Varnum's influence has extended into the national realm as well. He was a trustee of the American Hospital Association (AHA) from 1994 to 1997, and he chaired the board of directors of the VHA (formerly the Voluntary Hospital Association) from 2001 to 2004. Varnum currently serves on the National Quality Forum's board of directors. Other members of that board include Dr. Mark McClellan, administrator of the federal Centers for Medicare and Medicaid Services, and Dr. Jonathan Perlin, undersecretary for health at the Veterans Health Administration. Most recently, Varnum received the 2006 Award of Honor from the AHA, which "recognizes outstanding initiatives, by individuals or organizations, to improve the health status of individuals, targeted groups, communities, or the nation as a whole."

The letters of support that accompanied Varnum's nomination for the AHA award capture the breadth of his influence:

"It is now likely that Northern New England will emerge rapidly as the rational, communityminded, integrated health-care region we need as an example," wrote Donald Berwick, president and CEO of the Cambridge, Mass.-based Institute for Healthcare Improvement. "If and when that happens, it will have been Jim Varnum more than anyone else who birthed it." Later in his letter of support, Berwick adds, "Jim is one of the finest 'triple threats' that American medicine has seen in his generation: organizational leader, regional leader, and national leader—all at once." In another letter, Thomas Smith, former president and CEO of Yale-New Haven Hospital, wrote, "One resounding impression everyone has after dealing with Jim on whatever matter is that he is a genuinely decent person, who always takes seriously the issues but never himself."

Varnum's reputation and his ability to build trust and consensus have been key to one of his greatest regional accomplishments—the creation of the Dartmouth-Hitchcock Alliance (DHA). Made up of 11 member organizations throughout New Hampshire, Vermont, and Massachusetts, the Alliance includes nine hospitals, a mental health center, and a home-health agency. Members of the Alliance are united by the shared goal of improving the quality and efficiency of patient care in the region. Alliance members meet regularly to discuss services, programs, and patient needs and to try to develop common protocols and assist one another. The Alliance also helps in concrete ways, making it possible to buy supplies and equipment at bulk rates and providing a network for

sharing expertise and information.

When hospitals are considering joining
the Alliance, says Alfred Griggs, a member of its board of trustees, "basically what they're considering doing is joining Jim Varnum." Griggs also chairs the MHMH and DHMC boards of trustees. Before becoming involved with Dartmouth-Hitchcock, Griggs chaired the board of trustees at Cooley Dickinson Hospital in Northampton, Mass., one of the first Alliance members. "From the Alliance perspective, he really is the personification of DHMC, of DHA," says Griggs. Now, with Varnum retiring soon, "there is a skepticism about the ability of the trustees to find . . . a president who will maintain the priority that Jim has for the Alliance," Griggs admits. But, he adds, "the trustees feel the Alliance is important. It's consistent with the academic mission. It's consistent with the whole idea of being a tertiary-care center in a community."

Griggs, who is cochair of the search committee for Varnum's replacement, is also aware of the concerns employees have about Varnum's retirement. The search committee and trustees have come up with 10 qualities they're seeking, explains Griggs, to show that "without saying we're looking for someone like Jim Varnum, we really are." In the meantime, Griggs, the search committee, and the trustees have sought, as Griggs puts it, to "settle" the organization by appointing an acting president, Nancy Formella, the senior nurse executive at DHMC for the past seven years. "It is not a caretaker position at all," says Griggs of the acting presidency, but it does give Griggs and his colleagues more time to consider candidates for the permanent position, as well as the future of MHMH and its role within DHMC. And the acting presidency no doubt will give the organization time to get used to Varnum no longer being at the helm.

"There has always been a sense of security for me knowing that he was there . . . that we were going to be heading the right way," says housekeeping director Harry Kendrick of Varnum. But, Kendrick adds, "I know there are a lot of other people up there [in the fifth-floor administrative area] helping him."

It would be difficult to overstate the affection and loyalty that longtime DHMC employees have for Varnum. He has made himself visible and known to employees in all departments not only by making rounds, formal and informal, but also by attending retirement and employment anniversary parties; by hand-delivering patient letters of praise to