Some 23 years ago, when Britain born and London-educated John Gunn was vice president for finance at Chicago’s Michael Reese Medical – where he’d injected energy and order into a chaotic administrative system – he received an offer from Memorial Sloan-Kettering Cancer Center in New York, the world’s oldest and biggest cancer hospital and research facility.

“My friends and colleagues in Chicago actually used the phrase, ‘New York’s a nice place to visit but you wouldn’t want to live there’ – they said that as a warning,” Mr. Gunn recalled yesterday over lunch. “I came anyway. I like a challenge.”

The challenge wasn’t just adjusting to more frenetic pace of New York. It wasn’t even leaving the familiarity of Chicago, where he’d lived affluently since arriving in America in 1968 after obtaining a chartered accountant’s degree from London University to join Arthur Andersen & Company, a top consultancy at the time.

“The challenge was to streamline Memorial Sloan-Kettering’s system,” Mr. Gunn said. “The challenge also was to make the facility more accessible to everybody. There unfortunately had been a perception that in order to get into Mskcc as a patient, you had to know somebody. I wanted to change all that.”

It would be some years before he acquired enough authority to make the changes he wanted. Hired initially as Mskcc’s vice president for finance in 1982,within five years Mr. Gunn was promoted to executive vice president; he’s now also chief operating officer, responsible for managing an institution with an annual budget of $1.5 billion, and a medical and administrative staff of 8,500 people from more than 50 countries.

“We are a microcosm of New York – we are a melting pot of diverse ethnicities and a gathering place for hugely talented and skilled people whose ambition is focused on our mission – providing the best cancer care there is,” Mr. Gunn said.

Mobilizing resources in pursuit of Mskcc’s mission hasn’t been easy. Egos in medicine can be just as prickly as, say, in show business. All of the hospital’s 500 physicians and 100 doctoral research staff work exclusively for Mskcc. While reimbursements from insurance companies are calculated at top rates, some of these personnel could conceivably making much more money in private practice. It’s the history – Memorial Hospital was founded in 1884, and the Sloan-Kettering Institute in 1947 – and the reputation, and cachet of Mskcc that help retain the facility’s world-renowned doctors, according to Mr. Gunn.

He also has had to convert what he characterized as a “sloppy billing” system into one where accounts receivable were dealt with in a timely manner. He’s digitized billing records. He’s created electronic medical records. He’s established satellite Mskcc clinics on Long Island and in New Jersey. He’s set up “disease teams” that bring together specialists to diagnose a patient’s condition well before any therapy is advocated. And he’s increased the outpatient ambulatory care – for chemotherapy and other noninvasive treatments – 150,000 visits each year to 500,000. Now 80% of Mskcc’s revenues come from outpatient and inpatient billings, the rest from philanthropic contributions and research grants.

Such a record makes John Gunn a very powerful man indeed.

In addition to the day-to-day management of a sprawling facility, Mr. Gunn must contend with the soaring cost of health care, which is America’s biggest industry, with an annual turnover of $1.7 trillion. (In five years, health care is projected to account for 30% of America’s GDP, now $11 trillion.) There’s the attention that needs to be paid to the projected opening late this year of a new suite of operating rooms. There’s also attention to be paid to the completion of a new research building, which will be completed in January 2006 and for which Mr. Gunn and his board are still looking for donors whose generosity could ensure that the facility carries their name.

Most of all, there’s dramatic reality of cancer being a disease without a cure.

“That’s why patient care is so important,” he said. “We may not yet have a cure for cancer, but through our attentive service, we give hope to our patients.”

It helps that Mr. Gunn has a calm, emollient personality; he’s rarely ruffled. It helps that he knows leaders such as Lou Gerstner, formerly CEO of IBM, and Mayor Giuliani, whom he’s invited to speak to Mskcc staff at leadership seminars that Mr. Gunn organizes every three months to boost morale.

And his own morale? He says the out let for his frustrations is the fact that he’s a drummer: He plays regularly at a drum club on East 14th Street in Manhattan. Until his knee problems not long ago, Mr. Gunn was also an avid skier. “Going downhill has a way of helping you concentrate totally,” he said, with typical British understatement.

And does his accent also help in his job?

“Yes, people tend to pay more attention to you,” he said. “In New York, it certainly helps to sound British.”

It also helps, Mr. Gunn said, that he possesses British administration DNA. He reminded a reporter yesterday that even during the heyday of the British Raj in India – which lasted nearly 300 years until 1947 – there were never more than 2,000 Britons administering a huge, hot, and dusty subcontinent of hundreds of millions of not-always-accommodating natives.

“I think common sense and fair play have always been characteristics of British administrators,” he said. “My management style is to empower people. I set goals and then give people a long leash. And I believe in recruiting good people. Without interfering in their work, I carefully monitor our financials, patient-treatment records – all with the objective of seeing how we could improve our services. I’m not able to walk away from problems; I tend to want to fix them.”

His record as an administrator has won him seats on the boards of Empire BlueCross/BlueShield, the Devereux Foundation, and the Greater New York Hospital Association.

As the lunch wound down, the reporter asked the big question about the big disease: “Will there be a cure for cancer?”

Mr. Gunn reflected for a moment, then said: “Cancer isn’t just one disease but a hundred diseases. I think the next round of discoveries will be in the diagnostic field so that cancers will be discovered sooner, allowing the patient and the physician to have more options for treatment. For years, we thought that chemotherapy was the best treatment. However, newer and more targeted therapies are beginning to show promise. We’re not so sure now. I think that if there are cures to be found, they will address specific cancers.”

He paused again, then continued: “But regardless of where medical research takes us, there’s the enormous responsibility that institutions such as ours have. And that involves being supportive of every patient. Our patients trust us. We cannot let them down. I’m conscious of this every moment of the day.”