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allegations are true. The intention is to show the general
thrust of corporate practices as well as the nature and
extent of any allegations made.
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Paul Ramsay is an
enigmatic controlling figure who keeps out of the public
eye. Patrick Grier is his front man in Ramsay Health Care.
The operation of the business and its culture are a product
of these two men. This web page looks at what we know about
them.
The People
There are two driving personalities in Ramsay Healthcare as well as a number of managers who have been with Ramsay for many years. Some are old school friends. These people all contribute. It is sometimes difficult to decide which of the two chief policy makers is the driving force in any particular decision. Grier has been the public face of the recent aggressive expansion and the ruthless takeover of Alpha Healthcare. Ramsay indulged in his takeover spree in the 1980s and got burned. He has approved Grier's enthusiasm and aggression but perhaps restrained him when he has gone too far. Grier's enthusiasm for aged care was not shared by Ramsay in the past but Ramsay has gone with it.
At the heart of Ramsay Health Care is one man, Paul Ramsay. Any assessment of the company must come back to the man who in large part owns the company and controls the decisions made. This is not easy as he keeps out of the limelight and seldom speaks in public. Information comes from his actions and from comments made by others. What emerges is a complex character with some contradictions.
He is clearly a very different person to some of those whom the US system has selected for success. He is quite unlike Eamer, Turner, Elkins, Lunsford, Scott or even Frist, Catchlove and Smedley all of whose unsuited personal characteristics brought them to leadership positions in health corporations. I have described all of them on this web site.
Ramsay is unique because he did not display these characteristics but, after stumbling, he was ultimately spectacularly successful. Perhaps partly because he did not fit the pattern, his enterprises in the USA ultimately failed. He almost went under in Australia in 1989 and made a disastrous decision in one of his other companies in 1997. He has also shown a unique capacity to reflect and learn from his adverse experiences and not be tightly locked into a particular ideological perspective. Unlike the US health care corporations he has not repeated the same mistakes.
In Australia he has succeeded in the market by avoiding the processes which are claimed to make the market system work and in doing so has avoided many of the adverse consequences. He employs a very different style of management to that commonly encountered in health care multinationals. None of this appears to be an intellectual challenge to market beliefs but rather a pragmatic response to his experiences, perhaps with some rationalisation.
Ramsay does embrace ideas and policies which are in his interests and justifies them. He has continued to espouse market medicine and to strongly support the US system urging the introduction of some of its practices in Australia, even though he is well aware of its consequences. It would require a radical conversion to change that.
Ramsay's background in a catholic private school and the personal relations he formed there have made him very much an old time manager with a sense of decency and responsibility for the well being of his staff. This has worked well for him in health care.
More worrying and in conflict with this perception of Ramsay as a good guy is the way he has behaved when under pressure. When his own interests have been at stake he had shown a ruthlessness and a hard headed willingness to do whatever was necessary for his success.
In at least one instance this has resulted in very adverse outcomes for those for whom he was responsible. This is particularly so as some of the concerns about his business conduct are recent. In fairness to Paul Ramsay, had he not shown these characteristics he would not be where he is today and we might have someone far less suitable.
Ramsay is a businessman. Success in the marketplace demands self-interest and ruthlessness. When the interest is also in the interests of the community this works. The problems come when the interests are different and in health and aged care this is often.
Two articles, one in 1995 and another in 2004 examine Ramsay the man and I have drawn heavily on them for this web page.
Ramsay is one of Australia's wealthiest people, with a net worth estimated at $400 million. He is a long-term member of the BRW Rich 200 list and can attribute about one-third of his fortune to his 41% stake in Prime. Most of his wealth lies in his controlling stake in the private hospital business, Ramsay Healthcare.
Feb. 2004 Wealth
Primed For Profit Business Review Weekly February 26, 2004
Ramsay, who lives in Sydney, owns almost 50% of the listed company Ramsay Health Care, Australia's second-largest private-hospital operator. He also has about 40% of the fourth-largest television broadcaster, Prime Television, which is also publicly listed. He chairs both companies. Through his private company, Paul Ramsay Holdings, he has rural interests (cotton and wheat at Gunnedah and cattle in the New South Wales southern highlands) and various property subdivisions and developments in progress along the east coast of Australia.
Oct. 2004 Australian business interests
Old school and other ties Business Review Weekly October 28, 2004
Ramsay's family background and private catholic schooling set him up to be a decent guy, and potentially a leader of the business world. It determined his interests, and his delight in sport and friendships. He had twin sisters and a brother who became a priest at his old school. Ramsay's business career in health care has been described on these web pages. His other major interest was Prime television but he has had many other businesses. He is an entrepreneurial businessman and runs health as a money making business. He is certainly well motivated within his own business environment but he is not a health care professional - even vicariously. This is essentially a privately run enterprise and should be considered as the equivalent of a private for profit operation. Many of these have performed well and Ramsay is not really an exception.
Ramsay was born in 1936, and educated at St Ignatius College Riverview in Sydney. When he finished school, he started law at Sydney University but left before completing his degree. His father was a property surveyor and developer, and Paul was more interested in the property business than a law career.
Oct. 2004 Early background
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According to Siddle, Ramsay's success in health care is a result of his thorough understanding of the hospital business. "After 40 years, he knows it better than anyone.
Old school and other ties Business Review Weekly October 28, 2004
Ramsay's love of Rugby was born from an education at St Ignatius, Riverview, the Jesuit school for which he still feels a tremendous bond. He says the school taught him to do everything well and set his "ground rules for life".
Mar. 1995 Early background
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Ramsay, with a twin sister, was born in Sydney but grew up in the Southern Highlands town of Burradoo.
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"I was bored," he reflects. "I wanted to create something and reading English legal history wasn't helping me to do that."He did his first business deal shortly afterwards in the early 1960s, asset stripping a small publicly listed company he had acquired for less than its real estate value.
Back From Brink And Into His Prime Sydney Morning Herald March 25, 1995
A pattern of a sociable, likeable, intelligent and very effective businessman emerges from the many extracts on this page. He is unmarried and reclusive as far as the public is concerned but admired by those who know him. A rather confusing picture emerges from the many reports.
Ramsay, 59, is an enigma partly because he survived the media buying binge of the 1980s where so many others did not, and partly because of his reclusive mindset.
Mar. 1995 Ramsay the man
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Prime ranks as Australia's fourth-largest television network by audience numbers, yet Ramsay is probably the country's least known media proprietor.
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A tall, slightly lanky figure, Ramsay is distinguished by a thatch of snowy white hair. His office is simply furnished and has the unlived-in look of someone who does not spend much time there. There is a statuette to commemorate the listing of Ramsay Health Care Inc on the New York Stock Exchange and a key to the city of Miami, Florida, where Ramsay's business exploits once earned him the mantle of Entrepreneur of the Year.
Back From Brink And Into His Prime Sydney Morning Herald March 25, 1995
Ramsay Health Care and Prime Television attract their fair share of media attention, but Ramsay himself does not. He is mentioned occasionally in the Sunday social pages: seen at a country race meeting, out on the harbor in his latest boat, chatting to officials at a Wallabies game, or because he has employed the "in" decorator for his Sydney harborside apartment.
Oct. 2004 Who will succeed him?
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At 68, with no family (he has not married and has no children), the question of succession is an interesting one. But there are no clues from management or friends about his plans. According to Siddle, neither Prime nor Ramsay Health Care has a mandatory retirement age for directors and Ramsay has no intention of taking a hands-off approach. Siddle says: "He'll work until he drops."
Old school and other ties Business Review Weekly October 28, 2004
Ramsay relates well to everyone and enjoys good relationships with the famous, whether sportsmen, businessmen or politicians. He is not conceited or snobbish in any way. He relates well to staff.
Away from the business world, Ramsay's great passion is Rugby. A fanatical Wallabies fan, his office boasts a much treasured snapshot of a night out he hosted the entire team and management to at the famous Lido nightclub in Paris after the 1993 tour of France.
Mar. 1995 People skills
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A Prime director and friend, Graham Rich, believes Ramsay's great strength is his people skills."Most people that you come across within his companies would walk under a bus for Paul. "He is not one of those intensive, hands-on owners and manipulators of the business."
"He is very good at motivating and inspiring the best in the people who work for him."
Back From Brink And Into His Prime Sydney Morning Herald March 25, 1995
Ramsay likes mixing with Australia's financial, sporting and political elite. He is a man of undoubted charm, a networker of great ability whose connections reach easily from business to politics, sport and religion.
Oct. 2004 His network
His alma mater, Riverview, run by the Jesuit order, has more than a kilometre of harbor frontage near the Sydney CBD. His brother is a priest there. Ramsay retains close links with the school, which is one of Sydney's best-endowed private schools. He endows various scholarships, and has made big donations for specific building projects.
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Ramsay is a great fan of rugby union, - - - , and likes to rub shoulders with current and former players and officials. A former Wallaby, Tim Gavin, runs Paul Ramsay Holdings' cotton and wheat property at Gunnedah.
Old school and other ties Business Review Weekly October 28, 2004
"Much of his success springs from his personality. He is the better side of the Catholic faith, he treats everyone from the specialist doctors to the cleaners decently. It has paid dividends for him."
Oct. 2004 Everyone treated decently
Old school and other ties Business Review Weekly October 28, 2004
Loyal colleagues and friends are Ramsay's trusted lieutenants and they have been with him for many years. Some are old school friends.
There is an inner sanctum of executives who look after Ramsay's private business interests.
Mar. 1995 The Ramsay team
Michael Siddle and Peter Evans - described by insiders as Ramsay's right and left arms - run the Australian operation and Greg Brown presides over Ramsay Health Care Inc in the US
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Siddle has been with Ramsay for 28 years and Evans for 25 years. Brown is a relative newcomer - of just seven years.
Back From Brink And Into His Prime Sydney Morning Herald March 25, 1995
Two of his longest-standing and closest business colleagues, Tony Clark and Siddle, are Riverview old boys. Clark and Siddle are directors of Prime Television and Ramsay Health Care.
Oct. 2004 Old boy network
Old school and other ties Business Review Weekly October 28, 2004
Ramsay has a hands off style and delegates extensively. He trusts and supports his staff, yet at the same time maintains a close grasp on his businesses. He exerts a guiding and restraining hand. He is a good listener but ultimately he ratifies or makes the final decisions.
As media proprietors go, Ramsay is not so much an absentee landlord as he is a "watching brief" type of owner.
Mar. 1995 Delegating
One of his great attributes is his ability to delegate. "What's the old saying: why have a dog and bark yourself," he says.
"I love being involved in the business and I have got some great ideas going forward, but I don't think life is all work."
Back From Brink And Into His Prime Sydney Morning Herald March 25, 1995
Unmarried and with no family commitments, Ramsay travels frequently and has a healthy appetite for fun. When in Australia he resides in Sydney, where he has an apartment at Quay West, or at either of his beach properties at Coffs Harbour in the north or Mollymook on the south coast.
Mar. 1997 Relaxed style
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Ramsay has created a culture that is almost paternalistic. He looks after his staff and commands tremendous loyalty.
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Paul Ramsay has spent only one day in the past month at the Greenwich headquarters of his Ramsay Health Care group in Sydney. The rest of the time he spent holidaying at Bowral, Mollymook and Coffs Harbor. Ramsay, 62, single and childless, considers that his managers can run Australia's third-largest commercial health business perfectly well without him. - - - - A few figures by phone or fax keep him in touch.
Ramsay Hitches His Star To The Public System Business Review Weekly Mar 24, 1997
"For me (Grier) the most fortunate thing was to come to Ramsay Health Care, it's always been run by a particular family culture by Paul Ramsay, and he is a very special person.
May. 2004 The culture
"Paul Ramsay has enhanced my management skills of people and allowed me to run the company the way I wanted to the best way I could, and this fitted in very well with Paul who is that kind of person."
Ref In The Private Hospital Scrum Australian Financial Review May 28, 2004
The key decision maker at Ramsay Health Care and Prime Television leaves public performances to his trusted lieutenants.
Oct. 2004 Delegates public appearances
Old school and other ties Business Review Weekly October 28, 2004
Ramsay's thinking and his point of view can be seen behind everything described on the Ramsay web pages. He thinks in market terms with which he identifies strongly, but is not locked into an ideological view of the market. He is loyal to Australia and to his credit would not sell out to the Americans . He rejected the infamous Columbia/HCA which would have paid very well for his hospitals in 1997.
He is a strong supporter of market medicine and of the policies of the coalition government's with which he is closely connected. One wonders how much of this government's policy bears his personal stamp. Much of his success in health care is a consequence of these policies.
"If I had my time over again (ie the 1980s) I don't think I would have gone out on such a limb," says Ramsay. "But I believe mistakes are a wasted experience unless you profit by them."
Mar. 1995 Claims to learn from mistakes
Indeed, it is a source of irritation to him that entrepreneur has become a dirty word in Australia in the wake of the free-wheeling 1980s.
Back From Brink And Into His Prime Sydney Morning Herald March 25, 1995
Late last year, the big US health group Columbia/HCA, with turnover of $US22 billion, sought to buy Ramsay's Australian operation. "I was not interested," he says, "although there might be scope for a joint venture. I am proudly Australian and I've only sold one Australian hospital since 1963. In the 1980s, despite several approaches, I was about the only hospital group that didn't sell out to the Americans." Ramsay's caution about Columbia/HCA is understandable. The US group, which controls nearly half America's for-profit beds and issues 100-year bonds, has a take-no-prisoners approach to business.
Mar. 1997 US companies and Ramsay
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Paul Ramsay says the Federal Government's main challenge on health policy is to persuade voters that public health facilities under Medicare can only be a safety net, albeit a good one by world standards. Anyone expecting "bells and whistles", such as immediate access to a doctor of choice, should be steered towards private insurance. Otherwise, he says, the Government would need another $5 billion a year just to maintain the status quo and another $5 billion to upgrade Medicare services.
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The proposed 1% tax levy on wealthy people who rely on Medicare is a good start, Ramsay says, - - - - -He rejects the argument that privatising health delivery in Australia will drive costs from 8-9% of GDP to US levels of about 13%..
Ramsay Hitches His Star To The Public System Business Review Weekly Mar 24, 1997
No man is perfect and behind all of the positive comment Ramsay and the companies he runs have had several less savoury moments, particularly when they were under pressure. As a businessman he has not always identified or embraced community or medical values.
His ruthless business streak emerged in his dealings with other shareholders in 1992, with Alpha Healthcare in 2001 and with NIB in 2002. These are described on another page. Money is made by cutting costs and some at least of his favourable treatment of the medical profession is directed at securing their cooperation in treading a fine line between care and cutting costs.
One report suggests some inappropriate egotism was involved in Prime Television's failed adventure in South America.
Most worrying are his international operations, the scandal surrounding his Ramsay Youth Services in the USA and the accusation of overcharging by psychiatric hospitals in that country. Ramsay was chairman of both sections. These matters were quite recent and the businesses were both under pressure at this time.
The company's share dealings with doctors in Ireland is worrying. A report describing Ramsay's rejection of requests for kickbacks from Australian doctors for using their hospitals does not indicate that these were seen as illegal, or something which should have been reported to the medical council.
The Paul Ramsay health group has halved the staff needed to operate its newly acquired Hollywood Repatriation Hospital.)
Jun. 1994 Reducing staff
MAYNE LIMBERS UP FOR A PRIVATISED HOSPITAL SYSTEM Business Review Weekly June 20, 1994
But according to Prime's chief executive George Brown, "when Ramsay decides to toughen up on something, it toughens up".
Mar. 1995 He can be tough
Back From Brink And Into His Prime Sydney Morning Herald March 25, 1995
The fight is coming to a head over more than $5 million in Medicaid funds two politically connected psychiatric hospitals allegedly improperly received in the early 1990s.
Jul. 1998 Improper payments
DHH threatens to withhold funds ::: Agency seeks over $5 million in improper payments The Baton Rouge Sunday Advocate July 19, 1998
- - - where consultants are currently negotiating the size of their shareholding in a development by the stockmarket-listed Ramsay Healthcare group from Australia.
May. 2002 Medical shareholders in Ireland
Tax changes gave a boost to private health clinics Irish Times May 2, 2002
A grand jury will investigate the state's only maximum-security facility for girls following reports of inappropriate sexual contact, improper use of physical restraints and excessively long stays in isolation units.
Jun. 2003 Scandal n the USA
SEX, ABUSE COMPLAINTS SPUR PROBE AT GIRLS FACILITY SITE FOR TOUGH JUVENILES INITIALLY PRAISED The Palm Beach Post June 17, 2003
But analysts and investment managers recall mistakes, such as Prime's poorly conceived investment in 1997 in Argentina's Azul TV.
Oct. 2004 Being a media mogul
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" - - - - The whole thing was about being a media mogul in South America." So it is hardly surprising that there is wide interest in the powerful man who pulls the strings at Prime Television and Ramsay Health Care.
Old school and other ties Business Review Weekly October 28, 2004
- - its public relations advisers, portray Ramsay Health Care and Prime Television (and its forerunner Ramcorp) as enjoying a dream run in corporate development and growth. In reality, their positions have been precarious at times. Ramsay has made a fortune but some of the small shareholders along the way have not done as well.
Oct. 2004 A checkered and risky past
Old school and other ties Business Review Weekly October 28, 2004
In these pages I have indicated that Paul Ramsay is a very different person to the founders and leaders of the big US corporations and also Australia's other health care companies. Each person is a product of their history and of their experiences in different situations. One can speculate what the consequences would have been had Ramsay started his first hospital in the USA and had he been successful in that marketplace - and not had success in Australia. Would he have been locked into market management by a different set of beliefs and would he have followed a different pattern in Australia - a pattern revealed by what happened in his youth services business in the USA.
Chief executive since 1994, Pat Grier is now Paul Ramsay's front man in Ramsay Health Care. He is likely to be Ramsay's successor. A Zimbabwean he brought marketing and organisational skills to the company. He has been a driving force in its growth strategy, in its public relations, in promoting a corporate culture, and in pursuing good staff relations. There is no doubt about his skills, his sense of mission or his devotion to Paul Ramsay. His influence will grow as Ramsay's fades. The appropriateness of his corporate and market perspective to the health care context is certainly debatable as are the consequences for health care culture.
Siddle says: - - - - "In health care, the main strategist is Pat Grier; Paul is more hands-on at Prime because it does not have a chief executive."
Oct. 2004 Grier a major player in health sector
Old school and other ties Business Review Weekly October 28, 2004
Grier said that when he entered the healthcare industry, its marketing was still unsophisticated, and there was plenty of room for someone coming from the more sophisticated retail sector to improve how the industry sold itself.
Jun. 2001 Rephrasing the health vocabulary in market terms
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"I have always worked on the management principle of getting good people into the business. Healthcare is very much a people industry. Our commodity is people fixing up people,'' he said.
Selling Health Care's Solutions For A Balanced Industry Australian Financial Review June 25, 2001
Robert Cooke , who runs Affinity Health , the nation's largest private hospital network and Ramsay's main rival, admires Grier.
May. 2004 Selling the new market vision of health care
"Pat Grier has shown the type of leadership which has lifted the prestige of the entire industry. Before it was fragmented, but since Pat and Ramsay have come in, they have co-ordinated the sector, triggered consolidation and, importantly, promoted the value of private health care," Cooke says.
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Michael Vukadinovic , director at Rothschild Investment Bank, acted for Benchmark and describes Grier's negotiating style as tough, gritty but always fair and personable.
Ref In The Private Hospital Scrum Australian Financial Review May 28, 2004
Grier had no health care background when he joined Hospital Corporation of Australia (later bought by Mayne Nickless) in 1984 after a series of other jobs. He moved to Ramsay Health Care in 1988.
He is the front man for Ramsay and has been regularly interviewed. He is a marketing man selling his own convictions and himself. There is consequently a trace of overconfidence in his statements as he is interviewed about his background. There is a little arrogance in his cock-a-hoop comments after Ramsay's successes. Whether this confidence will lead him to overreach and stumble remains to be seen. Has he bitten off too much buying Affinity Health? Some are wary of his enthusiasm about aged care. How will he respond and how will the vulnerable elderly fare if aged care drags Ramsay down?
Grier joined Ramsay 14 years ago and has been chief executive since 1994. A former teacher, he moved to Australia from Rhodesia (now Zimbabwe) more than 20 years ago - - - -. He says much of his work has gone into developing a corporate culture - what he calls the Ramsay way - to keep staff motivated.
Oct. 2002 Grier's background
Right Prescription For A Healthy Company Business Review Weekly (Australia) October 24, 2002
Pat Grier, managing director of the hospital operator Ramsay Healthcare has never shied away from change. Twenty years ago, he made the biggest change of all, uprooting himself and his family from their home in Zimbabwe to come to Australia.
Jun. 2001 Grier's picture of himself
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"So when I arrived here, I arrived with no job, no house, and a family all wide-eyed and wondering what Australia was going to offer.''
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He landed a job as national sales manager of SC Johnson Wax, a manufacturer of commercial and home cleaning, personal care, and home pest control products. He gained valuable experience in the Australian sales environment, before becoming general manager of Revlon's toiletries division.
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"I have never been averse to change; I packed up and come to Australia with nothing. I thought if I am going to change direction, why not go for something completely different. and so I went into health care.''
Selling Health Care's Solutions For A Balanced Industry Australian Financial Review June 25, 2001
- - - - - , in 1984, joined Hospital Corporation Australia, which was the largest private surgical hospital group in Australia.
May. 2004 Selling himself
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Stuck in the middle of a rugby scrum at one of his sons' matches, Pat Grier cops abuse from both sides as umpires do.He endures the heckling of the crowd and jeers from the players with characteristic equanimity.
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Grier's team (he loves sporting analogies) looks after 4000 beds nationwide and balances competing interests of doctors, patients, shareholders and health funds.
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Grier likes making big bets. He is hoping his aggressive growth strategy will pay off for Ramsay and its shareholders and, just like the umpires in any sporting code, once he blows the corporate whistle and makes a decision, it's final there is no turning back."When I was a referee I use to think, this is fantastic training to make your own decisions, I take my hat off to [them] as you have to make a decision and never go back on it, always go forward."
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The best is yet to come, Grier promises, as he would. Not content with stripping out returns of 15 per cent from his hospitals, he is winding up for a leap into the aged-care sector, from which he reckons his management team can extract even better returns.
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Grier says he has always had boardroom support for his militant growth strategy."I came at a time when Paul Ramsay didn't just want to stand still, he really wanted to grow the business, and the combination of this, and also having a culture of passionate people. It proved fertile ground for me."
Ref In The Private Hospital Scrum Australian Financial Review May 28, 2004
Grier adopts Ramsay's positive ideas and a businessman's view of the US health system. He is blind to its many failures and its exorbitant costs. He ignores the absence of an alternate to the private for profit health service in that country. In promoting private care he simply promotes Australian hospitals as comparable with the good system in the USA in regard to care and cost claiming ours are a bargain. Both claims are incorrect.
"I still think the private hospital industry does not sell itself as well as it should. I still don't think that we get the value-added story across to people who are looking to use the private sector,'' he said.
"We are providing a fantastic service, comparable to the US's private hospitals, and yet people still say, `Does it give us value?' Health insurance is low for the product that it gives you, considering that in the US it is very much higher.''
Selling Health Care's Solutions For A Balanced Industry Australian Financial Review June 25, 2001
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History
This page created August 2005
by Michael
Wynne
