community who were very wired to the administration at that time, and it was working that side of it, still toward the same goals, but a very different approach. From that it’s just continually evolved; what you had to do, where the role of the leader of an organization could be most effective in advancing the organization and the ideals of the organization. They’ve been different. One is toiling in a committee; another is knowing which politician you have to really pay attention to. The next might be being on the policy groups. By the last, almost twenty, years I was either Vice Chair or Chair of the two major policy advisory groups in the State. That gave me an opportunity to track and contribute. I just concluded a ten-year term as the Chair of the Public Health and Health Planning Council (PHHPC), which is now the singular group; they’ve all been combined, so that I could be there. There were different phases; you had to figure out what the steps were. You had to pay attention. Paying attention was a big part of it.
VL:
Has there ever been a time where your personal politics or beliefs have conflicted with those of the organization or what you were trying to accomplish?
WS:
Not with the Bassett organization. They have conflicted with the government’s approach some of the time certainly, but that’s politics. You have your beliefs; other people have their beliefs. You just have to figure out the political situation. But at Bassett, no. I think we’ve always had a congruence of effort, a shared philosophy. That’s been one of Bassett’s great strengths over all these decades is that the people believe in what we’re doing, so they’ll put up with the things they might not fully understand or agree with. There is an element of trust, an element of shared values that actually gave myself and others the freedom to do some of these crazy things that in the end people say, “Oh, I get it. I see this really worked out” and I say, “Yeah, [phew] it did. Thank goodness. I’m glad I’m not here explaining to you why it didn’t.” A lot of this stuff, to a very hardworking physician who’s trying to get his work done, see his patients, and all this stuff, to say that I’m out here talking to this insurance company about a new model of care we’re going to deliver. It’ll take a couple of years to put it together and it may have some impact on you. They’re going, “I’d like to take care of my patient,” and I said, “I want you to be able to take care of your patients, but it’s a complex world that’s closing in on us.” So, never at Bassett. Then it was just mastering the politics to protect Bassett where protection was required or to advance Bassett when you saw the direction was very congruent with what we were trying to do.
VL:
Now healthcare has changed a lot in the past couple of years. How has that affected Bassett?
WS:
Well, it’s had its effects. There have been trends that have been to our disadvantage. “Our.” I have to say “their” now, since I’m no longer at Bassett, but I can’t quite get past “us” since it’s so intrinsic to me. I would say we watched those trends and the last few years every ounce of my energy has gone into understanding those trends and taking the actions that I thought would get us through it. As of 2014, it looks like a very successful effort. [In] 2015 they may turn around and say, “What was Streck doing and why didn’t he do this?” But we just covered a lot of these things, and we are a model that is the model for the future. That’s why we were in the New York Times front page in 2009. We have the elements to do it correctly, and we’re on track to do it and we made the investments. I think Bassett has a good future, and I could not have said that three or four years ago. I would have said, “I’m hopeful we have a good future because I’m very concerned we have to put all of this together.” Now I’m feeling pretty good. It all goes back to the core thing of the employed physician model back to the ’20s; that core strength built upon and expanded has really allowed everything else to happen.
VL:
You said three or four years ago you weren’t sure. What changed in those three or four years?
WS:
A lot of work, and some success in pulling some of that effort into products, organizational change, new strategies, real change. I mean the organization underwent the necessary change to get prepared for the next phase. Organizational change is tricky. I always feel like there have been about five, maybe six, phases of organizational change over my tenure. You just had to explain it, explain why we’re changing this way. It was because, this goes back to the beginning of our discussion, when I came here it I said it was an idyllic little place where you just worked at the pace you found appropriate; you had plenty of time. There were very few pressures other than to make sure that your patients were happy. But there was time; that was it. Time, time, time. Now, if you ask anybody they would say they don’t have enough time.
VL:
Kind of comparing the idyllic age to now…
WS:
Yeah
VL:
Are there other benefits and drawbacks when you compare the two? Does that make sense?
WS:
It is. It does. I guess the simple thing to say is that the idyllic stage was not financially sustainable. It wasn’t financially sustainable. It didn’t appear to be that way because of social trends, medical trends, economic trends. I think that was a correct conclusion. That model could not survive today. Now the question is: can you take all the strength of that model, which is this intense commitment to education, these high values, this shared enterprise, this focus on quality and the patient more than money, can you take all those best elements and move them forward to be an organization that has those best elements and is a savvy business organization with all the capabilities you need to survive in the real world? I think we did, thus far. Now, this isn’t the first time it’s been done. It’s been done since Bassett was founded, but this stretch was, in my mind, a fundamental shift in the character of Bassett in bringing business performance parameters, knowledge, experience, measurements, accountability. It’s a business. The business ethic and still protecting the best parts. I think that’s why Bassett is able to recruit effectively now, bring in talent, and continuing to grow is because the combination of those two is unique. It’s not easy to protect. That’s why I tell everyone, “You’ve got to keep the sanctuary lamp of education lit no matter what’s going on around the church.” Okay? That’s always, in my mind, been the critical goal of leadership at Bassett. [To] protect all the best elements and deal with the realities.
VL:
I think we’re almost done. Do you have anything that you wanted address that we haven’t talked about yet?
WS:
No, I’m always surprised in these interviews how the thoughts sometimes coalesce. I think those latter comments would be the way I would frame my thirty-six years at Bassett and thirty years as the CEO. I would say the thing in which I take the greatest pride is that those core values, “The Social Responsibility of the Modern Hospital,” with Mackenzie, education, innovation, all of those over this thirty-year period have been protected and the place is a viable business model. Yeah, I’m proud of that.
VL:
Great! I think that’s a perfect way to end. Thank you so much!
[END TRACK 2, 26:42]

Duration

29:59
26:42

Bit Rate/Frequency

128 kbps

Files

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Steck_photo1.JPG

Citation

Victoria Lee, “William Streck, November 16, 2014,” CGP Community Stories, accessed August 4, 2020, http://cgpcommunitystories.org/items/show/203.