As a new graduate I worked from home for over a year on several projects. My wife and I thought about starting a family, and fortunately I was hired as a junior administrator at Seattle Children's Hospital and Regional Medical Center in 1997. I later went to Virginia Mason Medical Center, managing medical/surgical sections, and earlier this year started at Group Health Cooperative where I certainly hope to serve long-term.

I have always wanted to help shape the health care delivery system, directly, and to maximize its value to everyday people like you and me. As a manager, I am constantly reminded about the hassles of steering my own kids, and a frail parent, through the medical system. So I try to measure business ideas by their novelty, simplicity, and economy of process.

Like a lot of folks I get a kick out of helping others, but never desired a hands-on role like a doctor. So, something about serving patients indirectly is very rewarding. I'd also like to say that professional morale in health care is generally high, and that every day is fun, but I'm afraid there is surplus stress throughout most delivery systems.

I think the hardest part of managing people-and moving large jobs forward-is helping others have a decent sense of "context" in the midst of fast-changing circumstances, especially in big companies. Big companies in our industry are undergoing radical changes on so many fronts, and yet often the everyday front line staff are left out of the loop. In failing to provide a positive everyday "context" for front line staff, I'm afraid we (big companies) risk a really strategic loss of engagement and morale.

The MHA experience gave me a really strong sense of community as a newcomer to the Northwest over 10 years ago. Faculty and university staff really cared. Also, in the mid-1990s the state government pushed hard to establish reform modeled on the Clinton health plan; so for everyone connected to the MHA program there was this terrific policy debate in "real-time" before the state plan eventually lost in court over the federal benefits law. It was kind of a life-imitating-art thing.

No question, it was the friends we made. And one particular trip to visit with health management students in Vancouver, at the UBC program. Yes, Vinnie, that was fun.

Working from the vantage point of an HMO, I am optimistic that large numbers of our patients get great care and are able to focus on prevention, but I am afraid this is less and less easy to do in the open market. My advice is to join the debate on health care reform wherever you can, and however you find your own voice. It would be wonderful to watch a stable, equitable national health care policy take shape one day.