MARK FINUCANE: L.A. County Health Director Steps Up to the Challenge

      During his three years at the helm of the public health system serving the nation's most populous county, Los Angeles County Health Services Director Mark Finucane has felt the heat from county supervisors but "dodges politics," Modern Healthcare reports. Juggling a "relatively small $2.4 billion annual budget against the endless task of modernizing public health care delivery while still pleasing his politically motivated bosses" is like "getting on the freeway at 85 miles per hour," Finucane said. Taking it all in stride, he says, means enduring a "constant barrage of criticism" while pushing forward with his main goal: revamping the county's "antiquated inpatient-based care toward an outpatient model." At the same time, he has been saddled with bailing out the system that teetered on the brink of insolvency and was rescued in 1996 with a $925 million federal waiver. Charged with finding $294 million in savings for the system, the county is expected "to realize only $82 million in cost savings" and outpatient visits are trailing projected goals. In addition, Finucane has overseen the plans to replace County-USC Medical Center as supervisors and lawmakers wrestle over the choice between a 600- or 750-bed replacement facility. Conceding that his rehabilitation plan may be "overambitious," Finucane is nonetheless known for his communication skills and his commitment to change the system. Jim Lott, executive vice president at the Healthcare Association of Southern California, said in the years since Finucane came on board, he has adopted a motto of change, most notably in moving out those managers who wouldn't cooperate with his strategies. "I was hired to change the department, not be changed by it," he said. Lott also noted, "He won't take anything to the supervisors without consulting all the stakeholders: the community clinics, union, hospitals, welfare rights organizations and physician organizations. He doesn't satisfy them all of the time, but there isn't a person in the group that can't get an answer from him." Mandy Johnson, executive director at the Community Clinic Association of Los Angeles County, said, "There haven't been any empty promises from Mark. He's laid out a commitment to expand ... partnerships with the private sector," she said, noting that when Finucane took over, the department had "little contact with the private sector." Now, she said, the county has 149 public-private arrangements (Shinkman, 6/14 issue).