Surviving Twin Challenges
Lois Quam had three babies and took on two high-profile jobs within 23 months. But the family demands she faced made her a better manager.
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The Responsibility Project
The morning after Lois Quam gave birth to her first child, Ben, the chief of staff to the governor of Minnesota called to ask if she would chair a new state health care reform commission. She said yes and used her six-week maternity leave from United-Healthcare, where she was research director, to set up hearings. Suddenly, at age 28, she was a working mother with two big jobs, juggling legislative sessions, business meetings, and baby rearing.
Less than three years later, shortly after she’d had twins Will and Steve, Quam was offered another high-profile opportunity. Her boss wanted her to run United-Healthcare’s public-sector services division. This time, she said no. “It was so overwhelming with twins. You can’t pretend it doesn’t make a difference. So I said, ‘I’d really like to do this, but my primary focus for this period of my life is my sons.’” She remembers thinking, “This is going badly. It isn’t strategic to be so blunt.” But her boss surprised her. “He said, ‘It’s not a job that pays by the hour. You do it in a way that works for you, and if it doesn’t for me, I’ll tell you.’”
Looking back, Quam describes his reaction as an “amazing gift”—not because it persuaded her to take a position that would propel her to the top of her industry but because it affirmed her instincts about the best way to balance career and family.
At work, her colleagues would see that she was a committed mom. And at home, her husband and sons would know how much she valued work. By embracing both parts of her life, she would become more focused and effective in each.
As one of four children raised by first- generation Norwegian-American parents in rural Minnesota, Quam had always wanted to be a mom. She married her husband at 23 and started planning a family not long after. But her desire to work, to lead and make a difference, was just as powerful. As a teenager, she was active in Lutheran Church youth groups. At Macalaster College, she majored in political science. And after graduation, she studied at Oxford University as a Rhodes scholar.
Quam returned to St. Paul, hoping to work for the state Medicaid program, since early experiences as an asthmatic child had stoked an interest in health care. But circumstances were tough. “We were living in a friend’s apartment, driving my grandmother’s car, and trying to pay my husband’s law school bills,” she recalls. “So I went into the business world.”
When she accepted her job at United-Healthcare—at that time a $440 million company—she was not yet pregnant with Ben. By the time she started, she was. Still, she says, “everyone was supportive,” and the pregnancy was an easy one. She worked until the Friday just before her due date, had Ben on a Sunday, and felt well enough on Monday to call the office. When she did, her assistant was breathless. The previous month, Quam had interviewed to be on the Minnesota Health Care Access Commission, building on work she’d done for the state’s Children’s Defense Fund, and Governor Rudy Perpich’s office had called three times that morning. Four days later, Quam put on her most respectable maternity dress and met the governor at a nearby state fair to accept the chairwoman appointment. “We were praying it would go fast so she could make it back in time for Ben’s next feed,” Quam’s husband, Matt Entenza, recalls.
Quam spent the next few months hiring commission staff and outlining a process by which she thought she could win broad-based support for reform. And she brought Ben to nearly every meeting. Perhaps some people thought less of her for working with a bassinet by her side. But rather than feeling “aggrieved,” Quam saw it as an opportunity, a chance to “make headway fast.” “I was underestimated,” she says, “which gave me some running room.”
By October, she had also returned to United-Healthcare, leaving Ben with Entenza, who had 12 months off before starting a federal clerkship. Over the next year, she found a happy balance between her job, the government work, and her family. But then, in late 1990, Quam became pregnant again—this time with twins. “I felt different immediately—very exhausted,” she says. “I remember sitting in my office and being tempted to go take a nap in my car.” Yet she pressed on, working full time, pushing the commission’s proposal through the state legislature, and making time for Ben and Entenza at night.
The multitasking came to an end on June 3, 1991, when Minnesota’s new governor vetoed the bill and, hours later, Quam went into premature labor. Doctors managed to stop it—the babies were only at 31 weeks—but they put her on bed rest. “I had to lie on my left side and only go between the first and second floor of my house once a day,” Quam remembers. Communicating by telephone and fax (this was before e-mail was common), she did stay involved with the commission, meeting with executive director Jim Koppel to craft a post veto strategy and, with her office, working on research articles. “I tried to do it in a way that allowed [things] to progress without my day-to-day engagement,” she explains. “My overwhelming concern was that the babies be healthy.”
Will and Steve were born on July 23, at 38 weeks, weighing 8 pounds and 7 pounds. “That’s been my greatest achievement—no question,” Quam says.
A New Balancing Act
Still, the twins’ arrival opened up a host of new anxieties: “How do I reenter life? Can I stay on the track I’m on?” Quam remembers thinking. “I’m the only woman in my family to work. My mom stayed home; my sister and sisters-in-law all do. And I wanted to be a very involved mother. But I also wanted to contribute to building other really important things. When I came off this hard pregnancy with three little people to care for, I had to figure out what I was going to do differently to be true to what I wanted for me.”
She took eight weeks’ maternity leave before going back to both jobs: managing research at United-Healthcare and trying to revamp the health care legislation so it would be accepted. (Entenza, whose clerkship had ended, stayed home with the twins for 10 months, then went to work in the Minnesota attorney general’s office.)
The next two years at home were filled with sleepless nights (“If the kids woke up before 3 am, I got them; if it was after 3, Lois did,” Entenza says), hospital visits (Steve and Ben had asthma problems), and the general chaos of life with three small boys (piles of cloth diapers, Legos on the floor, juice stains on the couch). “We were pretty ragged,” Entenza admits.
At work, however, Quam remained a model manager, accepting her promotion and then laying the groundwork for what would become Ovations, a UnitedHealth- care division employing 20,000 people and generating $32 billion in revenue when she left it. “Going back to work when she had these babies had to be an emotional stress,” says colleague Marcia Smith, who also has twins. “But Lois was calm, supremely organized. You didn’t pick up on any angst.”
Her fellow commissioners tell a similar story. “I recall the twins, but I don’t recall it impairing her in any way,” says George Halvorsen, now CEO of Kaiser Foundation Health Plan and Kaiser Foundation Hospitals. “She was very collaborative, and she worked extremely hard.” The result of that effort was MinnesotaCare, legislation enacted in 1992 that became a model for other states.
So how did Quam do it? “There were times I was really tired and thought, ‘Should I take a break?’” she admits, “but my husband reminded me that if you’re home with three kids, you’re tired, too. He said, ‘you’ve got a lot to contribute. You enjoy working. Let’s just think about what we have to change to make this work.’”
Her first strategy was to focus on big- picture goals. At home, her main priority was to be an engaged mother and wife with a healthy, happy family. To that end, she started work later than many officemates, left earlier, never worked week- ends, and was always available in case of emergencies. (“There were days I would get to work and turn right around because someone was sick.”) At work, her ambition was to build a business to scale by understanding how United-Healthcare could help government programs succeed. So she started each morning not by returning messages but by sitting down with tea and a notepad to think about key issues: opportunities, risks, recruitment, retainment, next steps. Koppel says she brought the same focus to MinnesotaCare. “I have many memories of Lois saying, ‘How do we get this done?’”
Two other tools that served Quam well were division of labor and delegation. If she cooked, Entenza did the dishes. If she paid the bills, he picked up the toys. Friends and family helped with babysitting, but the couple also used all their savings to pay for a full-time nanny, a college student errand runner, and conveniences like grocery delivery (though a professional cleaning service was deemed too much of a luxury). Quam took the same approach at United-Healthcare. “In every case, I questioned, ‘Does this require me?’” she explains. “I might send a team member to a key meeting that my peers would do themselves because the boys were sick or I didn’t want to be away another night.” Yet that made her a more popular boss: “People wanted to be on my team because they got a lot of opportunity.”
Quam’s last rule of thumb was to be honest about who she was and allow her disparate worlds to overlap. So, just as she brought Ben to commission hearings early on, she started taking business trips with one twin in tow, partly to save Entenza the pain of being home alone with three boys, but also to do some one-on-one mother-son bonding, and, later, to expose her children to her work. (A corollary rule was that if she traveled alone, she had to return well rested.) On the job and in public forums, Quam also frequently talked about being a parent. It was a way to engage people on a personal level and encourage them to keep thinking about the importance of affordable health care, particularly for kids. Smith notes that this candor was unusual at the time; “work/life balance” had not yet become a corporate buzzword. “Lois carved that out for herself,” her colleague says. “Although her career became just huge, if she was asked to choose, you always knew what she would say.”
Quam’s oldest son is now 21; the twins are 19. Having left UnitedHealth Group in 2007 and done an 18-month stint over- seeing investment bank Piper Jaffray’s environmental and health care division, she now runs her own company, Tysvar, an incubator for “new green economy” and health care reform businesses. Looking back on her time as a young working mother, Quam acknowledges that she started out with the goal of “just making it.” “It was a very tough time,” she says. “But I was forced to learn things that made me more effective. It was the experience that should have made it impossible for me to become a CEO. But it actually gave me the remaining skills I needed.”