TAKING OVER THE management of a young company is frightening enough. Taking over the management of a young company with no experience in the marketplace it serves is even scarier. But taking over a young company with no experience in the marketplace it serves when that marketplace is home health care can be sheer terror.

That's what faced Sharon Lawler, president of Express Medical Supply, Abilene, Texas.

"I was very new to the industry, and because I didn't know too much about [home medical equipment], it was spooky," says Lawler. "During the first couple of years of my running the company, cash flow in particular was scary. You want to build up your infrastructure, but sales are slow to come in because you're the new kid on the block."

Despite being new to the business, however, Lawler has managed to put her finger on the pulse of her customers-and give them the kind of care they want and need.

Express Medical opened its doors in February 1996 but did not prosper. The original owner then sold the company in July 1997 to one of his partners, who brought in a new management team that included Lawler.

>From the outset, Lawler tried to bring a new approach to the >operation, focusing on the delivery of patient care rather than the >sale of products and services. "Most of this focus emerged because >I'm a nurse, and so I come from a patient care background," says >Lawler. "In addition, our director of patient care is a respiratory >therapist.

"But what made this focus successful," she continues, "is that our CFO and the owner of the company brought in their business expertise. We were able to combine the various experiences to make sure we would eventually become profitable but never sacrifice patient care."

One way Express Medical has centered its business operations on patient care is by setting up a decentralized management structure. The company has five retail stores, each with its own manager who has considerable authority and responsibility over everything from employee supervision and inventory control to marketing.

"It looked to me that home medical equipment is a very personal service," says Lawler. "And all of our success has had to do with the fact that we have forged very strong relationships with not only our customers but also our referral sources in each retail center."

Most of the company's referral sources like dealing with providers in their own area, Lawler says, and the issue of locale seems to be even more pronounced in small towns, where patients living in nearby rural areas tend to prefer local providers.

"I can go to a retail store and do a health fair, and it's OK if I show up," says Lawler. "But what customers really want to see is the manager of the retail store and the staff at the health fair because they're neighbors. Doctors like it a lot, too. If I've got something new I want to talk to them about, they don't mind if I show up. But what they really like is to see a local person come in. So we decided to make our business a very grass-roots organization.

"That way," she says, "the managers of each retail location are responsible for forging personal relationships within their communities."