Blog Archives
I Had To Do Something, But What?
Rabble Rouser tells the remarkable story of how a coalition of citizens fought to preserve a cornerstone of public health care. What ultimately convinced you that this story needed to be preserved in book form?
The plan of the University of Illinois President to give the U of I Hospital to Cook County and move clinical education to Michael Reese Hospital was an important pivotal episode in the history of Chicago, and of public health care in the city. The events of that time determined the future of the U of I College of Medicine and had a major impact on Chicago’s West Side. People were fascinated by the story of the fight to defeat the plan. Whenever I related the saga, they responded that it was a story that needed to be told, and I was encouraged to write it. As time passed a new generation was unaware of this history, and I thought that it was important for them to know it. I had collected bankers boxes full of notes, letters, and newspaper clippings that I carted around with me during various moves after I left the U of I, intending to sometime write the book. When my wife threatened to toss the boxes into the recycling bin if I didn’t get started, I had no choice but to begin.
Before this experience, you had relatively little exposure to public advocacy and political organizing. What was the steepest part of that learning curve, and how did your understanding of leadership evolve during the campaign?
It’s true that overnight I was swimming in uncharted waters. As I was President of the Hospital’s Medical Staff, people began to approach me, telling me that I had to do something. I knew that something had to be done but had no idea what, or where to start. At an ad hoc gathering U of I faculty and staff founded CAUSE, the Coalition Against the University Sell-out Endeavor. It was an informal organization that had a “charter” membership of over four hundred which soon grew to over five hundred members. CAUSE became the voice of the opposition. This provided a forum for people to voice their dissent. An early lesson was that although it was important to represent a large constituency, the administration wasn’t going to be swayed by votes, petitions, or other demonstrations of opposition to the plan. The usual academic processes were not going to be effective.
A small group of us were meeting each morning, brainstorming on how to proceed. We were soon joined by other members of the medical center community, and then by leaders of community organizations who had prior experience “fighting city hall.” This small group of a dozen or so front-line troops was what was needed for effective day-to-day action.
Before this any leadership position that I held was not associated with significant controversy, and when one was the issue usually could be dealt with at a monthly meeting preceded by a little preparation. Now I was in a position which required daily (and sometimes nightly) attention. Learning to balance this with ongoing obligations presented a challenge. Fortunately, I had colleagues willing to relieve me of some of my clinical responsibilities.
Looking back, what would the consequences of closing the hospital have been for Chicago’s West Side?
There was no coordinated system for public health care in Chicago. Legally, it was Cook County’s responsibility. Chicago Board of Health Clinics played a part. Some care was given in private hospitals. The University of Illinois Hospital and Clinics played a key role — seventy percent of its patients were either “self-pay” (i.e., no-pay) or underinsured (Public Aid). The loss of the U of I Hospital would have created a big hole in the system.
The medical school would have been severely damaged, if not destroyed. Collaboration between basic scientists at the medical center and clinicians, six miles to the east at the new primary teaching hospital, would have been difficult, if not impossible. And as it turned out, Michael Reese was in worse shape financially than the U of I Hospital. It’s not likely that it would have survived, even with an infusion of state funds when the U of I programs moved there, leaving the University with no teaching hospital.
The Illinois Medical District would have lost a major component. And Chicago’s West Side would have lost a major anchor, impeding further growth and development of that part of the city.
What advice would you offer professionals who suddenly find themselves serving as advocates for their institutions?
First of all, you will be in a foreign arena and won’t know the rules of the game. I was fortunate that I was joined by people who had been in similar situations. Learn from those people if they are available.
Meet with your team often, if not daily. Listen. Two heads (multiple heads) are better than one.
There will be many at the institution who are only peripherally involved. Have frequent large group meetings to boost their morale and keep them informed and engaged.
It’s likely that there will be small defeats and setbacks along the way. If you are discouraged, be discouraged in private. Be honest with your constituents but project a positive outlook.
Choose your words carefully, especially when speaking to the press. Anything you say could end up in tomorrow’s paper or the 6 o’clock news. Be optimistic, but don’t overstate. Know the facts and stick to them. If you make an error, and you certainly will, admit it and correct it.
Develop a thick skin. You’re going to need it.
Author Links: GoodReads | X | LinkedIn | Facebook
It almost happened when the President of the University unveiled a plan to give the hospital to Cook County and outsource medical education to Michael Reese Hospital.
Opposition sprang up immediately. As President of the Medical Staff of the University of Illinois Hospital, Dr. John Skosey led a determined coalition of physicians, nurses, hospital staff, and community activists to combat the plan. Their exploits with the University administration, politicians, the press, and the community catapulted them into the risky world of high-stakes politics.
The six months that it took to defeat the plan left the hospital crippled and the medical school in disarray. The critical tasks of restoration took years.
That era left an indelible mark on the University of Illinois, its Medical Center, public health care in Chicago, and Chicago’s West Side. In Rabble Rouser, Dr. Skosey pulls no punches while recounting these events in an accessible narrative that will provide lessons for public health and public policymakers everywhere.
Rabble Rouser: The Battle of 1989 to Save the University of Illinois Hospital
John L. Skosey’s Rabble Rouser: The Battle of 1989 to Save the University of Illinois Hospital is a detailed memoir of a six-month campaign that grew from an internal university dispute into a public fight over medical education, political power, and access to health care. Skosey was president of the hospital’s medical staff when the University of Illinois administration announced its plan to close the hospital, transfer the facility to Cook County, and make Michael Reese Hospital the medical school’s primary teaching site. Recognizing the likely consequences for the university and Chicago’s West Side, he became a leader of the opposition. The book follows that struggle from the surprise announcement in December 1988 through the Illinois Senate’s rejection of the necessary legislation on June 30, 1989, then continues into the difficult work of repairing the hospital and medical school.
The book works especially well as a firsthand account of an ordinary professional being pushed into an unfamiliar public role. Skosey begins with little experience outside academic politics, but he gradually learns how to organize meetings, work with reporters, lobby legislators, build public support, and keep a discouraged coalition together. He’s candid about his mistakes, including presentations that were too long, missed opportunities with the press, and conversations in which he didn’t know the information that mattered to the audience. One West Side alderman gives him a blunt lesson after asking about the hospital’s Black physicians: “When you come to speak to someone like me, you’ve got to know those things.” Moments like this make the book more than a victory narrative. They show Skosey changing his methods as he begins to understand that defending the hospital requires listening to the community, not simply explaining the faculty’s position more forcefully.
The coalition at the center of Rabble Rouser gives the story much of its energy. Physicians and researchers are joined by nurses, hospital employees, students, lawyers, politicians, church leaders, neighborhood organizers, and patients. These groups don’t always share the same priorities, but they find common ground in the hospital’s importance to the West Side and its role in caring for uninsured and underinsured people. Trustee Gloria Jackson Bacon gives the faculty a crucial strategic correction when she tells them, “Nobody’s going to give a damn about a bunch of rich doctors losing their jobs. You need to engage the community and focus on healthcare.” That advice becomes the moral and practical center of the campaign. The coalition succeeds when the issue is framed around people, public service, and the future of health care.
Skosey tells the story with a conversational mixture of documentation, irritation, dry humor, and personal recollection. He describes tense board meetings, late-night telephone campaigns, legislative maneuvering, newspaper coverage, lawsuits, administrative rivalries, and the slow unraveling of clinical departments. The level of detail can be demanding, especially when the book traces agreements, appointments, committees, and institutional chains of command, but that density serves its purpose. Skosey wants to preserve a record of who acted, what was decided, and how a plan developed behind closed doors affected an entire medical community. The extensive appendices reinforce that documentary purpose by including letters, reports, resolutions, presentations, and contemporary statements. At the same time, small human details, such as nervous waits for votes, improvised strategy sessions, and a colleague later thanking Skosey for saving his job, keep the institutional history connected to lived experience.
Rabble Rouser is a civic memoir about collective action inside institutions that often seem too large and entrenched to change. Its most satisfying insight is that the hospital wasn’t saved by a single heroic speech or powerful insider. The victory emerged from persistent organizing, relationships with community members, strategic use of the press, legislative knowledge, and the willingness of many people to keep working through discouragement. Even after the Senate rejected the transfer legislation by a 39-16 vote, Skosey makes clear that the hospital and medical school had been badly damaged and needed rebuilding. That extended aftermath gives the story weight. The book captures both the excitement of stopping a major decision and the less glamorous responsibility of living with what comes next. It’s a valuable account of Chicago medical history and a thoughtful reflection on how professionals can become effective public advocates when their institutions and communities are at risk.
Pages: 444 | ASIN : B0FLYD5NK7
