Setting priorities for health care.

L.A. County Health Services Director Mark Finucane is working his way through a heavy-duty list of needs to cure the Southland health system

An A-list.

In Los Angeles, that refers to many things. An agent's brightest, highest-paid clients. Or those most likely to get the best tables at Spago's.

But in this context, it pertains to health care rather than Hollywood. In specific, it represents Los Angeles County Health Services Director Mark Finucane's priorities.

Everyone has their A-List, Finucane (whose name is pronounced "Fin-ew-kin") asserts in a recent interview. He just happens to update his constantly, and makes sure everyone has a copy. Indeed, the 25,000 or so Health Services employees received the A-List with their March 15 paychecks as part of Finucane's "strategic memorandum."

"There's a list of things I consider essential to do my job, and that is to change the department," Finucane says. "That's the A-List ... it's probably the only way in a large organization to send an unambiguous and widely understood message."

He also has made it clear that any senior managers in his department resistant to the changes the A-List represents should seek employment elsewhere.

Among the A-List's current items:

* Secure the federal Medicaid waiver from the Healthcare Financing Administration, which will allow the diversion of Medi-Cal dollars from inpatient to outpatient services.

* Communicate his philosophies effectively.

* Improve morale; and keep his relations with the labor unions and the county Board of Supervisors running smoothly.

By all rights, the whirlwind decision-making that comes with the director's job and the difficulties of relocating should be taking a toll on Finucane, who took over on Jan. 15 after serving as director of Contra Costa County's health department.

His family has remained behind in Northern California so his children can finish out the school year; he's renting an apartment in the Bunker Hill towers. Finucane regularly puts in 12-hour days and has been so busy that he has yet to use the computer that's perched prominently on his desk.

When he's not at work, he blows off steam by long-distance running through the streets of downtown near his apartment, his Walkman customarily playing his beloved Bob Dylan, or one of the new bands he favors, such as the "Counting Crows."

And while Finucane may be an A-List person, his resume suggests he is far from an Type A personality. He has accumulated the experience that led up to his current job more out of chance opportunities than anything else.

Finucane confesses to having had no interest in higher education when he graduated high school in his native New Jersey, and he did not complete college until he was 28. He does not hold an advanced degree.

Instead, Finucane spent more than a half-dozen years after high school doing diverse things like managing rock music bands, serving a four-year stint in the Army and "bumming around" Europe before he finally enrolled at Wichita State University.

In his senior year, Finucane was elected student class president on what would be considered an anti-establishment campaign in much of the Midwest. He vowed to abolish the football team, which he thought cost too much money (the university eventually did just that a few years after Finucane departed).

He was working as an administrator in the Wichita public school system and was poised to enter law school when the system's superintendent, Mervyn Silverman, was appointed to head San Francisco's health services department. Finucane was tapped to be his executive assistant.

After working with Silverman for a couple of years, Finucane served in a myriad of other city and county government posts in San Francisco before being named to the Contra Costa job in 1984.

Six weeks into his new job, Finucane declares it to be "fascinating."

"I can't say how interesting and exciting the job is. That does not mean I'm naive, and that this isn't a back-breaking job. But it's every bit as interesting intellectually as I thought it could be," he says.

An example: Within his first two days on the job, Finucane had to decide whether to appeal the findings of an administrative heating regarding a physician at Martin Luther King-Drew Medical Center who claimed reverse discrimination at the historically African-American institution. That led to Finucane's decision to convene a diversity panel that would oversee the structure of Health Services' workforce.

"He's a no-b.s. type of guy," says Anthony D. Rodgers, CEO of the Local Initiative Health Authority of Los Angeles County, the region's nascent provider of managed care Medi-Cal benefits. Finucane sits on the authority's 13-member board of governors. "He's exactly the type of person Health Services needs at this time to turn things around. I can't say enough about him."

Raymond J. Baxter, who was San Francisco's director of public health the same time Finucane was in Contra Costa County, echoes Rodgers' sentiments.

"He's a very no-nonsense type of guy, very knowledgeable about the operational and policy issues, and very pragmatic," says Baxter, who is now a senior vice president at the Lewin-VHI Inc. research and consulting firm in Fairfax, Va. "He's one of a fairly rare number of people I know of who has his eye on the big picture but also knows the details. So he is able to translate back and forth what a broad policy change is likely to mean at the front-line, operational level ... that is an absolutely critical skill."

Finucane - by bearing an A-List, among other things - represented the focus the Board of Supervisors thought had been lacking in Robert Gates, his predecessor. Gates was voted out last summer when he admitted to the board he had no contingency plan to deal with last year's $655.5 million budget shortfall.

He is one of the few county officials who has the support of both the Democrat and Republican supervisors. The L.A. Times also lavished praise on him when he was appointed.

Finucane shrugs off the initial plaudits.

"Some of the early reports about what I was capable of were so personable that it made me uncomfortable. It was very flattering and my mother loved it, but I want to make sure that people understand you can't just change the health director, and change the health department," he says.

"And although I want to lower the expectations of Mark Finucane, I want to increase the expectations of the health department. ... I don't want people to think that I'm over-confident and that I think this job is easy. This is going to be the most difficult job of my life."

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Mark Finucane

Age: 48 Native of: Red Bank, N. J. Education: B.A., English, Wichita State University Spouse: Laurie (executive with Macy's department store chain) Children: two daughters, Claire, 11 and Lucy, 8.