BLOY: Doing the basics well

Francis Saba, president and CEO; William Muller, MD, vice president of medical affairs; Robert Srebnik, MD, emergency physician; Maria DaSilva, director of emergency services, and Cheryl Bonasoro, vice president of patient care services.

Francis M. Saba, president and CEO, Milford Regional Healthcare System Inc., Milford

When Frank Saba took over the top job at then-named Milford-Whitinsville Hospital, in 1990, the hospital’s board of directors had just canceled the contract of the for-profit management firm that had been running the hospital since the mid-1980s. Saba inherited a system that was so broken that the hospital employees’ health insurance was about to be canceled due to nonpayment of premiums.

The hospital’s physician group was alienated from the board and from management. Hospital finances were shaky. Patients were asking their doctors to send them to Worcester hospitals instead of Milford-Whitinsville, according to Dr. William Muller, now vice president of medical affairs and president of the medical staff of Milford Regional Health Systems. Into this situation came Saba, who had been hired as the hospital’s vice president of clinical affairs in 1988. He became COO and then CEO in 1990.

"He didn’t fit the stereotype" of a hospital administrator, says former state Senator Louis Bertonazzi, now a hospital board member. Saba wasn’t the hard-driving CEO type, and in the situation at the time, "I wondered how that was going to work for him."

Sixteen years later, Milford Regional Medical Center has survived a situation that has driven many a community hospital into merger or closure. It has regained the faith of investors and its community. As the keystone of the $178 Milford Regional Healthcare System, the hospital has kept its independence, expanded its physical plant and widened its affiliations. When asked what it was about Saba’s leadership that has made the difference, former board chair Jack Roth quickly replies, "His personality." Putting Saba in the leadership role, Roth says, "was by far the smartest thing I’ve ever done in my life."

After the management shakeup in 1990, "It was clear there was a lot of conflict and tension among those groups because of some of the experiences that had occurred in previous years," says the soft-spoken Saba. He started inviting doctors to board meetings, and bringing the board and the management together to develop a bond.

Attorney Christopher Jedrey of McDermott, Will & Emery LLP, who has handled the hospital’s legal affairs throughout Saba’s tenure, says he has "a gentle and kind way. People have underestimated Frank. He’s incredibly tough and persistent, a smart, nice guy who’s tough enough to get the job done."

Under Saba’s leadership, Milford Regional Medical Center has invested in the latest and best technology, and in basic services such as its emergency department, primary care, and obstetrics practices.

Milford Regional Health Care System has raised more than $100 million to finance this expansion, despite serving in a rapidly-growing region that doesn’t have an abundance of wealthy donors. The hospital has kept its community roots, throwing out the welcome mat to the public for its annual meeting, where, for the last several years, staff and administration have put on an amateur theater production recapping the year just past, boosting public attendance and involvement.

And when the chips were down, as they were in June of last year when an accomplished surgeon made a highly-publicized error on the operating table, removing the wrong organ, the hospital took the less-easy approach of standing by him rather than dismissing him. Milford Regional Medical Center was found by the state Board of Registration and Medicine to have done nothing wrong. It instituted measures that would satisfy conditions of the doctor’s probation, thereby staying the suspension of his license by the state board.

"We did everything we could to support him," Saba says. "Our first concern, as always, is the patient. ...Don’t get me wrong, we have detractors, we have people who would criticize how we handled that matter, but by and large as a community we all want to support each other. Because we all know that sometimes bad things happen."

Saving the hospital

The transformation of Milford-Whitinsville Hospital into Milford Regional Health Care System had several building blocks. But the first priority in 1990 was controlling costs. One component was layoffs – the toughest part, Saba indicates – and by renegotiating the terms of contracts with staffing agencies and with health care payrs as those came up for renewal. Within a year, the hospital was operating in the black, says Muller. Once the financial crisis was over, the next measures were:

• Affiliating with a major medical center

• Increasing primary care practice physicians by establishing a group practice

• Upgrading emergency response

• Making capital investments in leading technology

• Expanding critical services such as cardiac care and cancer care

• Reaching out to the community to build a capital campaign.

The 1991 affiliation with the UMass Medical Center (see timeline) was important to boost the hospital’s primary-care practice. Saba had come from the UMass Medical Center system as an assistant vice chancellor and assistant to the chancellor, and knew all the players there. UMass already had an affiliation with Tri-River Family Health Center in Uxbridge, a community health center organized in 1979 and headed by Muller, with 17 doctors and 5 nurse practitioners.

Bertonazzi, who was in the legislature at the time, recalls the initial trepidation among local hospital advocates regarding the UMass affiliation. But Saba won people over. "It’s his constant patience and the fact that he is such a good person that gets to people after a while," Bertonazzi says.

Milford Regional Healthcare System

1988: Francis Saba joins hospital as vice president of clinical services and ambulatory care

1990: Saba appointed CEO

1991: Milford-Whitinsville affiliates with UMass Medical Center, becoming a UMass teaching center in internal medicine.

1992: Establishment of Tri-County Medical Associates, a physician group practice that now has 56 doctors.

1994: Opening of Hill Health Center, an outpatient facility; residency program in emergency medicine established.

1997: VNA of Greater Milford-Northbridge Area Inc. merges with the hospital, becoming a hospital department providing home healthcare services.

1999: Expanded pediatric and women’s health fields; established family medicine residence program.

1999-2002: MRMC recognized as a Solucient 100 Top Hospital for four consecutive years.

2002: Expanded ER

2005: Complete $45 million expansion of the Patient Care Center, including 8 state-of-the-art operating rooms; a 24-bed telemetry floor; an expanded cafeteria and nursery; and a separate building for additional expansion of surgical services, maternity rooms, and office and meeting room space.

2006: Breaks ground on $25 million Dana-Farber Brighams Women’s Cancer Center

A strong presence in a growing region

The hospital also upgraded its emergency response system. "I think your emergency room is actually your face to the community," says Muller. "Particularly in Milford, where everyone’s got a hundred relatives in the general area."

The $25 million Dana Farber/Brigham and Women’s Cancer Center will round out Milford Regional Health Systems’ services to include medical oncologists and cancer specialists, advanced chemotherapy and radiation services, participation in Dana-Farber’s and Brigham and Women’s clinical trials, and cancer care that follows the same clinical guidelines and patient safety measures in place at Dana-Farber Cancer Institute and Brigham and Women’s.

Elizabeth Liebow, vice president of business development at Dana-Farber Cancer Institute, says of the 22 communities targeted for centers, Milford emerged as one of the top three. Saba, she says, has "set a tone" for the enterprise. Dr. Lawrence Shulman, chief medical officer and senior vice president at Dana-Farber and director of network development, says Saba’s vision was instrumental to the choice to site there. "He has a clear vision of what he wants the institution to be. His job is not to tread water; it’s to move the institution to the next level," Shulman says. "It takes somebody with some experience and the right skills to frame a vision."

Francis Saba

Age: 57

Residence: Shrewsbury

Education: Harvard University, 1971, BS in Biology; University of Michigan, 1976, MA, Health Services Administration

Family: Married, three grown daughters

Board of Director affiliations: Milford Chamber of Commerce; Blackstone Valley Chamber of Commerce; Massachusetts Hospital Association (also serves as vice chair of standing committee on public affairs): Sisters of St. Joseph; Bethany Health Care Center, Framingham

Memberships: Milford Industrial Commission;; MetroWest United Way Campaign Cabinet; School Council, Shrewsbury High School; St. Mary’s, Parish Council (also serves as religious education teacher); youth baseball and basketball coach; participant in Stepping Stone Community Theater Production.

Saba’s non-work passions are his family, the University of Michigan Football team and amateur theater. He’s alternately enthusiastic about the team and sheepish about his zeal for it, despite its inconsistent win record. On the job, he says, "I try to keep a positive attitude. I think I do most of the time."

It’s his spirit and collegial good humor that has helped him give the hospital a human face. With help from a pro, Saba introduced the tradition of theatrical skits to the organization’s annual meeting in order to foster staff morale and cameraderie, but also to get the public interested in the hospital’s activities. Theatrical sketches interpret the events of the preceding year, have brought the community out with enthusiasm.

"The business we’re in can be very sad with a lot of tragedy and loss," Saba says, so he endeavors to create a good work environment. "It’s nice to get away from the sadness and the difficult business issues and the difficult medical cases, and have a little fun." Besides, he adds, "I’m selfish about it because I like this."

Saba cites his family as a bulwark of support through good times and bad. His wife and three daughters are "just a great part of my life."

The growth of the hospital system is an achievement, he admits, but the end goal is patient care. "You keep that in mind as much as you can," he says. "You’re dealing with strategic, difficult issues and big projects, and that’s all exciting, but don’t forget, there’s people in those beds."