excellence. In 2003, DHMC achieved Magnet Status, which recognizes nursing programs with superior quality of care and employee satisfaction. Likewise, DHMC has been singled out by the federal Centers for Medicare and Medicaid Services, as well as the national press—including the New York Times and the Wall Street Journal—for its quality improvement initiatives, outcomes reporting, and commitment to what's known in the field as "transparency," which means being up front about matters such as the costs of procedures.

Varnum's accomplishments are especially impressive when one considers that "he came [to MHMH] as a pretty young man," says Michael Hill, president of the New Hampshire Hospital Association (NHHA). "He came here on the heels of one of the most highly respected, wellliked hospital administrators that there has ever been in New Hampshire. That's a hard thing to do." But, in Hill's opinion, Varnum has been hugely successful at earning the respect and loyalty not only of his staff but also of health-care leaders throughout the region. Varnum served on the NHHA board of trustees from 1980 to 1992 and chaired the board from 1984 to 1986.

"One of the problems you have when you're running a place like [MHMH]," observes Hill, "is you're always the big guy on the block and some people are naturally intimidated by that. Or you become a target for people. But he has navigated so gracefully that people who get to know him . . . just sort of have an automatic confidence in him." Hill recalls many times when he was trying to advance an NHHA initiative and other health leaders in the state would tell him, "Don't give me the details—if Jim's with it, it's okay."

When Hill became president of the NHHA in 1993, he met with every hospital administrator in the state to gain advice on how to steer the organization into the future. "I heard pretty much the same stuff from most hospital administrators," recalls Hill. "But I'll never forget when I sat down in Jim's office."

If the NHHA was going to focus on selling insurance, which many hospital

Donald Berwick, CEO of the Cambridge, Mass.-based Institute for Healthcare Improvement, considers Varnum to be "one of the finest 'triple threats' that American medicine has seen . . . organizational leader, regional leader, and national leader—all at once."

associations did, or on lobbying, Varnum wasn't interested. "I can do better than you can," Hill recalls Varnum telling him. "I can get better deals than you can. If you're just about advocacy, we can do pretty well ourselves with that. But," Varnum continued, "if you're involved in doing things that are going to improve care for patients, I have to be there. We can't afford not to be there." That message stuck with Hill and has helped guide the NHHA.

Hill credits Varnum with inspiring the NHHA to become involved in quality improvement, transparency, and access issues, largely through an NHHA spin-off called the Foundation for Healthy Communities. "In many ways," says Hill, "Varnum has provided a role model of what people leading health-care organizations should be. I think he's had a lot of impact on a lot of younger administrators, not just [at Hitchcock], but in Vermont and New Hampshire."