I felt overwhelmed by the chaos of it all when I walked into Cook County Hospital. People were all over the place: sitting, walking, running, standing, laying on the floor, and just hanging around. They were crying waving, talking, yelling, gesturing, screaming. How could anyone manage pandemonium like this?

I was there to interview Ruth Rothstein, Chief, Cook County Bureau of Health Services, Chicago, Illinois. Ms. Rothstein’s first professional position was as an organizer for the United Packinghouse union, and she began her hospital work in 1940 as a laboratory technician at Jackson Park hospital in Chicago. Today she leads approximately 12,000 employees with a budget of $650 million.

I planned on 8 hours for the interview about leadership. It took less than two hours to ask my questions and to get them answered. A tall and energetic woman, Ruth Rothstein looks twenty years younger than her seventy-five years, knows who she is, knows what she thinks, and doesn’t mince words. I chuckled frequently as I listened to her.

 Her wisdom and experience speak for themselves and require no additional comments from me.

On vision:

The vision was to re accredit the hospital, and we did that. The vision and mission is to build an ambulatory care system, and we are in the process of doing that. The vision and mission is to build a new hospital, and we are in the process of moving toward that. The mission and the vision were to have one medical school rather than have everybody cherry-pick you to death, and we have done that. The mission and vision are very important, and if you are not an integral part of your environment then you may not survive.

On organizing community:

It is a skill you learn by dealing with people and their families and by understanding what their goals are and what they need out of life. It is really pretty simple. It is jobs. It is a decent wage. So they can support their family. So they can make a contribution back to where they live. Community is important because all organizing should be at the grassroots level.

On her credibility with the residents in poverty-stricken West Chicago:

I have worked on the West Side for over 30 years. I think the people on the West Side trust me because I never over-promised and under-performed. I think that is an element. The other element is that I don’t talk down to people. I respect people no matter who they are unless they have proven otherwise.

On facing reality:

I cut through a lot of bologna. I can hear and cut through a lot and sometimes it is aggravating to people because you cut them off in a sense. I don’t need to hear all that you know. I mean, I know that already. Cutting through a lot of garbage is a skill you don’t learn from books. You learn it from living.

I am very honest. I cut through a lot of garbage. I am honest about myself. I never forget where I came from. I never forget how I got here. I don’t delude myself. I know what my strengths are. I know what my weaknesses are. I am willing to look at it. I am willing to deal with it, and I am willing to face up to it. I am willing to tell it to anybody.

On courage:

Courage comes from how you were brought up. How you developed in your work life. I am not afraid of myself. It doesn’t mean I want to be alone. It doesn’t mean I don’t get lonely, and it doesn’t mean that I don’t get sad, and it doesn’t mean that I don’t get depressed, but I am not afraid of myself.

On energy:

I think you get it from doing things. I get the energy from constantly wanting to make a difference. I have to tell you, I do not understand young people in terms of their health and their energy. I certainly didn’t take care of myself. I smoked until about seven years ago. I don’t exercise. I can’t tell you what my cholesterol is, because I don’t really care. Everyone is always tired. What the hell are they tired from? But they are always tired. I am not sure I understand that. Yes, I get tired, clearly I get tired. But not the way they do.

On passion:

I believe in me. I believe in the people I work with. I believe in the communities that I am serving, and I work together with them to make it better. How could I be anything less than passionate about it?

On people:

I think most people are honest and honorable. I think most  people want to do the right thing. I think most people want to take care of  themselves and their families. I think even the most  distressed of people want to do that. They don’t always have the opportunity to do so. Life has not always been good to them. I don’t want to blame the victim.

On telling the truth:

I put a lot of emphasis on being truthful. That, if I say it, I mean that is what I am going to do. If I am not going to do it, I am going to tell you I am not going to do it.  And nothing you could do is going to make me change my mind. Not that I am going to be right about it.

On trust:

I think trust is important. I think most people trust me because I tell the truth. Even if it hurts me. Even if it hurts me, I will tell the truth. I think you build trust by being an authentic leader.

On change:

I make changes here as I did at Mount Sinai and Cook County hospitals because I utilize all the resources that I have around me and that is human resources. I try to pick people who are smart. I  try to pick people who care the way I care. I try to pick people who have the same courage and the same passion that I have to accomplish stuff. Then we set about to do it. Set about to figure it out and to get about to doing it. I think that is where that is. I don’t suffer fools easily, I will tell you that. I don’t care who they are. They can be elected officials for all I care.

Everyone doesn’t love me clearly. Well clearly, I don’t love everyone either. That is a two-way street. You know I don’t have to love them either. I need to be honest. I need to give the facts. I need to be open. I need to do a good job. But I don’t have to love you. Conversely, you don’t have to love me. But you have to trust me. That to me is very important. Trust is very important. On both sides.

On resistance to change:

I don’t walk around saying, “I have resistance.” Of course you have resistance. Of course people have trouble changing. What the hell are you there for? What are you going to do about it? You bring all your skills to the table and you try to work your way around it. You try to figure out “how do I work my way  around it?” One of the things that became important here was to figure out how do you make the institution inclusive. I think it is  important to be inclusive. I think it was important for me to bring together leaders who are both formal and informal leaders. And pose the questions and say “now you tell me what the answers are as you perceive them.”

We worked on three important issues over a period of a year and  one-half. They came to the solution. They came to the answer. It took a long time. A year and a half. Sure I could have done the same thing in 20 minutes. But so what. Then I couldn’t get them to change. They changed themselves.

You could shoot them. And then you won’t have anybody to work for you. So that is not helpful. You could take the next 20 years and have them look at their navels and try to figure it out.

Or you can help them. You can help them. You can help them to organize, to go through the process, to work with it.

On herself as a leader:

I am tough. I am very tough. Maybe some people will tell you I am abrasive. I don’t think I am, but that is okay. Everybody perceives themselves the way they want to perceive themselves.  But everybody will tell you that you always know where you stand with me. I am forthright. I am up-front. I will tell you the  truth. If it hurts, it hurts and if it hurts me, it hurts me. I have no secrets. I never have secrets. No hidden agendas. I am what you see. I mean this is for real. I admit my mistakes. I can apologize. But I cut through a lot of bologna. I think people appreciate that.

Learning about leadership:

In everything that I have worked at: the trade union movement, healthcare organizations, the Jewish community, whenever you work with people you try to draw from them the best that you can get out of them. You want to draw the best knowledge. You want to draw the best advice. You want to be able to listen. You want to be able to give as well as take information. But then as a leader, you and you alone, have the ultimate responsibility for making the decision. You can’t run away from that. You can’t blame it on anybody ever. And people do that. They do that a lot. It makes me crazy. Like, “Oh, but I told you that.” “When did you tell me that?” “Oh yes, you just weren’t listening. I mean I told you that.” Well, that is just bullshit. Of course they didn’t tell me. That is just a game. It is a game.

On memos:

I don’t write a whole lot of memos. Not a whole lot. I write memos to congratulate people or thank them. I don’t write big   memos. I think talking to people by phone or face-to-face is a  human contact. A memo is a piece of paper. That is not a human contact. That is kind of an arrogant contact, in some ways, and cowardly in some cases.

On technology:

I am technologically illiterate. I don’t want to be bothered. I am not going to be around long enough to worry about it. It will, however, change the way people function. I think it will change the way they interact with each other. It’s like a science fiction thing for me.

On spirituality:

I don’t have a great deal of religion myself. If spirituality is a sense of the mythical, if it is a sense of equality, and if it is the sense of decency, than I am spiritual. My personal code is to do the very best that I can do for the greatest number of people that I can do it with and for.

On coping:

I suppose when I cry, I cry alone.

Ruth Rothstein used the word Menschlichkeit when we talked about leaders. She said Menschlichkeit “is almost an indescribable word. It’s a New York word. It means you are a wonderful whole human being. Menschlichkeit is a marvelous word.”

As she said, Ruth Rothstein cuts through a lot of bologna.

Excerpt from: Learning to Live: Essays on Life and Leadership