H. Richard (“Dick”) Nesson was born in Boston on May 6, 1932, and died on October 18, 1998. His parents were hardworking, and struggled to ensure that their children were educated. In the summers and part-time during the school year, Dick worked in his father’s store. The clientele were primarily blue-collar workers and their families. For the rest of his life, serving people from all walks of life was his lodestar.
Dick attended Brookline High School, Harvard College and Boston University School of Medicine. He was an intern and later Chief Resident in Medicine at the Beth Israel Hospital, and then completed a fellowship in nephrology at B.U. After joining the Faculty of Medicine at HMS, based initially at the Beth Israel Hospital, he accepted a series of leadership positions in Harvard-affiliated institutions. He was, successively, Assistant Director of the Medical Services at Beth Israel Hospital; the first Medical Director of the then-fledgling Harvard Community Health Plan (HCHP); Director of the Office of Extramural Health Programs at the Harvard School of Public Health (HSPH); Founding Director of the Division of General Medicine within the Department of Medicine at the Peter Bent Brigham Hospital; Vice President for Ambulatory and Community Health Services at Brigham and Women’s Hospital; President of Brigham and Women’s Hospital; and the first Chief Executive Officer of the Partners HealthCare System.
Dick Nesson’s personal qualities, values and accomplishments were exceptional.
Bringing People Together. Few people were as good as Dick Nesson in bringing people together. He was not a leader who worked to achieve consensus just long enough to be sure he had the votes. Rather, he genuinely sought to understand the judgment of others. He had the ability to communicate effectively and personally with the many different kinds of people that make up a community as complex as a hospital or health care system. He worked hard to achieve the consensus, and had an uncanny capacity to help people see that consensus was in their interest.
At Beth Israel Hospital he played a central role in integrating the private and teaching services into one medical unit, thereby eliminating a two-class system of care. At HCHP he united doctors affiliated with different hospitals into one practice group, and helped reduce the tensions between the community of private practitioners and this first Health Maintenance Organization in New England. Many close observers credited Dick with starting HCHP on the right track, assuring it later success.
At Brigham and Women’s Hospital he united both the administrative and clinical leadership of what had previously been three independent hospitals: the Peter Bent Brigham, Robert Breck Brigham and Boston Lying-In hospitals. At Partners, he began the process of pulling together the leadership of Brigham and Women’s Hospital, Massachusetts General Hospital and several other healthcare institutions. He also oversaw the building of a network of over a thousand community physicians linked to academic teaching hospitals. He saw the potential, as well as the perils, of institutional mergers, and through his leadership demonstrated the potential of two difficult and successful mergers. Succeeding at any one of these efforts at bringing people together would have been a major accomplishment. Succeeding at all of them was astonishing.
A small anecdote serves to underline Dick Nesson’s ability to achieve consensus. During economic hard times in the late 1970s, he initiated a group discussion among the faculty in his academic unit witnessed by several of us. The group was inexorably led to the obvious and unanimous judgment that its salaries should be cut. It even felt good. Houdini could not have pulled that off.
Innovating. Dick Nesson was intellectually curious and professionally adventurous. He had the vision and the courage to be an innovator. He was a key figure in the growth of the HMO movement in New England. He also was responsible for creating the first academic presence for HMOs in a teaching hospital, in which house staff worked in HMO practices and were taught (both in the outpatient and inpatient setting) by HMO physicians.
Dick Nesson also played a major role in the development of academic primary care general internal medicine units, and led a national program sponsored by the Robert Wood Johnson Foundation to disseminate the model he helped build at Harvard-affiliated hospitals.
He anticipated the power of computer technology to improve the quality and reduce the cost of medical care, and initiated the development of what became state-of-the-art and award-winning computer systems at Brigham and Women’s Hospital. The Brigham’s computer system, through which doctors write patient orders, has become the international gold standard, following the widely read report from the Institute of Medicine on the need to improve the safety of patient care, including the errors that stem from handwritten orders.
Service. In a world with many classes, Dick Nesson struggled throughout his career to come as close as possible to the goal of one-class medical care. He began this process at Beth Israel Hospital, where he helped make private and “ward” beds part of the teaching service, thereby upgrading the quality of both. At HSPH, he built a series of community outreach programs that became models for other schools of public health.
At Brigham and Women’s Hospital, he merged the faculty and house staff internal medicine practices. When the new bed tower opened, he did not allow the creation of inpatient units with greater amenities for patients of means. The hospital’s community outreach programs were vigorous. During his tenure as president, Brigham and Women’s Hospital provided more free care to indigent patients than any private hospital in Boston. Whenever he thought about a decision involving patient care, Dick would always try to put himself in the place of the patient. When you talked to Dick about “the patient” in the abstract, you could see that for Dick the discussion was always concrete: “the patient” could be anyone’s parent, spouse, sibling, or child, including yours.
Judgment. In his many positions of leadership, Dick Nesson was often faced with “tough calls,” decisions about which he frequently received quite different advice, all of it delivered with considerable conviction and passion. In retrospect, as reflected in the many accomplishments we have cited and others, it is remarkable how often Dick saw clearly, and thereby helped to define, the future.
Integrity. Dick Nesson knew very well when someone did not want to hear something. Sometimes he dealt with that temporary reality by what a friend called “the Nesson verbal bob-and-weave.” You couldn’t disagree with what he said, because you weren’t sure you understood it. This rhetorical technique was designed to buy time, to allow you to cool down and to begin seeing the other side of the issue. It often worked. What Dick Nesson would not do was pander, and tell you what he knew you wanted to hear. He conveyed the facts as he saw them and encouraged those around him to do the same. He had a favorite saying: “You don’t need the world’s greatest memory if you always tell the truth.”
Loyalty. Literally hundreds of people considered Dick Nesson their mentor. He helped them define their career paths. He was there to help see them through difficult times. He followed their careers closely and kept in personal touch with all of them. Like many executives, Dick Nesson could recall the CVs of a large number of people. What was remarkable was that with many, he also knew about their families, hobbies, passions, joys, and tragedies. Whether this was a talent learned from his parents or from his years as a primary care doctor, he knew exactly when to call, and he did. He was the consummate coach: he helped people accomplish more than they thought they could. Unless he felt it was in your interest, he would not support your plans: he was capable of “tough love.” When you failed, he would make sure you understood why, and would help dust you off. His fierce loyalty was reciprocated: people who worked for him gave him their best.
Finally, close relationships with Dick often meant close relationships as well with his wonderful wife, Lois, and their devoted children, Ted, Sarah, and Sue. Dick and Lois had an extraordinary capacity to make you part of their family. In dealing with the enormity of his loss, this blessing continues.
Anthony L. Komaroff, Chairperson
Joseph L. Dorsey
David M. Eisenberg
Howard H. Hiatt