Corresponding author: Joel T. Allison, MS, FACHE, Executive Office, Baylor Health Care System, 3500 Gaston Avenue, Dallas, Texas 75246.

William Clifford Roberts, MD (hereafter, WCR): Joel, I appreciate very much your willingness to speak to me and therefore to the readers of BUMC Proceedings. I also appreciate your coming over to my house. It is August 2, 2000. To start, could you discuss your years growing up and your mother and father and siblings?

Joel Tribble Allison (hereafter, JTA): Thank you, Bill. I was born in my grandmother's house. My mother didn't quite make it to the hospital. I was a true “home delivery.” As a child I grew up on a farm outside of Jefferson City in a little town called New Bloomfield, Missouri (Figure 2). I'm the third of 4 children. The oldest child was my sister, Jayne, who died several years ago at age 55. My older brother, Jim, still lives in Jefferson City with his family. He retired last year from the Missouri Highway Department. I have a younger brother, John, who lives in Stafford, Virginia, with his family. He retired last year as a lieutenant colonel in the Marine Corps after 20 years of service.

After the war, my father and mother married and bought the farm near Jefferson City. Both my parents worked for the state for nearly all of their careers, and they also farmed. My father worked for the Department of Welfare, and my mother worked for the Department of Corrections as secretary to the director of prison industries. My mother's family was from Kennett, Missouri, down in the Bootheel. Her father was the editor of the newspaper there. My mother initially worked for the state in the driver's license division and later at the capitol in one of the representative's offices there. The farm, however, produced little income.

I enjoyed the farm and valued that experience. I grew up in pretty hard times. We didn't have indoor plumbing when we first lived on the farm. We had a little 4-room house. As a young child, one of my chores was to bring in wood in the winter. We heated the house with a King heater. I learned what it meant to “rick” wood for the winter. We always had dairy cows, and my older brother and I had the responsibility of milking a couple of the Jersey cows in the morning and in the evening. We also always had a few hogs and chickens. In the fall we usually killed some hogs, and that would be our meat for the year. My father's sister and her husband owned the farm next to ours, and they were full-time farmers growing crops and producing livestock. I spent a lot of time with them in the summers because my parents worked in town. I have many good memories from those days.

As I look back, they were difficult times but some of the best times. I learned a lot about discipline, values, and responsibility from taking care of the animals. If I didn't milk the cows, they weren't going to get milked. I fed the animals in the mornings and in the evenings. I learned to appreciate nature and to respect the land.

In the summers I worked in the neighbors' hay fields. That was my first job. I started working when I was about 8 years old. They let me drive the truck and paid me a penny a bale. In hay season the farmers would form a co-op. One had the mower and cut the hay, one had the baler, one had the rake, and then we'd get a crew to haul the hay. My uncle had the mower, and he mowed not only his farm but also those of 2 or 3 neighbors. It was a team effort. I worked with the hauling crew. As a little guy starting out, I could do the truck because they would put it in a low gear and all I had to do was let the clutch in and out. My feet would barely touch it. That job was a lot of fun. As I got older, I hauled the hay myself (“buck bales” as they'd say) and got paid 2 cents a bale. You got an increase as you got older.

My older brother graduated from New Bloomfield High School when my younger brother and I were in elementary school. There were 2 grades in each classroom in a very small country school. My mother felt the schools in Jefferson City offered a better education, so we moved there before I started seventh grade. I was the first in my family to go to college and graduate. My younger brother also attained a college degree.

My mother, who was a wonderful Christian, had a tremendous influence on me from the spiritual side and made sure that we were in church every Sunday and that I was involved in church activities during the week. Church was a very important part of our lives.

I enjoyed basketball, football, and track. I played baseball in the summers. When I got into high school, I started focusing on football. By my senior year I felt a commitment to some type of ministry. Because of the family financial circumstances, I knew that it was going to be difficult for me to get into some colleges, so I initially looked into the smaller colleges.

My pastor, G. Nelson Duke, as well as my high school football coach, Pete Adkins, had a tremendous impact on my life during my high school years by taking special interest in me. They were role models and mentors for me. During my senior year, we had a great football team (Figures 3 and 4). Coach Adkins was one of the all-time winningest football coaches. We never lost a game during my high school years. My pastor felt I could play college football. Although I had never considered myself that capable during my senior year, I was awarded some football honors and received some scholarship offers. I told Pastor Duke that I would prefer to go to a Baptist school such as Baylor or Wake Forest.

My pastor helped me to start thinking about getting a scholarship. A friend of his called one of the professors at Baylor University (unbeknownst to me at the time), and he contacted one of the coaches. I got a call, visited Baylor, and they offered me an academic/athletic scholarship in football. I'll be forever grateful to Dr. Mark Richards, a member of our home church and a graduate of Baylor, who made contact with Dr. Wimpee at Baylor.

WCR: What does an academic/athletic scholarship mean?

JTA: A student had to have a certain grade point average to go along with the athletic abilities. I had been influenced by both my teachers and my mother to concentrate on school as well as athletics. I graduated tenth in my high school class. I was viewed as a potential scholar, although I never considered myself one.

WCR: How many students were in your senior class in Jefferson City?

JTA: There were about 480 in the graduating class. At that time Jefferson City had a population of about 30,000. There were 2 high schools: a public high school, which I attended, and a Catholic high school.

WCR: You played teams from all over the state?

JTA: We played teams from St. Louis, Raytown (outside of Kansas City), Hannibal, Columbia, Sedalia, Mexico, and Springfield.

WCR: Let me go back a bit. When you lived in New Bloomfield on the farm, how many acres did you have? How big was your farm?

JTA: It was 360 acres.

WCR: How many cows did you have?

JTA: When I was little, my father “ran” Black Angus. He had a fairly good-sized herd of about 50. Later, we raised only 1, 2, or 3 calves. We always had 2 dairy cows. We always had Jersey or Guernsey cows, primarily for our own use. One of the hardest jobs I had (besides the milking) was to crank an old-fashioned separator with a handle. We'd pour the milk in and the separator had all these little metal screens on it, and you'd crank that to separate the cream from the milk. It was an arduous job. Jersey milk was great, and of course it was never pasteurized. It was straight from the cow. We strained it with a tea towel to remove whatever may have fallen in off the hayloft, and we would put the cream in the cream jar.

WCR: How old were you when you started milking the cows for the family?

JTA: I was 6 or 7 years old the first time I milked a cow.

WCR: From that time on until you left New Bloomfield, you were milking a couple of cows every morning and every night. What time did you wake up in the morning?

JTA: Usually Dad would get us up to go do the chores around 4:30 or 5:00 am. We would have to get everything done so he could drop us off at school on his way to town. He always wanted to get to work around 7:00 or 7:15 am, so we had to get up and get moving.

WCR: What time did you go to bed at night?

JTA: I don't really remember, but it wasn't too late. We were ready to go to bed. In the winter we wanted to go to bed because when the fire went out, under the covers was the warmest place to be. When I was young, we didn't have a television. We basically just did our homework and went to bed.

WCR: You did have electricity in the 4-room house when you moved into it.

JTA: Yes.

WCR: Bathroom facilities were in the house or outside?

JTA: When we first moved there when I was only 3 or 4 years old, we had outside facilities, but soon we got them inside. I still remember the outhouse with the half moon on it and the Sears Roebuck catalogue. When we moved into town we had a larger brick house. It had radiator heat but no air conditioning. Few neighbors had air conditioning at that time. In Missouri, July and August can be pretty hot. I enjoyed sitting outside on the porch and visiting in the summers. We'd sit out on the porch for the coolness of it and talk with neighbors walking by. I miss that now.

WCR: Three hundred and sixty acres is sizeable, and yet your mother and father were working every day in town. Was anybody else using your land to farm or to raise cattle?

JTA: My father would sharecrop part of it for corn or milo. He had the other land in what was the old soil bank program, where basically the government pays you to leave the land fallow for conservation and to let wildlife grow.

WCR: When you moved to Jefferson City, you were beginning the seventh grade. Did you keep the farm?

JTA: Yes, we leased it when we moved in. My mother sold it not too long after my father died.

WCR: When was your father born?

JTA: My father was born in 1910 and died in 1983.

WCR: When was your mother born?

JTA: She was born in 1914 and died in 1992.

WCR: I gather that your mother had a considerable impact on you. What was she like?

JTA: She was a wonderful lady. She made many sacrifices for her children. She worked so that we could have nice clothes and the extra things. She demanded little for herself. She was very religious, very committed to the church, a strong Christian. She was bright and understood people. The thing I remember most about my mom was that people would come and talk to her. She was almost like a therapist. She valued people, she understood relationships, and people trusted her. They would share their concerns and issues with her.

When we boys went out at night, she waited up for us. She'd want to visit with us about what we did, where we had been, and with whom. We always knew we'd have to kiss and hug her goodnight before we went to bed. We always made sure that we were pretty straight guys. We had a curfew, and she always wanted to know when we would be home. If she was back in the bedroom reading and still up when we came home, we knew we were okay. If she was in the front living room, we were in a little bit of trouble and had to talk our way out of it. If she was ever out on the porch when we got home, we were in big trouble. We judged how things were going to go by where she was positioned in the house when we arrived home.

Mother had a way of listening that made people comfortable. She had tremendous common sense and gave good advice. She gave me a lot of guidance and direction although she had a rough life. My father was an alcoholic, and because of that there were some tough times. That's why my pastor and high school football coach were such an influence on me. I'll always appreciate the special role they played in my life.

WCR: Your mother was the one who really kept the family together. She was the blender but the disciplinarian also. Was it a pleasant home?

JTA: It was very difficult at times, particularly on the weekends when my father would get drunk. For a long time I wanted to go away to school just to get away from the alcohol situation at home. Going to college at Baylor University was my first time to get out of the state. We rarely traveled when I was a child. The holidays at home could be particularly difficult, and I had a hard time reaching a point when I could enjoy holidays.

WCR: What kind of man was your father? If you could separate the alcoholism for a moment, what kind of person was he inside?

JTA: I want to believe he was a good man because he was a self-made man. He only had an eighth-grade education. He went into the military during the war and became an officer. He performed extremely well in the military. He advanced to being an inspector of troops before they went overseas. Eventually he went overseas himself and was wounded in the war. People would say to me as I grew up, “You should have known your dad before the war.” Perhaps some changes came about because of the war.

He worked hard, and I never knew him to miss work even though that could be difficult because of the alcohol. He would get up regardless and make sure that we were up. I remember saying as a child after waking up in the morning, “I don't feel too good.” He'd say, “Well, go do your chores and you'll feel better.” We just weren't sick! We weren't allowed to be sick with stomachaches or headaches. If you had the chickenpox or something that was visible, he would believe you. Otherwise it was, “Just go do your chores and you'll feel better.” He wanted us to do well and was very pleased when I went to college. However, the alcohol ultimately killed him.

WCR: Would he drink every night when he came home?

JTA: Yes.

WCR: What was dinner like? Did you sit around the table and have discussions?

JTA: Yes. Most of the time we'd have dinner together, but my dad would soon leave the table. It was usually my mother and siblings and myself sitting around the table talking. That was always enjoyable. We always ate well because we grew most of our own vegetables. I loved fresh vegetables. One of my favorites of Mom's dishes was cucumbers and onions in vinegar, and fresh tomatoes and wilted lettuce. I could make a meal of that. She would work all day and come home and fix a nice dinner.

We always had a good breakfast. We'd have fried rabbit, biscuits and gravy, or a piece of round steak and eggs for breakfast. We'd hunt rabbits and squirrels and swim in the creek. There was nothing better after hauling hay all day than to take off our clothes and jump into the creek at midnight. That was a great experience as a kid. We took some healthy risks. I look back on it now and say, “How did we survive some of the things we did?” I think every child needs healthy risks. I consider hunting and fishing, swimming in the creek, and driving when young as rites of passage into adolescence and manhood.

WCR: Would your father take you hunting, or was that just a brothers' activity?

JTA: When I was a child, he would take me. I usually went to carry the rabbits and the squirrels. My dad would also take me fishing. He liked to fish, and we'd go down and catch perch and catfish. “Be mindful of what you catch because anything you catch or kill you are going to clean and eat.” That was my father's rule. We cleaned a lot of fish.

WCR: Were there books around the house? Did your mother read much?

JTA: Yes, she read. When I was a child, she belonged to the Book-of-the-Month Club and had many books. She enjoyed reading and encouraged me and my siblings to read. She'd come in and say, “Let's read some.” She urged us to get a good education. I appreciate my mother's values and her commitment to education as well as her strong belief in the church and her strong spiritual life.

WCR: Did your father go to church?

JTA: Maybe once a year at Easter. That was it. My mother did not drive. When we moved to town, she found a house close enough to church for me to walk there so I would never have to depend on a ride to get to church.

WCR: Your mother managed the house. She made the decisions, it sounds like.

JTA: She was a very strong influence. My father managed the checkbook. That is why my mother worked, so she could give us extra things. He was very strict on how we spent money. He taught us to pay bills and save. When we moved to town in junior high, he'd send me out to make the house payment, and he paid in cash. Whatever we bought we paid for in cash. He taught us the importance of managing money--almost too strongly. He was definitely very tight. He would say that he was “tight twice.”

WCR: How old are your siblings? The oldest was your sister.

JTA: She was born in 1938. My older brother was born in 1942. I was born in 1948. My younger brother was born in 1956.

WCR: There was an 18-year spread of the children. How did your mother handle your father's alcoholism?

JTA: She was an enabler. She handled it by trying not to let anything upset him. We always had an environment of “Don't upset your dad. Everybody keep calm.” She handled it the best she could. I guess denial and tolerance were factors.

WCR: Did he get rambunctious when he got drunk? Was he loud? Abusive? Would he strike you?

JTA: There were times when we were threatened. He verbally abused my mother and the children. The shouting was very unpleasant; I just wanted to leave the house. Finally, she would get him to calm down and go to bed.

WCR: When your family moved to Jefferson City, you were 12 years old. Was that when you started playing sports?

JTA: Yes. In grade school, I had played baseball and basketball for fun. I began organized sports (football and basketball) in junior high school.

WCR: You developed into a pretty good athlete.

JTA: I was pretty good. I had opportunities because of my size. In my peer group, I was one of the largest boys, so in football I played on the line and in basketball I was the center. I enjoyed both sports, and they were a great release for me. It was a good outlet and kept me occupied, and I didn't have to go home. I also got to travel with the team, which was another opportunity to be away from home.

WCR: Did high school start with the ninth grade for you?

JTA: No, the 10th grade. Junior high was seventh, eighth, and ninth, and then high school was 10th, 11th, and 12th.

WCR: When you entered the 10th grade you dropped baseball?

JTA: Yes. I dropped baseball and played football, basketball, and track. I did all 3 through high school.

WCR: What did you play in football?

JTA: I was an offensive and defensive tackle.

WCR: How much did you weigh back then?

JTA: About 200 pounds.

WCR: And you are how tall?

JTA: Six foot 2 inches.

WCR: You played what years?

JTA: 1962, 1963, 1964, and the fall of 1965.

WCR: Did your basketball team win as often as your football team?

JTA: No. We didn't win quite as much as we did in football. My ninth grade year, our team went to state finals. After that we never got back to that level. The predominant sport in Jefferson City is football. If you played football, you were a local town hero. It's almost like it is in Texas. We had huge crowds for the football games. It was “the” sport.

WCR: Jefferson City is the capital of the state of Missouri.

JTA: Yes.

WCR: You mentioned your pastor and your football coach as having major influences on you. They must have known that your home situation was difficult.

JTA: Yes, they did.

WCR: How did the football coach influence you so much?

JTA: There were a couple of things. As a sophomore I'd had a couple of head injuries. My mother was very concerned. She didn't want me to get hurt and tried to convince me that I probably shouldn't play football, just basketball and track. She took me to the family physician when I got hurt, and I told him it was from playing football. He advised me not to play football and I said, “OK.” One evening before “2-a-day” practices started that year, the head coach came to our house, visited with my mother, and said, “We will have your son tested. We'll take him to the University of Missouri, do x-rays, and find out if there's anything that you need to be concerned about. We would like for him to be cleared to play. We will pay for it and get him cleared.” He was pretty persuasive, and she consented. She said, “That's fine if you get a clearance.” They took me to the Medical Arts Center in Jefferson City and had all kinds of x-rays and exams done. I saw a neurologist and got a clean bill of health. So she allowed me to go back and play. The coach didn't have to do that. I think he felt that I needed that outlet--not that I was a great football player, just that it was an opportunity for me.

Coach Adkins was a wonderful teacher as well as coach (Figure 5). The lessons he taught have never failed me. They were fundamentals that I was not getting from a male role model at home. One was never to quit. Every week you had to earn your spot. If you were first string, you were graded on your performance every Friday night through the films. On the following Tuesday anybody could challenge you for your position. If the challenger beat you one-on-one on the field, the coach would make you take off your first-string jersey and put on a second-string jersey. His comment was, “I never wanted anybody to be satisfied with their performance, and there is always somebody who can step in for you.” He wanted all his players to be the best they could be. “When you don't quit, you find a way to win. You train, you work hard, and you make sacrifices, but you also get the results and the rewards that go with it,” he would say. He convinced me that I needed to be involved in football.

WCR: What did you do in track?

JTA: I threw the shot put and the discus.

WCR: How far could you throw the shot put?

JTA: I don't remember. I think I threw the discus 100+ feet. It was definitely my best event.

WCR: How well did your track team do?

JTA: We won the conference in track 2 of the 3 high school years.

WCR: Did you play first team sophomore, junior, and senior years?

JTA: In my sophomore year I got injured midway in the season. I started my junior and senior years.

WCR: In both football and basketball?

JTA: In basketball I did not start. I was a second string backup center.

WCR: Did anybody influence you academically in junior high or high school?

JTA: A couple of people. The lady who had the most influence on me academically was my sixth grade teacher in New Bloomfield, who drove in from Jefferson City to teach. Her name was Madge Pavitt. Ms. Pavitt knew I was going to go to Jefferson City. She took a real interest in me in the sixth grade to prepare me. She actually brought me some books that the sixth graders in Jefferson City were using and had me study them. She encouraged me to study hard, and her encouragement prepared me for the transition from a small country school in New Bloomfield to a junior high in Jefferson City. I always remembered her continual reminder to study and to do well.

WCR: Did you find it more difficult once you entered junior high school in Jefferson City compared with the New Bloomfield grammar school?

JTA: The schooling wasn't that much more difficult. The environment was obviously a big change. It was large, and I was a country boy coming into the city. They tiered the classes for the accelerated students, the medium, and those who needed a little more help. I guess because Jefferson City did not know much about me, they put me in that middle class. About a quarter of the way into the school year, after our first round of exams, they moved me up to the accelerated class, and then I realized that I had been well prepared.

WCR: In your home did you read the Bible much? Did you read it out loud or did you read it to yourself?

JTA: At night my mother and I and any of the siblings who were there had devotionals. Mom would have us read out loud. We also had devotional time before we went to bed.

WCR: Did you pray together as a family?

JTA: We would pray as a family when we had a meal and at night again during our devotional time. One of us would pray, or if it were just Mom and I, we'd pray together. If there were 3 of us, we would have prayer time.

WCR: But your father did not participate?

JTA: He never participated.

WCR: When did you decide to go into the ministry?

JTA: When I was in high school, I again felt a calling. I worked quite a bit in the church. I was very active in Royal Ambassadors, a boys' youth group. I was very involved in the choir and Sunday school. I even did some preaching. During Youth Week I preached a couple of times in our church to the entire congregation. I also did some preaching during my senior year in high school. I did some “supply work,” preaching in some of those very small country churches that needed a pastor to fill in on a Sunday. It was an excellent experience. I was licensed as a minister by my home church before I went to Baylor.

At Baylor University I had a double major, religion and journalism, again sensing the call to serve the Lord in some way. During my senior year in college I carefully considered what I was going to do, maybe the seminary or religious journalism. I tried to work through what the Lord had planned for me. Diane and I were married at the end of my junior year. We came to visit Southwestern Seminary in Fort Worth, and the experience was negative. We knew that Diane had to work. She was an elementary education major, and they told us that they could not help her get a teaching job. It was a discouraging weekend. Even the housing was not guaranteed. We came back with a sense of, “Is this really what I'm supposed to do?”

I became interested in hospitals through Diane's brother, who is a physician. While we were in Waco at Baylor, he went to the Baylor College of Medicine and then began a family medicine residency at John Peter Smith in Fort Worth. We would visit him and his family on the weekends, and I'd go with him to the hospital. He'd let me put on scrubs and walk around with him. I was fascinated by the hospital environment. It was the first time I'd been around a hospital. I was taking a class in photojournalism, and I had to do an essay with pictures. I decided my topic would be “A Day in the Life of a Resident.” I got to know more and more about hospitals, and I loved the environment, the contact with people. It's busy 24 hours a day, 7 days a week.

I was still struggling with what I was going to do as far as the Lord's will was concerned. Diane's brother was getting close to finishing his residency and was considering where he was going to practice. He called Diane at our apartment in Waco and said, “We're going to go down to Uvalde and look at a practice. Would you all like to ride with us? We'll ride down, go through San Antonio to see our parents, and drive back. It would be a day trip.” Diane and I said, “Sure, we will go.” We went down and met the physician that he was thinking about joining. We toured the city and the hospital. While touring the hospital, our guide said, “Here's our administrative area and the administrator's office. By the way, we are looking for an administrator now. There was a young man in our community who was going to go into the ministry, and we asked him if he would consider going to Trinity for his master's and become our hospital administrator.”

It was like the lights flashed--hospital administration and the ministry. I'd never really connected the two, but it hit me at that time like a ton of bricks. Diane and I talked about it all the way home. We got back to Waco, and I called the administrator at the Baptist Hospital there (Hillcrest). Just out of the blue I said, “Tell me a little bit about hospital administration and how you view it.” He was very positive and said, “It's really a ministry. I feel like there are a lot of faith-based organizations, and this is part of the ministry. I find it very enjoyable and I love what I do.” I said, “I love the hospital environment, but I'm not here to be a doctor. I love the people. It's very exciting. I think if that's what the Lord's will is, maybe he's opening a window here. He may have closed the door, but he's opened a window.” We prayed. I looked around at the programs in health care administration because I knew I needed a master's. Trinity University in San Antonio was the only accredited school in Texas for health care administration. I applied to Trinity and was accepted. That was 1970.

I had a low draft number and knew I was probably going to be drafted before I could get into graduate school. Knowing I needed a delay to get into graduate school, I joined the Marine Corps Reserves (Figure 6). I went into the Marine Corps as a private after graduation from college. One day I was a college graduate (at the top of the heap) and the next day I was the lowest thing in the world. I was a shaved bald-headed private standing there with a bunch of 17- and 18-year-olds and wondering what happened. I did my 6 months of active duty in the reserves in California and did 5 1/2 years reserve obligation after that. I came home, went to graduate school at Trinity, got my master's degree, and then did my fellowship at Hendrick Medical Center in Abilene under Boone Powell, Jr.

I said, “The Lord always has a plan, and if you let him have control of your life, you'll come out okay because he'll direct you. Why am I doing this? Why have you got me going here?” As I look back on it, the Marine Corps is probably one of the best management training experiences I ever had. Part of what I learned was what it is to be the lowest person in the chain of command. I began to appreciate how the lowest person is treated by superiors. I began to appreciate that lack of information breeds fear and rumors. It was fascinating. I learned discipline, respect, and loyalty.

The Marine Corps is a unique branch of the military. That “esprit de corps” is intense. They are extremely loyal to each other--officers to enlisted and to each other. It served me very well to go through the Marine Corps because I learned how to appreciate the officers. I learned that the enlisted men could make the life of a pain-in-the-rear-type officer miserable. If you didn't have the respect of your men, you weren't going to be a successful officer. I worked in the administrative area for a while. When there was an officer who was really full of himself and was always treating the other folks with somewhat less than proper respect, it seemed like his pay always got messed up, his leave orders always got lost, and things just didn't work out for that poor guy. It helped me to understand what it means to be a leader, why people respect leaders, and why they will follow capable leaders.

WCR: Where did you spend those first 6 months?

JTA: I went to San Diego, California, for the Marine Corps Recruit Depot for boot camp. I did 10 weeks in San Diego and then went to Camp Pendleton for other training until my 6 months were up.

WCR: Camp Pendleton is where?

JTA: It's north of San Diego.

WCR: And then you stayed in the Marine Reserves for 5 1/2 years. What did that really mean? How much time did you spend per year in that?

JTA: We had drill with the local active duty men 1 weekend a month and then had 2 weeks of summer camp each year.

WCR: Did you stay a private during that time?

JTA: No. I was promoted to a sergeant. When I left I was an E-5, and they said they would make me an E-6 if I would “re-up.” I said, “I think I'll pass.”

WCR: Let me go back to college. You went to Baylor University in Waco, Texas. You started there in 1966. Jefferson City had a population of 30,000. Waco, Texas, was how many people?

JTA: About 100,000.

WCR: So you were now living in the largest community you had ever lived in. How did college strike you? Did you enjoy college?

JTA: Yes, I did, in part because I was away from home. I also loved college because it had central air conditioning, the first I had ever experienced. I enjoyed the culture of the university. The people were very friendly. I got to know my football teammates well. I still have friends from those days. Professors took a real interest in me. Baylor is a relatively small school, and I liked that.

WCR: How many students were there?

JTA: At that time there were about 7000 students. Everyone was friendly, and that impressed me. In my freshman year I met Diane just before Christmas. After Christmas we dated and ultimately became engaged and married. That made college life enjoyable.

WCR: How did you meet Diane?

JTA: A blind date! Before English class, I usually talked with another girl who was real nice. I was trying to get the courage to ask her out for a date. I said, “You know, I've got this weekend coming up and there's not much going on. I sure wish I could get a date and go out. What are you doing?” She said, “You need to meet this friend I've got. She lives a door down from me in the dorm. She is sweet and beautiful.” I said, “What's her name?” She gave me Diane's name. I went back to the dorm, picked up the phone, and asked to speak to Diane Bailey. She said, “This is she.” I said, “You don't know me and I don't know you, but do you want to go out Friday night?” She said, “How did you get my name?” I said, “A friend of yours gave me your name.” When she asked, “Who?” I was so nervous I blocked out her name. The reason is that the other girl's name was Diane also--Diane Davidson. “I can't remember,” I told her. “But anyway, would you like to go out?” She said, “When you remember her name, you call me back. I have to go to class.” And she hung up. As soon as she hung up I thought, Diane Davidson. I quickly dialed her back but she was already out the door. Later that night I called back and I gave her the name. Diane Bailey then talked to her and asked if she knew me. We ended up going out on a Wednesday night. We walked to Waco Hall for Baylor religious hour (because I didn't have a car my first semester). It was an interesting first date. She was pretty elusive. It was kind of a rocky start. If you talk to Diane, you'll find out it was not all that great a first date. We continued dating and then went home for the holidays. I went home and told my mom, “I met a great girl. In fact, I think I met the girl I'm going to marry.”

WCR: That was within a couple of weeks?

JTA: Yes. Our first date was in early December, and then we went home for the Christmas holidays. We came back and dated again in January and February and then started dating more seriously. At the end of our freshman year, I asked her to marry me. We got married after my junior year. She went to summer school all the time, so she was a semester ahead of me. We were married on May 31, 1969. I went to work in the summer. I had a youth director job at a small church outside of Waco and worked for L. L. Sam's Church Furniture Company in Waco. I had a couple of jobs while she finished her teaching requirements. She then went to work as a teacher.

A year after we married, we moved back to San Antonio because I was going into the Marine Corps within 2 weeks of graduation. I went to boot camp because I wanted to get home before the end of December. She taught at Randolph Air Force Base for 2 years while I was in the Marine Corps and then when I went to graduate school in San Antonio.

WCR: You were smitten with Diane right off the bat?

JTA: Yes. She was just different from the other girls I had dated (Figure 7).

WCR: Why did you choose journalism as one of your 2 majors in college?

JTA: I enjoyed writing. I had enjoyed working on the school newspaper my junior year in high school. My senior year in high school I had been editor in chief of our school newspaper. My mother's father had been in the newspaper business, and that was influential. I enjoyed interviewing and asking questions. I liked dealing with people. It was exciting.

WCR: What was your journalism major like in college?

JTA: It was excellent preparation. Being able to write, to do it correctly, to be accurate in getting the facts--asking the who, what, where, when, why--has been helpful. I never will forget one class in editing when on a test you made a B if you misspelled a single word; if you misspelled 2, it was a C; 3, it was a D. It taught me the importance of thorough investigating and reporting. I'm not sure that happens today. They can slant it as opposed to presenting the facts. Good reporting is getting the information correctly and accurately and then writing it so that the first paragraph captures the reader's interest. It was a good all-around education on how to communicate, how to write, how to express myself, how to get the facts, and how to analyze a situation.

WCR: Did you work for the college newspaper?

JTA: I didn't work for The Baylor Lariat, but, as a part of our courses, I wrote some articles for it. One year I was the golf reporter. Whether one actually worked for the paper depended on one's classes and other commitments.

WCR: What is a religion major in college?

JTA: Baylor has a fine school of religion. It is geared more to the ministerial students. It provides a good foundation in biblical studies. We were required to take courses on the Old Testament and the New Testament, prophecy, philosophy, ethics, revelation, and mission ministry (the life and teachings of Jesus Christ). The courses were geared to thoroughly understanding the Bible.

WCR: You played football all 4 years at Baylor?

JTA: I played on the freshman team. During the sophomore, junior, and senior years, I was not a major player. I wasn't big enough, and I was slow. Size caught up with me. The guys on the line were very big. I was going to quit football after my sophomore year and transfer to a smaller college. The coach (the one who had been there when I was recruited) was fired after my sophomore year. The new coach was not a great coach. We were 1 and 10 in his first year. He wasn't much interested in the boys who had been recruited before he came. I was discouraged and went to the line coach, Ken Casner, and said, “Coach, I'm not contributing. Maybe I need to transfer or do something else.” He said, “Joel, as long as you keep coming to practice you are helping this team and making a contribution. You need to get your education, and you won't get the kind of education that you can get here if you leave.” I will always be thankful to Coach Casner.

WCR: That took about 3 hours or so every day in your college career?

JTA: Yes. I was committed to keep practicing; I helped the other members be better players on Saturday. It took time, but it was the only way I was going to get the quality of education I needed for opportunities later. Two great things came out of my 4 years at Baylor--a great education and a great wife.

WCR: And you were in great shape.

JTA: And I was in good shape. I then went off to the Marine Corps and got in even better shape. I didn't know how great a shape you could get in!

WCR: Tell me about Trinity in San Antonio. Once you entered the health administration arena, did you feel like you had made the right decision pretty quickly, or how did it hit you?

JTA: It hit me very positively. I loved Trinity. The dean was Leonard Duce. He was excellent. I loved graduate school. It was a great experience.

WCR: How many colleagues did you have there?

JTA: They started classes in both September and in January then, each class having about 25 students. There was an overlapping class. I delayed starting until the fall because I wanted to work to get some money to go to school, and I wanted to get a couple of courses that I needed to have before I started my master's. I went to night school and worked that semester after I returned from the Marine Corps.

WCR: What kind of work did you do those 6 months?

JTA: I worked for Diane's father who had an insurance and finance business. I worked in his offices and did whatever was needed. I filled in for people and helped do the books.

WCR: That must have been pretty useful to you in the long run.

JTA: Yes. I learned a lot. I learned to deal with people and to work with the public; I learned something about business issues and how to balance the books at the end of the day.

WCR: You started Trinity in September 1971. What was it like? What courses did you take?

JTA: I took a variety of courses. It was good information. We had basic hospital administration and basic management courses. They combined the MBA school courses with health care administration. We took planning, public policy, statistics, and hospital finance. I took some research courses involving public health, social, and health issues.

WCR: You were learning how to operate a hospital.

JTA: Yes. The most important part of the educational process was the Friday seminar day. We had classes Monday through Thursday, and a variety of things occurred on Friday. We would have an outside speaker, maybe a hospital CEO or someone in the public policy arena or the government. We also took field trips to hospitals and talked to administrators in the field. It was very useful getting insight from the leaders in the industry in the state of Texas.

WCR: It was 1 year of courses?

JTA: Yes. Twelve months on campus and 12 months of residency fellowship. I also had to do a master's thesis.

WCR: What did you do your thesis on?

JTA: The importance of the role of the nurse executive in health care.

WCR: Why did you choose that?

JTA: I was impressed by the value that nurses bring to the hospital team, and I was interested in how nursing fit into the overall administrative function.

WCR: There are more nurses than any other employees in hospitals?

JTA: As a percentage, yes. Good nurses help attract good physicians. The nurse plays a crucial role in the hospital! Nursing leaders need to be recognized as strong executives. They need to be at the level in the organization that gives them input and feedback.

WCR: How did you choose Abilene to do your residency?

JTA: I believe the Lord leads you in the way you are supposed to go. I was interviewing for a residency at 2 places--Hendrick Medical Center in Abilene and Baylor in Dallas. I knew I wanted to go to a faith-based, preferably Baptist, hospital to do my residency because of my commitment and my sense of where the Lord was leading me. During the Christmas break I interviewed in Dallas. I interviewed with Dave Hitt, who was the head of operations at Baylor. I didn't get to see Boone Powell, Sr. After the interview, Mr. Hitt said, “We will get back to you after interviewing the other candidates.” Boone Powell, Jr. was the preceptor in Abilene, and he invited both Diane and me to come for an interview. He treated us extremely well. They had a dinner for us. It was a young staff, and Boone had just taken over from Mr. Collier a couple of years before. They were growing and building. Abilene had a population of 100,000 people. While we were there, we really enjoyed getting to know Boone and the team. Before we left, Boone said, “If you want to come here for your residency, you can.”

As we drove home we discussed the pros and cons of each city. We had only one car, and Diane had to work. We worried how we would get around in Dallas with only one car. I decided to go to Hendrick Hospital in Abilene, believing that that is where the Lord wanted me to be. It was a wonderful experience. I viewed it as a part of God's plan for my life. Having that relationship with Boone is what helped me get to Baylor eventually.

WCR: What was it like in Abilene?

JTA: I really enjoyed my year in Abilene as a resident. I had a great experience and considered it a part of the continuation of my education. The residency was structured to truly be an educational experience plus provide health care administration. That was the golden age of health care. Medicare was coming into existence. It was a better payer then than today. Managed care had not come. The biggest problem we had was how to get more business. As I was finishing my residency, Boone offered me the chance to stay on as an administrative assistant. I've always appreciated that Boone gave me my first real job. He gave me my first chance to get involved in the field of health care administration. In a relatively short time, one of the vice presidents was recruited to another hospital in another state, and I was promoted into that position and took on more responsibility (Figure 8). We were growing. We were adding beds and new services.

We loved the community. Both of our boys were born in Abilene. There was a great sense of community there. Life revolved around the family, church, and work. It was just a great time in life. A lot of our friends were going through the same challenges in life--starting a family and building a career. We'll always cherish that period in Abilene.

Boone promoted me to chief operating officer just before he was recruited to Baylor. That was a new challenge. Boone left in 1980. A search committee was formed to find a replacement for Boone. I put my hat in the ring, but I was not chosen. Mike Waters, the CEO from Baptist Hospital in Kansas City, was recruited, and Mike is still there today. He and I had a good relationship, and he said he would help support my career in any way he could. Mike was young, and I knew he was going to be there for a while.

Other opportunities opened for me. I had the opportunity to go back to my home state, to St. Joseph, Missouri, as the CEO in a very difficult turnaround situation. My dad had had a stroke and was in a nursing home. It was the time to go back home. I became CEO of Methodist Medical Center in 1981. During that time, my father died. There was one other hospital in town that had been owned and operated by a Catholic religious order. The nuns decided they didn't want the responsibility. The Western Conference of the Methodist Church had decided because of liability issues that they would turn the hospital over to the community. Now there were 2 community hospitals, and Medicare reimbursements were being reduced. Other hospitals were forming systems and competing in our market from Kansas City, Omaha, and Iowa. The CEO of the other hospital and I got together and decided that the best thing to do was to put our 2 hospitals together. We had a common medical staff. We merged these 2 hospitals before it was fashionable and did it fairly expeditiously. We created the Heartland Health Affiliates.

About the time my father died I had a call from a search firm about a CEO position in Amarillo, Texas. It was a public hospital that needed restructuring. They were looking for someone who had been through some reorganization and had developed some other approaches to delivering health care. Although Heartland Health had asked me to be their initial CEO, they needed somebody to come in and really put those 2 hospitals together. They recruited an individual who is still there today. I took the position in Amarillo. I loved the people of Amarillo. It was a challenge. The former CEO had been fired (as had the one at St. Joseph); he had gotten crossways with the media. The newspaper was on his case and the hospital's case. It gave me an opportunity to work with the media. I spent a lot of time rebuilding the relationship. With my interest in journalism, I enjoyed it.

The city had just built a new hospital at the Amarillo Medical Center complex. The board wanted to separate the hospital from the tax district and become a not-for-profit hospital devoid of local politics. The board was appointed by the city council, which had approval over the budget. It was a fine hospital, the clinical leader in several specialties with the only trauma center in town. After a major planning process, we came up with a proposal to disconnect the hospital from the city commission, but they rejected the proposal.

Again, about that time I got a call from a recruiter who said, “I want to talk to you about the sleeper job of the health care industry. I think you'd be the one. I've never met you but I'd like to come talk to you about it.” Our boys at that time were 8 and 12. I'd been building a career, working long and hard. One day not too long before this call, Diane said, “You know, I've done about all I can with the boys. They really need you, and they are going to need more time with you.” Our oldest was not particularly happy and hadn't really made the adjustment to Amarillo. She said, “We really need to think about how you can spend more time, do more things with the kids.” We have a place in Port Aransas, just outside of Corpus across the Corpus Christi Bay. This man came up to talk to me. He said, “We are looking for a CEO at Driscoll Children's Hospital in Corpus Christi. I think this would be ideal for you. Would you be willing to interview?” I said, “Sure. We love that area. We love Port Aransas. The boys love Port Aransas.” We were already going down there for spring break, so I suggested we get together for the interview with the board during that time. Diane and I had dinner with the board, and they offered me the job. We asked the boys how they felt about living down here full time. They were elated and I took the job.

Because we hadn't sold our house in Amarillo, we moved into our house in Port Aransas and put all of our furniture in storage, and I commuted into Corpus. The boys went to school in Port Aransas, a 1A school. That was the greatest year of our lives. We considered it a paid vacation. It was wonderful, and the boys loved it. They were outstanding. We hunted, we fished, and we had a chance to spend a lot of wonderful time with each other.

After a year we moved into Corpus Christi, and the boys went to school there. I was there for 6 years until Boone asked me to join him. We look back on our time in Corpus as a special gift from God and part of his plan. It was also during our time in Corpus that we adopted our daughter, Celeste. We stayed there until our oldest son graduated from high school. I had made a commitment that we would not move until he graduated. Our 2 boys consider that home. We had a lot of times when the 3 of us were fishing from a boat or duck hunting from a blind. It was a great family time for us.

WCR: That was during the key years for them.

JTA: These were the critical years. Our oldest didn't particularly like Amarillo, but last summer he married a girl from Amarillo whom he met when he was in the fourth grade (Figure 9). They were family friends. They were reunited after they both graduated from college and she had moved to Dallas to work.

WCR: Joel, these experiences that you've had at 4 different hospitals must have introduced you to a lot of problems and challenges that you wouldn't have gotten if you had stayed in one place.

JTA: That's true. I agree. Diane and I have talked about that. All those experiences allowed me to meet some wonderful people that I wouldn't have had the chance to meet if we had stayed in the same place. It has helped me have a wonderful network of friends and colleagues in the business. Also, I got exposure to many different types of problems. They were turnaround situations. The hospitals had different sponsorships. I worked with faith-based institutions and in the public sector, where I learned to be accountable to the media and to focus on community and physician relationships. A prior CEO did not have good physician relationships, and the hospital suffered as a consequence. Under Boone's tutelage, I developed a great appreciation and respect for clinicians. Every one added to my knowledge and experience base. Had I stayed in one place, that depth of experiences and challenges would not have been possible.

WCR: When you first went to Abilene, do you remember now anything that surprised you or shocked you a bit about how a hospital is run? Did you see some things right off the bat that you said, “You know, I think we ought to do it this way, rather than that way?”

JTA: I think as a young person in the field I would go in there and I'd ask, “Why do we do it that way? Why don't we do it this way? Why can't we just make that decision?” Sometimes that worked. Sometimes I would have to go and sit down and visit with Boone, and he'd explain why you couldn't do it that way. What I was doing was being very narrowly focused because of my lack of experience. I learned that I can't just solve one problem without realizing that solving it might create other problems. I gradually understood the implications of decisions in a complex organization. I learned to appreciate the decision-making process in hospitals. It's not simple, easy, or straightforward. There is an art to administration, of being able to understand all the different components and the implications of all decisions. That's when maturity and experience are most useful.

WCR: Tell me how Boone Powell, Jr., got you to Baylor University Medical Center.

JTA: I've stayed in touch with Boone since we were both in Abilene. I've had him come and speak and advise the boards at the other 3 hospitals where I've been since leaving Abilene. I've always considered him a mentor and asked his advice on many occasions. He has provided my boards with an outside perspective. He always said, “One of these days I'd like for you to come join me at Baylor.” When I was in Amarillo, we started talking more seriously about some role for me as he was developing the multihospital system. I think he was anticipating my coming to Baylor before I took the Driscoll job. He said, “I understand why you are going to Driscoll, the priority being your family, but I still want you to come to Baylor.” Many times he invited me to Baylor while I was at Corpus Christi--for example, when the Tom Landry Center opened. We'd visit, and he'd introduce me to people. We really started talking seriously about it about 3 years before I came. He wanted me to come up after our oldest son's junior year in high school. I said, “I just can't do it. I can't move him. I understand that you have to fill the chief operating officer position for the system and start the integrated model and pull it together. You've been very patient, very kind. If you need to fill that role, you need to go ahead and do it. I'm happy here. I'll just stay.” He said, “Nope. We'll just wait.” That was the way it came about. He had visited with the board and some of the key medical staff about my coming and had their concurrence. I joined the executive staff in 1993.

WCR: Before you came to Baylor in Dallas, you had been involved with only one hospital at a time. You had not been involved with a system of hospitals. Is that correct?

JTA: Correct, except at St. Joseph's where we were pulling 2 hospitals together. And Methodist had both an acute care hospital and a subacute hospital. In the Amarillo hospital district, Northwest Texas Hospitals had the adult acute care hospital, a psychiatric hospital for adults, and a psychiatric hospital for children. There were various facilities on that campus that were part of the Amarillo Hospital District doing business as Northwest Texas Hospitals. That gave me a sense of more than one facility to manage. In Corpus, the Driscoll Children's Hospital was only one hospital.

WCR: Baylor was the biggest hospital and the biggest system you had been involved with up to 1993.

JTA: Correct.

WCR: How did Baylor strike you early on after you became more knowledgeable about its complexity?

JTA: As you can appreciate, it was big. It had a tremendous reputation in the community, the state, and the nation. I began to recognize the magnitude of its influence and the number of different communities it influenced as well as the Dallas community. I was quite impressed by the breadth of the system and by what it was attempting to do and the challenges it was facing. Boone had said, “I want you to spend time getting to know the system. I want to give you a year when you won't have to get involved with too much. You can just understand and visit all the different components.” Unfortunately, the environment changed pretty rapidly, and by the time I arrived, there was a lot going on in the competitive environment. Hospitals were starting to affiliate and grow. Columbia was coming on the scene as a major competitor. Presbyterian Hospital was competing in the outlying areas. Harris Methodist was looking for affiliations. We ended up early on getting involved in some of our affiliation relationships, including the Irving lease. There really wasn't much time to learn. I had a steep learning curve, and I had to get after it. Managed care was beginning to have a major impact in Dallas. When I came, there was a lot of change going on. But again it was a wonderful opportunity because I was in the mainstream of some of the most dynamic activities in health care at the time.

WCR: Are you glad that you and Baylor examined whether or not to merge with the Presbyterian/Harris system? That must have been an extremely tense period. You must have firmed up your views from that experience. Could you elaborate on that?

JTA: I think that you have summed it up well. People ask me if it was a waste of time, and I tell them no. I look at it as an investment, because it was a very thorough review of what Baylor needs to do to preserve its vision and its history and to go forward in a very rapidly changing environment. When we began the discussions we were in one environment, and the business reasons for looking at the merger were very appropriate. As we got into it, the environment also began to change, especially with the Balanced Budget Act. Hospitals started having difficulties, and some of the earlier strategies were not proving to be appropriate in the health care industry. What Texas Health Resources was going to do with its health plan was a concern. I consider it an investment in learning.

We learned a lot more about ourselves and each other and realized that Baylor has a commitment to this community that is appreciated by the residents of not only Dallas, but of all the surrounding communities we represent. People have a very strong feeling for Baylor. There's a culture here. With all these changes going on--the internal and external challenges we were facing and those facing the industry and the unwinding of several larger mergers that had already occurred--it became apparent to the boards of both Texas Health Resources and Baylor that it would be best for the community and the organizations to discontinue the discussions. The time was not right. We have our issues, and we would be better off working on our own issues than trying to bring these 2 large organizations together to create an even bigger organization. The discussions were demanding, challenging, and exhausting. We thought deeper than we had ever thought before. I totally believe the right decision was made. Baylor needs to move forward as Baylor. There is a value that the physicians and the community put on the name “Baylor.” During these times, we heard from the community how much people trusted Baylor doctors, how people respected Baylor's ability to do the right thing. We will continue to do everything possible to preserve that trust. Trust was something people were afraid we would lose if the merger had been completed. I learned that mergers of equals are very difficult.

WCR: What do you see as your biggest challenges in your new position for the short term and then for the long term for the betterment of Baylor and this community?

JTA: In the short term, it's taking the work that the refocusing team (physician leaders, board members, management) did over the past several months and striving to realize our new vision statement: By the end of this decade the Baylor Health Care System will be the most trusted source of health services in our area. In the short term, it's building my team, the team that will lead Baylor into the 21st century, and making certain that we are putting the processes and systems into place to help us achieve that vision. We must continue our efforts to partner with physicians. We want to make sure that we keep that a top goal for the system. We want to operationalize some of the strategies and objectives we have on the table now, i.e., the heart hospital, making sure that it is successfully implemented and opened. We also have a major initiative under way looking at the role of research in the Baylor Health Care System, and we want it to continue to be a major part of our mission.

We also have challenges around the use of the Internet and the impact that the Internet is going to have on the delivery of health care and how people access health care. A team appointed by the board is looking at how we can partner with technology experts and others to be very proactive in using the Internet, particularly for physicians, hospitals, payers, and consumers.

We continue to work on our performance improvement program. We want to stay strong financially so that we will have the necessary resources to continue to grow the system, to invest in people, technology, programs, and services. How do we meet the challenges of reduced reimbursement and particularly the impact of the Balanced Budget Act? We now have the challenges of the ambulatory patient classifications that were implemented August 1, 2000. We also have to focus on how we are going to retain and attract talented people to help us take care of our patients. We've got severe shortages in some areas, i.e., nursing, pharmacy, and laboratory technicians. How do we keep our team motivated and professionally competent to meet the needs of a growing population?

We're blessed that we are in an area that is growing. We need to look at other geographical areas where we need to be. How do we provide staff for growth and have the necessary financial resources to continue to operate the system and keep it at the top quality and safety levels? We want to be the safest provider of health care services--the safest hospitals with the highest quality. We are perceived already as having the highest-quality physicians, nurses, and services. Our challenge now with information systems available is to provide more outcome information. The public is demanding it. We've got to be able to prove that we are the safest and the highest-quality provider of health care available.

WCR: I've heard a bit about your time commitment in the position you are in, your energy, vigor, and willingness to be at any meeting virtually any time, day or night. How do you balance your life now? You have a major responsibility on your shoulders. You can't just leave Baylor and forget about these multiple discussions you've had all day long. You must be thinking about them as you are driving home. You must think about them when you lie in bed at night. What do you do to diffuse some of these stresses? The decisions physicians make usually involve only one person. Some decisions you make involve hundreds of people. I'm sure that gets tiring and straining. So what do you do to balance your life a bit?

JTA: The first thing I do is rely heavily on my team. I am blessed with a very talented and competent team. I can delegate a lot of the work to that team because they are so qualified. I have just added 2 people, as we have elevated the role of human resources and the general counsel to senior management positions that will report directly to me.

I believe in bringing a balance to life. For me it's a balance in my spiritual life, family life, and professional or career life. God is first, family second, and job third. If any one of the 3 gets out of balance, the other 2 are impacted. I'm blessed with a wonderful wife who helps me keep a balance. She'll remind me. She's not bashful about saying when I need to make time for something. We still have a child at home. The Lord gave us Celeste, who is only 8 years old. I just cannot get totally locked onto the hospital. I like to exercise to try to help deal with some of the stresses. I love what I do. I have a passion for my work, a sense of calling. For me to be effective, I must have a balance. I believe in being healthy in mind, body, and spirit.

I enjoy my time with the family, especially in Port Aransas. We have a little sign there that says “Just another day in paradise.” Port Aransas is my getaway. I try to get there 3 or 4 times a year to rest and relax.

Because my requirements have changed as I've moved from chief operating officer to CEO, there's a lot more demand on my time for meetings and community involvement. I now need more time to think, to strategize, and to continue to learn. Baylor does a great job of allowing everyone to continue to learn. Many years ago on our strategic integration action team, Pete Dysert stressed, “Time is an asset. How do we manage that time?” You have to work at it. I don't always succeed. I don't make it home as soon as I'd like to sometimes. When I get home I focus on my family. It's hard to let it go, but there has to be time to focus on the family.

WCR: I know that no 2 days probably are exactly alike for you. What would be a typical day? What time do you get up in the morning as a rule?

JTA: Four days a week I get up about 4:10 am and go to the Landry Center. I like to be there by 4:50 am when it opens, do my workout, and get to the office about 7 am. One day a week I have a 6 am meeting at the hospital. So 4 days a week I get there by 7 am and the other day at 6 am. I'm reminded of what our son Blake said when somebody asked him, “Blake, what does your dad do?” Blake said, “He doesn't do anything. He drinks coffee and goes to meetings.” It's not a bad description of my schedule. A typical day includes meetings relative to operations involving the staff, meetings out in the community, and meetings about some of the activities going on at the state and national levels. I save some time to see physicians and employees. I'd like to spend more time being accessible and visible. I haven't done that as well as I would like. No 2 days are alike. I can have my day planned and something can happen that will just totally change it. A lot of my time is geared around strategy and thinking--what can we do to take advantage of an opportunity? How do we deal with an issue or problem? Building relationships with the board, physicians, and employees is an important aspect of my position. As the CEO I've got a responsibility to continue finding ways to provide the necessary resources and then allocate them to allow us to accomplish our vision.

WCR: What time do you generally leave the hospital?

JTA: Sometime between 6 and 7 pm. My goal is to leave by 6. Sometimes that's not possible.

WCR: How far is home from the hospital?

JTA: In the evening, going to far north Dallas takes 40 to 45 minutes. I get to the Landry Center in the early mornings in 20 minutes. At 4:30 am, nobody is on the road.

WCR: What time do you go to bed at night?

JTA: I try to be in bed by 10 pm.

WCR: You do very well on 6 hours' sleep a night?

JTA: I try to get 6 hours' sleep and I'm OK on that.

WCR: It sounds to me like that's the way it was from the time you were a little boy--getting up early to milk the cows and do the chores.

JTA: I believe rising early is simply the right thing to do. Maybe it's what I heard as a little child. The early bird gets the worm. Get up early, go to bed with the chickens. When I was on active duty in the Marine Corps, we were up bright and early all the time. I also like exercising in the morning. I've always gotten up early to exercise. I can do that when family members are sleeping.

WCR: Tell me a little more about your family. I've met Diane, and she's a lovely lady. It looks to me like you have a wonderful marriage, that you two are best friends. Your 2 older children, both boys, are your biological children.

JTA: That's correct.

WCR: You have an adopted daughter. How did that come about?

JTA: We lived in Corpus Christi, and I was involved with the children's hospital. I have a real heart for children. I love children, and I am an advocate for children. We'd been blessed that Diane could be home with the boys, be there when they came home. That's what we wanted. With my schedule, she needed to be available. She did the carpooling, so I was always able to stay at work if necessary and schedule late meetings. As the boys got older, she realized that there was going to be a time when they weren't going to need her, and she is a very active person. What was she going to do? She had gone back to doing some substitute teaching. I asked her, “What do you want to do? Do you want to go back and teach full time? Do you want to go back and get a master's degree? Do you want to get involved in politics, community service?” She said, “I want another child.” I was stunned. I didn't get the answer that I was anticipating. I swallowed deeply and said, “We're kind of old!” She said, “Maybe we'll do some foster care. There is so much need.” We did some foster care and realized that that had a lot of positives, and it was also possible to become attached to a child that was not your own.

I was serving on an advisory board in Austin, and the chairman of the board at that time was president of Lutheran Social Services. We visited one day after a meeting and I said, “Are we too old to adopt?” He said, “Oh no. Go to our office in Corpus Christi and find out about their process.” I talked to Diane, and she agreed that we should do it. The caseworker in Corpus said, “Yes. You would qualify. You're eligible, but you have to go through all the requirements we have for adoptive parents.” We said, “Fine, we'll do it.” We felt that experience was one of the best we'd ever had in life. It was a blessing. It was so emotional to see what people go through. We felt guilty because we already had been blessed with 2 healthy boys. There were young, childless couples who would have given anything to have a child. We wondered if we were going to take a child that someone else might want. They assured us that there was much more need than there were adoptive parents available, so we stayed in the program. We heard from adoptive parents and from birth mothers. It broke our hearts to hear the birth mothers talk about giving up their children and how difficult the decision was.

It took awhile to fulfill the requirements, because both of us had to be at every meeting, and I missed a lot with my schedule. We had to make up the missed meetings. We had to do an autobiography, each of us independently. We sent those in with our references. We got a call in 2 weeks that we'd been chosen for a baby. We thought initially that it might be an older child. Celeste was our blessing, and she was 8 months old when we adopted her (Figure 10).

We didn't discuss our adoption plans with anyone except our pastor and my physician. I sent my primary care physician in Corpus Christi all the forms to do a health assessment for me and send it in with the report. He filled everything out and wrote me a note on it: “Allison, if this is what I think it is for, I'm going to give you a psychiatric consult.” Our friends were so surprised but so supportive when Celeste arrived.

Our boys were wonderful. This adoption was not an open one. The birth mother gets to see the file anonymously. She doesn't know our names, but she knows our history. Celeste had been in a foster home in Beaumont. The caseworker told us the birth mother had 2 reasons for choosing our family. First, she was not a college graduate and wanted her daughter to have a college education. The fact that both parents were college graduates made her feel that there was a strong chance her daughter would receive a college education. Secondly, she had grown up in a family with older brothers, and she wanted her daughter to have siblings. The boys felt very much a part of this. It was truly a family adoption.

WCR: So it worked out well?

JTA: Wonderfully. She is a delight and a blessing.

WCR: You are on a large number of boards--local, community, state, and national. Some of these boards concern Baylor. Others don't. How much time do you envision you will be spending on these obligations? You are responsible now in a sphere bigger than just Baylor. How much time does that take away from Baylor?

JTA: I am now looking closely at where I spend my time. Involvement in boards that are relevant to the health care industry and to Baylor may bring some value to Baylor, and they have to be weighed against those that are more outside that realm. I have a role as the representative of Baylor to be involved in the community. I went on the United Way board. I see that as important for the relationship with the community and Baylor's strong relationship as a corporate member of the community.

I will be winding down some board memberships. This year, I will be rotating off the Health Careers Foundation board that I currently chair. It's a program that I believe in because it raises money for scholarships and loans for students going into the health care profession and particularly the nontraditional student that maybe wouldn't have a chance to go on--a single mom, an older student that wants to go back. I believe in the mission and the people that helped start that program.

Other boards will be considered periodically as time permits. The legislatures in both Austin and Washington, DC, of course, have a major impact on the health care industry and Baylor. Some of these boards involve networking, and being in meetings with other CEOs and executives from other health care systems is instructive. At times, it's a way to get a fresh approach and a review of what's going on in the industry. I do not want to spend an inordinate amount of time away from Baylor. I still have to keep my main focus at Baylor and work primarily with those community, state, and national boards that have some relationship to Baylor.

WCR: You are very active in your church here in Dallas, just like you've been active in the church since you were a little boy. You are a deacon in the Park Cities Baptist Church. I presume that that is still a major part of your life.

JTA: Yes. As a family we consider church very much a part of our life. Raising our children in a Christian home and church environment has been very important to us both. Diane is a very strong Christian also.

WCR: Do you have any hobbies outside of your work?

JTA: Yes, I do. I love hunting, fishing, and traveling, particularly traveling with the family. At Diane's suggestion beginning years ago, we do a family Christmas vacation. Our gift for all of us will be the trip, and we go as a family. We have had some wonderful times together. The kids never knew where we were going. The fun of it for them was finally learning the destination. The fun for Diane and me was playing “Where are we going to go?” We did all kinds of trips, internationally as well as in the USA. It has been a wonderful learning experience for our children. With our oldest now married, it's a lot harder now to plan schedules. We will continue these Christmas trips with Celeste, who also enjoys them. We just may not have the whole family all the time now, but we'll have a part of the family.

WCR: What is your older boy going to do?

JTA: Brent is in his first year of admiralty law at Tulane Law School. He went to Texas A&M at Galveston and has a bachelor of science in marine transportation. He's been working for the past 3 years on commercial ships. He was a second officer on a 285-foot petroleum vessel. He is continuing to get his licenses and certifications. He wanted to get that experience before applying to law school. Brent and his wife, Leigh Ann, now live in New Orleans.

WCR: What is your second boy leaning toward?

JTA: Blake is now a senior at Baylor, and his current major is health fitness management. He has started working part time at Hillcrest Baptist Hospital. He is going to do some type of management.

WCR: Is there anything that we haven't discussed that you would like to talk about?

JTA: That was pretty thorough. It's probably a whole lot more than you wanted to know. I appreciate this time. I love what I do. I have a passion for what I do because I see it as a calling. With all the problems and challenges, I see it as a great opportunity to be involved with a wonderful organization like Baylor, wonderful physicians, wonderful employees, a great board, and a tremendous history. My challenge is just making sure it doesn't get harmed in any way. Determining how to serve and preserve what Baylor has and stands for and how to continue to respect and honor the past while creating the future is challenging. Obviously, we have to do things differently from the past. The one thing I value about Baylor is that while we've had to make changes, Baylor has never compromised its values in any way. It's kept that sense of mission and ministry and the values of how to do business and how to treat patients and employees. I hope that we will always honor, respect, and continue that.

WCR: Joel, I must say that after listening to you here for nearly 3 hours, I feel very secure about whose hands Baylor is presently in. I think the readers of BUMC Proceedings will be enormously grateful to you for the insights that you've provided not only into yourself but also into those goals that you have for the medical centers.

JTA: I appreciate that. Thank you.

WCR: Thank you.