Good Medicine

Since he arrived at Baystate Medical Center 12 years ago and assumed the title of president, Mark Tolosky has made it a habit to attend the facility’s twice-monthly new-employee-orientation sessions. He says he does so to "put a face" on the massive health care system, and share with the newcomers his thoughts on the values and goals he considers most important. It’s part of a personal approach to management that Tolosky, now CEO of Baystate Health System and the subject of this month’s CEO Profile, owes to a childhood spent in a tiny mining town in upstate New York, and the lessons he learned from the people who carved out a life there.

Baystate Medical Center is the second-largest health care facility in the state. More than 5,000 people work there, and 1,000 physicians administer care to the thousands of people who visit the complex every day.

This is a city unto itself, one that is a world — make that several worlds — away from the place where Mark Tolosky, CEO of the Baystate system, grew up and eventually developed a special interest in health care.

That place is Lyon Mountain, N.Y., an iron-ore-mining town in the Adirondacks near the Canadian border. Its claim to fame is that the cables in the Golden Gate Bridge were made with ore from the Republic Steel mine that gave the community its identity. When Tolosky grew up here in the ’50s, the town’s population was 900, and dominated by Poles, Lithuanians, and other Eastern Europeans who worked hard to support their families.

"Everybody knew everybody, and life was really simple," said Tolosky, who would become an Eagle Scout and an athletic star at the town’s tiny high school. "It was very close-knit, and everyone looked out for each other. I could walk down the street and tell you who lived in every house."

Tolosky, the subject of this month’s CEO Profile, takes the same approach to his responsibilities within the Baystate system, where he succeeded longtime CEO Mike Daly in January. He practices what he calls a very personal style of management, despite the size of the facility and the scope of his responsibilities.

For example, Tolosky often hand-delivers complimentary letters he receives about employees from patients and reads them to the individual in front of his or her co-workers. Meanwhile, he still attends many of the company’s bi-weekly new-employee- orientation meetings.

"I like to meet and greet the new employees and talk about values … I want to put a face on the organization," he said, noting that he started attending the sessions soon after he arrived at Baystate in 1992. "I also want to let them know that the leaders that are making decisions about this organization live and work in the community, and you can see them, touch them, and converse with them."

Tolosky assumes the helm of the Baystate system at a very challenging time for this industry. He told BusinessWest that providers are being stretched to the very limits of their capabilities and imaginations, and he doesn’t believe the health care system can maintain itself much longer without meaningful reform.

"I know people have been saying that for the past several years, but it’s clear to me that we can’t keep going in this direction," he said. "There is a fundamental belief among people who know this business well that the course we’re on is not sustainable.

"There are 600,000 uninsured people in this state now — that’s equivalent to the population of the city of Boston," he continued. "The data is looking continually troublesome, and when you factor in the aging population, the Baby Boomers who are reaching retirement age, and the unbelievable advances coming in technology and interventions in pharamaceuticals, and there’s a mismatch between what our capabilities are going to be and what society may want to commit to."

The problems facing health care are so acute and so numerous that, when asked what he would do if he had a proverbial magic wand, Tolosky said leaders in this industry have pondered that very question, and have come to the conclusion that there are no easy answers or quick fixes.

He said that, if possible, the process would begin with a national dialogue about what people expect from the nation’s health care system, and whether they’re willing to pay for that care.

"In the absence of the war on terror, health care will be, over the next five to seven years, the single biggest state and national political issue," he said, adding that while the presidential candidates have been relatively quiet on the subject to date, that will soon change. "I’m very frustrated with some elected officials who have a very short-term view and are simply not dealing with the very predictable long-term consequences of the track that we’re on."

In a wide-ranging interview, Tolosky talked about the challenges facing the health care sector, his short- and long-term goals for Baystate, and how his upbringing shaped his leadership style.

Lessons in Caring

Tolosky told BusinessWest that he was first drawn into health care, and first considered it as a profession, after listening to the stories told by a longtime friend of his father who managed a small hospital in Southern New York.

"Our families would see each other in the summertime … I would listen to him talk about health care and became intrigued," he said. "When I finally went to visit his hospital, I was absolutely fascinated by what was behind the walls.

"Until that time, when I thought of hospitals, I thought of doctors and nurses," he continued, "but this visit really opened my eyes; I was fascinated by all the different types of people, the different disciplines, how complex the processes were, and the overall business aspect of a hospital. It caught my attention."

Tolosky attended schools in Lyon Mountain (there was one building for all 12 grades) before his father was transferred to another community in New York after the mine closed in the late ’60s in the face of heavy foreign competition. He later went on to attend State University of New York in Binghampton, and then Xavier College in Cincinnati, where he earned a master’s degree in Hospital and Health Care Administration.

After serving as an administrative resident at Ingalls Memorial Hospital in Chicago, Tolosky took his first job at Franklin Square Hospital in Baltimore. He started as assistant director, moved up to associate director, and later to senior vice president.

During his stint at Franklin Square, Tolosky devoted three summers and countless nights to pursuit of a law degree at the University of Maryland School of Law, and at one time had a small private practice.

"I always enjoyed law, and I think it really helped me develop my analytical skills and my writing and speaking," he said, adding that while he considered joining a large law firm and specializing in health care, he ultimately decided that he would stay in hospital administration. "I enjoyed management, and I enjoyed being part of an organization and leading it, and in 1980 I made a very deliberate decision to stay the course."

From Franklin Square, Tolosky moved on to Faulkner Hospital in Boston, which he served first as chief operating officer and later as president and CEO. In 1987, he took a job as executive vice president of Mount Auburn Hospital in Cambridge.

Tolosky told BusinessWest that he greatly enjoyed his work at Mount Auburn, and had no intentions of leaving there. But Daly and others actively recruited him for the position of CEO of Baystate Medical Center and senior vice president of the Baystate system.

In the end, it was an opportunity to work at a bigger system and a chance to stay close to his family in New York, and thus it was an offer he didn’t want to refuse.

"I wasn’t going to go to Texas or Florida or California," he said. "My whole family is from Albany north, and my wife’s family is also in New York, and our families are very important to us."

And while Tolosky was soon on a track to succeed Daly, he wasn’t thinking that far ahead when he made the decision to come to Springfield. "You never go somewhere for the next job, because something can, and often does, go wrong," he said. "I came here for the job I was hired for."

Getting Personal

That job evolved considerably over the years, he said, noting that, while he was charged with administering Baystate Medical Center, he also had a system role. He was involved, for example, in the broad care delivery system that includes Franklin Medical Center, Mary Lane Hospital, and the Visiting Nurse Association. He was later assigned academic affairs, research, and information technology.

"The scope of my role kept getting more pervasive — bigger, broader, deeper — and that happened over a period of many years," he said, adding that the depth of his responsibilities left him well-positioned when, about three years ago, Daly initiated the process of selecting a successor.

That search process morphed into what became a lengthy transition period that Tolosky described as "remarkably smooth," in part because of the careful planning that went into it, but also because the two leaders share many of the same visions and management philosophies.

When asked for a job description for the CEO of a system of Baystate’s size, Tolosky said that individual obviously helps to shape a vision for the institution and is intricately involved with putting together the business plans for meeting goals and objectives. But the bigger assignment, perhaps, is setting a tone for how work will be carried out and how care will be delivered.

"I think that’s an important role — determining what this leadership team stands for, and what kind of organization we’re going to be," he said. "Are you going to be driven purely by the numbers, or are you going to be a compassionate organization?

"The CEO puts the stamp on the values of the organization and answers the question: what do you stand for?" he continued. "And how do you, as a CEO, project that in real life, on an hourly basis, in how you conduct your work?"

Tolosky answered his own question by saying that he takes a decidedly personal approach to what he does. Attending new-employee-orientation meetings is part of the equation, but the work continues after the individual is hired.

"I make a deliberate, concentrated effort, which I thoroughly enjoy, of making phone calls to thank people for things," he said. "I send notes, and I hand-deliver complimentary letters to staff members. Those are just some of the ways that I like to personalize my work and not be remote; I think it’s very important to be visible."

As for Baystate’s short- and long-term future, Tolosky said he will work in conjunction with the system’s board and other members of the management team to shape a strategic plan. Long-term planning is more difficult than ever given the current climate in health care, he said, but health care systems can project a few years out and plan accordingly.

"You can’t stop thinking mid- to long-term, but you can wait on your specific commitments as long as you can to make sure you have the best sense of the environment," he explained. "We’re always thinking out and looking at demographic trends; we have a five- to seven- to 10-year look, and we keep translating that back into three-year goals and then one-year objectives. We have a multi-layering of how we look at the world.

"Overall, we need to evolve," he continued. "That’s because there’s a natural migration of procedures and technology to community hospitals and physicians’ offices. We need to keep climbing up the sophistication scale, so that we’re differentiated. If we just sat back and we didn’t change over the next eight to 10 years, a lot of our business would go right out the front door."

Critical Condition

As he talked about the situation facing health care providers today, Tolosky spoke as both the CEO of Baystate and the immediate past president of the Mass. Hospital Assoc. In that role, he pressed the case for all the hospitals in the Commonwealth, and became keenly aware of the political, economic, and logistical challenges facing those now seeking reform of the current system.

"The bigger view of the industry is very troubling," he said, "and it doesn’t appear that the political ambition to take this on is there — at either the state or federal level. We learned with the Clinton administration that a wholesale change in the health care system is not something that is embraced by most Americans."

Summarizing the problem facing the health care industry today, Tolosky said medicine is advancing at a phenomenal pace. New technology and new pharmaceuticals are improving the quality of care that can be provided and, in most cases, the quality of life of individuals receiving that care.

The big problem, of course, is how to pay for it all. Americans want and expect the best, but they are also reluctant or, in many cases, unable to pay for it, said Tolosky, and neither the government nor private insurance companies are moving to pick up that cost.

Reimbursements from public and private payers continue to fall, said Tolosky, while, in the case of insurance companies, double-digit increases in premiums have been placed on individuals and businesses.

There are other problems, as well, starting with shortages of many health care professionals, especially nurses, and lack of any real solution to the problem. In fact, in many areas, including Western Mass., there are more people trying to get into nursing programs than there are seats in the classrooms.

Meanwhile, the environment for physicians has become increasingly uninviting, especially in Massachusetts, said Tolosky. They face reimbursement problems of their own, coupled with skyrocketing malpractice rates that are driving them out of the state or into retirement.

And for facilities like Baystate, there is another issue to contend with — capital, or lack thereof. "When we look at some of the great things that are coming to the marketplace, as well as our need to rebuild some of our facilities, our tremendous need for information technology, and capital equipment to take care of patients, it’s going to be a real challenge to afford all that — and we’re one of the three strongest organizations in the state," he said. "Some smaller institutions just have no access to capital."

Add it all up, and it’s not a pretty picture, he said, adding that many in the industry have trouble even deciding where and how to begin fixing the system.

"When you talk about waving a magic wand, or asking people what they would do to solve the problem, that’s the question that causes the best and the brightest people to glaze over," he said. "What should we do? That question is so big, so interdependent, so complex, no one can take three minutes and say, ’this will fix our health system.’"

Tolosky told BusinessWest that, while waiting for that larger solution, elected leaders should refrain from quick fixes, which is how he categorized the national drug legislation that was recently passed.

"I think there’s going to be a revolt in this country by seniors when they figure out what this national pharmacy benefit is and what it isn’t," he said. "The average American thinks it’s first dollar, every dollar that’s covered by this proposal, and that’s not what it is — that’s nowhere near what it is, and that’s why I think that issue will get revisited, and soon."

Healthy Approach

Tolosky admitted that he certainly doesn’t know everyone at the Baystate Medical Center, let alone the rest of the system, on a first-
ame basis. But he knows many of them, and can usually recognize people by face and the department they work in.

He’s delivered letters from patients to some of these employees, and he’s met hundreds of others at new-employee-orientation sessions. When asked how and why he takes such a personal approach, Tolosky replies simply, ’that’s me … that’s how I was brought up."

It’s a style of management that has put Tolosky at the helm of the largest Massachusetts health care facility west of Boston, and one of the Top 100 hospitals in the country. It’s also made him Lyon Mountain’s other claim to fame, besides the cables in the Golden Gate Bridge.

George O’Brien can be reached at [email protected]