With $6 million in funding commitments for three years, the CHI has begun driving down the numbers of uninsured children in King County. Program employees are locating and enrolling children in public health insurance programs, spreading messages in many languages about the value of early prevention and insurance, linking families and children to regular sources of medical and dental care, and encouraging integrated services within clinics. Since early 2007, more than 2,500 children have received health coverage, and more than 70 percent of those have been to a doctor. In addition, more than 6,300 low-income parents have learned about insurance and preventive medical and dental care. “It was all because of Ron going out and talking to leaders in the community,” Quinn says. “He just made it happen. We started doing outreach in July 2007, and since then, we've outpaced our projections of enrolling children and getting them seen by a physician.” The CHI also has spurred the state government to reach farther politically than it has in the past, by setting policy goals for statewide coverage of children by 2010.

In another initiative, Sims created the Puget Sound Health Alliance (PSHA), a non-profit organization comprised of health professionals, businesses and governments, to ensure that all residents are receiving the proper standard of health care. The group spent three years studying and defining treatment and care standards for a number of medical conditions, creating the first regional comparison report of its kind in the United States. The group collected data from employers and health care providers and used nationally approved measures to determine whether medical procedures are treating diseases as research says they should. “It took three years to get the report done, and a lot of people were getting antsy because they just want their costs to go down,” Quinn says. “But Ron kept everyone on board, focused on the goal.”

Last year, PSHA piloted a community-wide reporting program that applied the standards to rank doctors across five counties. The PSHA now reports in detail on every practice with six or more doctors, and the information is available to employers, insurers and consumers. “It helps encourage providers to implement their own improvements, and it helps consumers to see who's really treating a particular disease most successfully,” Quinn says.

“The PSHA was created with the idea that if [we] put everyone in the same room, we could come together on strategies to improve health,” Sims adds. “And now, it's fundamentally changing health care.”

Steering growth

King County's residents heavily rely on automobiles, and increasing air pollution from those vehicles can affect residents' health, environment and quality of life, Sims says. In addition, a growing population and aging infrastructure demand new ideas. “Rather than building new freeways, Ron started looking at new solutions,” says Carolyn Duncan, Sims' communications director. “That's his signature.”

In early 2007, King County joined the Washington State Department of Transportation and the Puget Sound Regional Council to secure a $127 million Urban Partnership Grant from the U.S. Department of Transportation. The group's winning transportation strategy centers on Sims' suggestion of variable tolling, a market-driven approach to reducing congestion (tolls are higher during peak travel hours and lower when fewer vehicles are on the road). With the funds from the tolls, the state will help pay to replace a vulnerable, 40-year-old bridge across Lake Washington that connects Seattle and its growing suburban communities. The plan also specifies adding 45 buses to the suburban corridor, providing up to 1 million new bus passenger trips each year.

Early in 2007, Sims led the rollout of King County's Transit Now initiative to expand Metro Transit service, which was approved by voters in the November 2006 general election. Funded by a one-tenth cent sales tax, the measure will help Metro expand service by 15 to 20 percent over the next 10 years. Longer-range improvements will include creating bus rapid transit service in five busy corridors, more bus service on high-usage routes and in growing residential areas, and improvements to the transportation system's Rideshare and paratransit options. To support the increased service, the county is adding new buses to its fleet and replacing aging buses. Many of the new buses are hybrid diesel-electric coaches, which fit into the Regional Green Fleet Initiative that Sims organized with other neighboring governments in 2007.

With his transportation plans, Sims “has integrated pollution control with livable communities, which creates healthier people, which helps on health care reform,” Duncan says. “It really all fits together, and he has this integrated approach: All these initiatives used to operate in silos, but now we have cross-discipline teams working on solutions with a holistic approach.”

That holistic, big-picture approach is the genius of Sims' leadership style. But, while the ideas may start with Sims, he is quick to share the credit for what has been accomplished on his watch. “I'm most proud of my innovative, talented staff,” he says. “I believe you have to manage incompetence, but you can just enjoy intelligence that is calibrated enough to succeed.”
— Nancy Mann Jackson is a Florence, Ala.-based freelance writer.