Crashing the 'Old Boy' Party

    It was a chilly October night in 1984, at the end of a two-year recession and the start of a shakeout in Boston's medical establishment, when a dozen or so women — all health care professionals — got together over a dinner of chicken and shop talk in Brookline, Mass. The women, all in their 30's, most of them married with children, had been meeting monthly for seven years.

     During that time, they had navigated their way from middle management to senior positions at local hospitals and in state government and academia. And for the most part, their conversations focused on the nitty gritty of health care administration — nursing shortages, obstreperous physicians, salaries. But that autumn evening, the group, which would come to call itself the A Team, had a collective epiphany: "We realized that we had started low, and were now all among the senior management of our organizations," says Elaine Ullian, a founding member of the group, who recently took over as chief executive of Boston University Medical Center Hospital, a top teaching hospital. "We were all working for new C.E.O.'s. We could be C.E.O.'s. But none of us was."

     In 1981, not a single one of over 60 hospitals in the Boston area (except for one religious hospital) was run by a woman. And although the mid-80's saw a rapid turnover in the top jobs at Massachusetts hospitals, no A Team members had been considered for them. "There were three or four search firms that recruited for these jobs," Ms. Ullian explains, and "they didn't even know we existed."

     The women decided this wasn't for lack of qualifications, since several of them already had senior positions and felt their resumes matched those of men who got many top jobs, but for lack of contacts.

     So the A Team set out to be noticed. Over the course of a two-hour meeting, the women discussed the wisdom of an all-out push to help one another move up. Some women initially balked at appearing too aggressive, but in the end the group set a firm goal: to establish at least three of its members in executive suites within a few years.

     And they set out to do this with a sophistication rare among such networks. In a methodical, highly planned drive, the A Team worked the phones, brought in headhunters and local politicians, even held seminars on down-to-earth matters like financial statements. All this was knit tightly together with regular meetings, sometimes over Chinese food, sometimes over breakfast, always with clarity of purpose.

A Quick Payoff

     The payoff was dramatic. The A Team, which has maintained a membership of 12 to 14, far exceeded its original target, with nearly half its members clinching top positions by the late 1980's. In early 1987, Ms. Ullian got the first of two leadership posts she would hold in the coming decade when she became chief executive of Boston's Faulkner Hospital. In 1987, Marva Serotkin became chief executive of Lemuel Shattuck, a state hospital.

     And a year later, Judith Kurland became both chief executive of Boston City Hospital, a public hospital, and Boston's Commissioner of Health and Hospitals, a coveted job in which she won out over half a dozen established men. A Team members also took charge at several community hospitals.

     Of course, the network cannot be judged as if in a test tube. Sweeping changes were opening health care to a surge of new ideas and new faces, with Massachusetts on the revolution's front lines, and affirmative action was very much in the air. Placed as they were in the top ranks of their organizations, many of these women may well have won promotions on their own. But there's abundant evidence that the A Team speeded them on their way.

     The A Team is remarkable not only for its longevity and its members' accomplishments, but for what it says about the self-image of modern, professional women. Indeed, many in the group acknowledge that it took some time to come to terms with the extent — and limits — of their aspirations. Ms. Ullian, for one, said she was 22 and working in a clinic before she even realized a woman could be a doctor. And although she had been on a fast track since the mid-70's, it never occurred to her that she might want to become a chief executive until she joined a consulting firm in the early 1980's, advising the heads of some 35 hospitals on their strategic plans. Suddenly, she said, she realized that she could do the job her clients were doing and in many cases "do it better."

     Some A Team members were cautious at first. "I wasn't quite sure how aggres-sive we were going to appear and whether it would work potentially against us," said Sandra Fenwick, who in 1984 had already won three promotions in her first five years at Beth Israel. Ms. Fenwick said male colleagues had cautioned her that aggressive women might be seen as having "forced their way" to the top, rather than rising on merit alone. As it happens, Ms. Fenwick turned down a chief executive offer in 1987 — she calls it "one of the most difficult" decisions of her career — because she had a 2-year-old child and was pregnant.

     The A Team thus represents a new, pragmatic feminism, and a big departure from both the stridency of the 1960's and the ladylike passivity of earlier generations. To some extent, it was simply a challenge to the "old boy" networks that have long given men timely boosts up the ladder. But the A Team is different, the women insist. Membership was "not restricted by your class, your club, or your school," Ms. Kurland noted. Instead, the women were tied together only by their gender, a common profession, and a desire to share information and advice.

     But didn't conflicts arise, with the women vying for the same jobs? The women say no. From the beginning, they say, the A Team took a one-for-all approach, and there never seems to have been overt competition. The members say that since each woman was at a slightly different stage of her career, there was little conflict over individual openings.

In 1977, Lone Pioneers In a Largely Male World

     The A Team had its roots in a series of casual lunches that began in 1977 and brought together a handful of women health care pioneers — many young and isolated in what was still a largely middle-age, male world. One thing they missed was the companionship of like-minded women. "We had no agenda," Ms. Ullian recalled, "except to create a safe place to discuss our professional concerns. We wanted a place where we didn't have to worry that someone would say, 'She isn't very good, is she?' "

     From its inception, the A Team struck a responsive chord among a generation of women who were intent on building careers, not just holding down jobs. When, in the late 1970's, the network's founders sent a mailing to notify colleagues of a meeting in a basement classroom at Boston University, nearly 100 women responded. That meeting laid the foundation for an umbrella organization known as Women in Health Care Management, and a number of smaller, loosely affiliated networks modeled on the A Team. (The network's official name is Group A, with its offshoots bearing other letters.) Today the umbrella group includes some 400 members.

     The A Team was, in fact, one of the first of thousands of formal and informal women's networks, in nearly every profession, that appeared by the early 1990's. But in contrast to many networks, which tend to dissipate as the goals and lives of its members change, the A Team has maintained a nearly constant membership for close to two decades. So many women were eager to join, in fact, that early on the network decided to admit only a few new colleagues who came recommended by existing members. And although, over the years, there were slight fluctuations, most of the existing A Team was in place by October 1984, when the network gathered at Ms. Ullian's house.

A Sense of Urgency, A Sense of Mission

     The strategy of aiming for the top gave the group a sense of both urgency and mission. "We knew if we didn't initiate an organized approach it would never happen," says Linda Shyavitz, one of the strategy's aggressive champions. By early 1985 the group had already invited several of Boston's leading headhunters to its monthly meetings. Ms. Shyavitz also corralled a small group of A Team members to meet with David Kinzer, then president of the Massachusetts Hospital Association.

     Meanwhile, other A Team members fanned out across the state to speak with women executives in other industries, hospital trustees, and more headhunters — in short, anyone who might help them press their case. The group's ultimate aim was twofold — to learn more about how to break into the health care power structure and to make their names known at key institutions.

     Every time a senior-level job came open, A Team members phoned friends and former associates to recommend colleagues. The first payoff came in mid-1985, after Ms. Ullian and Ms. Kurland phoned some acquaintances at Sturdy Memorial Hospital in Attleboro, Mass., to recommend Ms. Shyavitz for chief executive. Ms. Shyavitz, who was first approached by Sturdy just two weeks after giving birth to a son, told the search firm to phone back a month later. They did. In the fall of 1985, she became the first A Team member to head a local hospital.

     Ms. Shyavitz wasn't alone in the executive suite for long. A few months later, Peter Rabinowitz, one headhunter invited to attend A Team meetings, recommended Ms. Ullian for the top job at Faulkner. To improve Ms. Ullian's chances, Ms. Shyavitz, who had once worked at Faulkner, also plugged Ms. Ullian in with former colleagues. In January 1987, Ms. Ullian, already the mother of two, became the A Team's second chief executive.

     As each member wrestled with her individual goals, the group continued to hone its broad strategy. In October 1986, at another meeting at Ms. Ullian's house, Dorothy Puhy, soon to be the group's first chief financial officer, conducted a seminar on analyzing financial statements. "We understood budgets and profit-and-loss statements," Ms. Shyavitz explained. But "many of us were not sufficiently sophisticated in reading hospital financial statements." To help bring the women up to speed, Ms. Puhy passed out the audited statements of the New England Medical Center, where she worked at the time, and went through it line by line. In early 1987, the A Team asked Ms. Puhy, now chief financial officer of the Dana Farber Cancer Institute, to offer a follow-up course.

     By mid-1987, the focus of A Team gatherings had shifted slightly. Although the group would never veer from its main goal, the meetings were now devoted to a broad range of personal and professional issues that affected its members' day-to-day lives.

     In March 1987, the A Team invited Janine Kolis, vice president for human resources at the Harvard Community Health Plan, to share a dinner of Chinese food at the home of Ms. Fenwick, and to talk about executive pay. Although the disparities between men and women are not as great in health care as in other industries, the A Team says, the differences between institutions is enormous. Ms. Kolis's lecture was intended to help members understand the differences in everything from salary to child-care policies at a range of institutions.

     By 1988, Gov. Michael S. Dukakis's proposals for creating universal health care in Massachusetts had been passed by the legislature and had become the focus for most of the state's health care executives, including those in the A Team. So in June the network invited Patricia McGovern, chairman of the state Senate Ways and Means Committee and a champion of universal health care, to address a breakfast meeting.

     In what would be called by many members one of the A Team's most memorable meetings, Ms. McGovern gave an off-the-record, blow-by-blow account of how the health bill had made its way through the legislature. For many women present, the meeting not only underscored the "importance of political alliances" but also gave a revealing look at how one of the state's most powerful politicians had parried a slew of powerful special interests.

     Indeed, it was already apparent that the accelerating changes in Massachusetts were creating a host of opportunities. Just as much of the nation's medical establishment was entering a new era of cost containment and competition, Boston faced a large surplus of hospital beds, and this, in turn, created a fiscal crisis for several local institutions. Suddenly, there was demand for a new breed of executive.
 
     Credentials to Meet The Changing Needs

     Traditionally, the old-boy network in Boston hospitals was dominated by doctors and career administrators. But now there was a need for executives who both understood strategic planning and were conversant enough in the workings of state government that they could navigate new laws and regulations.

     Many of the A Team held credentials that were not only ideally suited for the new environment, but would propel them to powerful health care positions. Ms. Ullian, for example, held jobs in state government, hospital administration, and strategic planning before taking over at Faulkner — credentials that helped her turn the institution into a model community hospital. During her seven-year tenure, she opened three community health centers, recruited a new team of doctors and established Faulkner as one of the best breast cancer treatment centers in the country.

     Her track record caught the attention of Boston Mayor Tom Menino, who calls Ms. Ullian "smart, results-oriented, charismatic — in short, a natural leader," and who considers her a key adviser on health care. Last year, that reputation helped Ms. Ullian, now 46, get the top job at Boston University Medical Center Hospital, making her the first woman to head a major private university hospital in the Northeast and putting her in charge of restructuring a powerful but debt-ridden and demoralized institution.

     Her path was paved, in many respects, by another A Team member, Ms. Kurland, who held one of the most unorthodox resumes in the group, and who, in 1988, at age 43, became the first female Commissioner of Health and Hospitals and chief executive of Boston City Hospital. A graduate of Mount Holyoke, Ms. Kurland held no graduate degree and had worked only about five years in hospital administration before clinching Boston's top health care job.

     Through her work in government — she served as a top aide to the late Tip O'Neill when he was Speaker of the House and chief of staff for former Massachusetts Lieut. Gov. Thomas O'Neill — and a stint at the New England Medical Center, Ms. Kurland had made a name for herself both as a savvy political operator and management strategist. She had "an amazing grasp of how the health care system works," said Robert Restuccia, who once worked for Ms. Kurland at Boston City Hospital. It was that reputation that won her the job, plus former Boston Mayor Raymond Flynn's conviction that Ms. Kurland was one of the few executives with both the skills and the will to rebuild City Hospital — and she did.

     Ms. Kurland, however, never let go of her political convictions, and became such a lightning rod for criticism that in the end the A Team provided one of the few havens from the fray. At a time when many local politicians and executives saw health care as Boston's only growth industry, Ms. Kurland predicted the impending crisis of overcapacity and fought the expansion plans of several leading hospitals, challenging them, instead, to increase community services. Although Mayor Menino praises her as a woman "ahead of her time," Ms. Kurland came under increasing political attack. Then, in 1992, in her fifth year on the job, Ms. Kurland's husband, who had quit working to care for the couple's three children, died of a massive coronary.

     As Ms. Kurland coped with her family's grief, her home was filled with A Team members. Ms. Ullian, in particular, fielded phone calls, organized meals, and helped with child care. In the end, Ms. Kurland became convinced that as a single parent she could not remain in a demanding political job. In 1993, she announced that she would not seek another term as commissioner, and she is now a health care consultant.

     Indeed, if the A Team was driven by a professional agenda, it was also one of the few places where members could find help juggling work and home life. By the early 1990's, the original mission was basically accomplished, but they now had aging parents and school-age children. As a result, the group was about to experience another transition as members struggled to balance family responsibilities with rising workloads.

     In June 1992, during a meeting at Ms. Shyavitz's house, the network tabled its agenda — handling workplace discrimination — when three members mentioned that they were having to cope with the terminal illness of a parent. Other members, like Ms. Fenwick, frequently sought advice at meetings on finding new au pairs for her two children.

Leisurely Dinners Give Way to Breakfasts

     Even as the members continued looking to one another for personal and professional guidance, there was less time to devote to meetings. The leisurely dinners of the 1980's gave way to breakfast meetings — although these too were held in members' homes. And although members continue to get together informally, the last full-fledged meeting was held several months ago.

     Yet most A Team members insist that the network will never lose its relevance — noting that it still maintains contact with the few former members who quit because they were transferred out of town. Says Lucy Farmer, a vice president at Mount Auburn Hospital in Cambridge and a founding member: "The A Team is like the priesthood; once you're in, you're never out."

Copyright 1995 The New York Times Company

{for Andrea to review...

GRAPHIC: Photos: Linda Shyavitz — "We knew if we didn't initiate an organized approach, it would never happen." Judith Kurland — Membership in the A-team was "not restricted by your class, your club, or your school." Elaine Ullian — "We had no agenda except to create a safe place to discuss our professional concerns." (pg. 6); In 1984, a group of Boston-area women, over a chicken dinner, vowed to land top health care jobs. Three successes: Judith Kurland, for five years head of Boston City Hospital; Elaine Ullian, of Boston University Medical Center, and Linda Shyavitz, of Sturdy Memorial. (Evan Richman for The New York Times)(pg. 1)
 
Chart: "Networking" shows how some members of the A Team fared over the years. (pg. 6)