hospitals, rising up through the administrative ranks to superintendent—the equivalent of CEO. "I loved the academic medical center environment," says Varnum. Indeed, what drew him to Dartmouth and MHMH was the chance to be in on building an academic medical center from the beginning.

Varnum's predecessor at MHMH, the late William Wilson, had headed Hitchcock for 30 years and was, by all accounts, a superb leader. In fact, employees at all levels who have known both Wilson and Varnum say that Wilson possessed the same qualities of empathy, warmth, sincerity, and genuine interest in people. By the late '70s, with MHMH being transformed from an excellent regional hospital to a core component of an academic medical center, Hennessey and his colleagues were looking for a leader who would bring to the enterprise a breadth of knowledge and experience in an academic setting. They found Varnum, age 38, a 1962 Dartmouth College graduate and a 1964 graduate of the University of Michigan's master's degree program in hospital administration.

In September of 1977, Hennessey boarded a plane for Seattle to interview Varnum, one of two finalists for the MHMH presidency. More than 28 years later, Hennessey still has his notes from that trip and letters of recommendation for Varnum. Clearing his throat and raising a yellowed page to eye level, Hennessey reads the words of a hospital executive who had worked closely with Varnum: "I've known Jim Varnum for a long time. He was already a leader in his late twenties, which is almost unheard of in our field. He is indeed precocious . . . [and] very, very solid in all respects. While he is not flashy, he is extremely dependable. He does not stand out in a crowd. I would describe him as circumspect. His particular strengths are that he is very well educated, very well prepared, and he's very effective in perceiving the cause-effect relationships in a situation and predicting the future with unusual accuracy. He is a person of vision."

Hennessey stops, puts that page aside, and then reads a letter of recommendation from a physician: "Jim Varnum is exactly as he seems. He is unbelievably consistent. He is always warm and cordial, and that's most unusual for the tough position he occupies. Jim projects warmth more skillfully than any of the other administrators I've ever known. Jim Varnum is very quick. He understands what is implied in a situation, as well as what is openly stated. He synthesizes information with great skill."

Hennessey pauses and then reads his own notes from his first meeting with Varnum: "My first impressions of Jim Varnum are very

favorable. He has an infectious smile, a generally warm and sympathetic attitude. He communicates empathy for the other person without in any way overdoing it. He retains not only a sense of maturity and dignity but a professional air. I found him very alert, intelligent, and perceptive in his observations and particularly in his questions about the Dartmouth-Hitchcock Medical Center in our search for Bill Wilson's replacement. Every question he asked me seemed to strike a central fact or nerve about our situation. So it is clear to me that he has been thinking about it and wondering whether it presents the sort of attraction for which he is looking." Hennessey pauses again and then adds, "That was when I first met a man I've now known for 30 years."

It turns out DHMC was the "sort of attraction" and challenge Varnum was looking for, and Varnum was the visionary president MHMH sought.

From 1978 to 2006, Varnum guided MHMH's evolution from a regional hospital in Hanover, N.H., to a core component of a nationally known tertiary-care medical center that employs 7,000 people and occupies 225 acres in Lebanon, N.H. Varnum is exceedingly proud of the Lebanon facility—now a national model for innovative hospital design—as well as of what goes on inside it.

This became clear to Dr. Stephen Spielberg, the dean of DMS, when Varnum gave him a personal tour shortly after Spielberg arrived at Dartmouth in 2003. "It was an incredible tour," says Spielberg, "and it reaffirmed for me what Jim had really been able to accomplish. I had never seen the old Mary Hitchcock Memorial Hospital, but I had seen pictures and heard what it was like and the contrast . . . was striking, absolutely remarkable."

Varnum took Spielberg into "the bowels of the institution," the dean recalls. "Repair shops and the power plant. The infrastructure necessary to make the place work. From central supply and pharmacy and all the aspects of a hospital that you don't see." It wasn't the usual CEO tour, but following Varnum around that day, Spielberg got an "enormous sense of what the place was about," he says. "Knowing a little bit about the history" of the decision to move DHMC to Lebanon, and "reading between the lines," Spielberg explains, he got a sense of "just how difficult it must have been to convince people to take the leap of faith to do this. And the leadership that that took at that time made what he was showing me all the more remarkable."

Varnum's leadership has also helped MHMH, and DHMC as a whole, emerge as a regional and national leader on several fronts—such as outcomes reporting, transparency, and nursing