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reshapes the Genesee Hospital

Joseph DeSilva: A change agent
reshapes the Genesee Hospital

The freezing rain and snow falling outside the Genesee Hospital reminded Joseph DeSilva of winters back in Massachusetts when he had to scrape a hole in the ice caked on his windshield in order to see the road. Sunny Phoenix has none of the Northeast’s blustery storms. Yet DeSilva left the warmth of Arizona to become Genesee’s new president and CEO, and to prepare the hospital for a health care environment that changes as quickly as the Rochester weather.
Genesee this month announced a dramatic reorganization of the hospital’s management structure. The new setup divides managerial positions into two categories: operations, which deals with day-to-day issues; and strategic, focused on preparing the hospital for the future.
DeSilva devised the plan with senior and middle managers in two months; he has been in office only since November.
“That’s late,” says Michael Nanko, a vice president of Mercy Healthcare Arizona who worked under DeSilva for some four years. “He has a lot of energy. He will act fast rather than sit on things for months or years.”
His willingness to move quickly in challenging the status quo earned him the nickname, “the Change Agent,” at Mercy Healthcare, Nanko says.
DeSilva left Cleveland in 1989 to become president and CEO of St. Joseph’s Hospital, an acute tertiary care institution in Phoenix. The region’s hospitals, like St. Joseph’s, had been somewhat conventional in their thinking, Nanko says. They knew managed care was coming someday, and they knew health care partnerships would be valuable, but they concentrated on the present.
Meanwhile, St. Joseph’s was badly in debt.
DeSilva arrived and shook things up, he says, not only at the hospital but in the Phoenix health care scene as well. He brought the area’s physicians and hospital executives together for the first time, and reached out to managed-care companies. He also began to shovel St. Joseph’s out from under its debt.
By the time DeSilva resigned last year, integrated delivery system Mercy Healthcare Arizona had risen from the desert to consist of a long-term-care division, a primary-care physician employee network, a managed-care plan for Medicaid patients, a fund-raising and philanthropic gifts foundation, and St. Joseph’s Hospital and Medical Center, which now posts an operating margin of approximately 10 percent.
Expect the Change Agent to do the same work in his new post, Nanko says.
“In Rochester, I can tell you, the market will change just by Joe being there,” he says. “Rochester, or the Genesee Hospital, or the Greater Rochester Health System, will never be the same.”
DeSilva’s actions in Phoenix were somewhat misunderstood at first, Nanko notes. His vision went beyond what many people could see. It took time for DeSilva to fully communicate his plans, and for his ideas to be fully understood.
A similar period of adjustment may be needed at Genesee too, he says.
While some staffers have shown discomfort regarding the new structure, the feedback has been overwhelmingly supportive, says Jean Haskins-Dalmath, vice president of public affairs.
The hospital’s board of governors unanimously approved the new organizational plan. DeSilva recognized the health care system’s dramatic changes, and set up a structure designed to meet the needs of the institution and its customers: the patients and the medical staff, says Beth Wilkens, immediate past chair of the board and attorney at Harris, Beach & Wilcox.
DeSilva’s vision also was unanimously supported at a recent meeting of the past presidents of the medical staff and medical chiefs, says Derace Schaffer M.D., chairman of the medical board. Schaffer called DeSilva’s articulate presentation one of the best-received communications between an administrator and a medical staff since he has been in the Rochester community.
“Joe is a very dynamic, hard-working, far-sighted individual who has a very good perception about the direction that health care is taking, and what will be required to provide high-quality health care in a cost-effective manner,” he says.
The reorganization will result in at least one cut, DeSilva says. The vice president positions for ancillary and general services were merged as vice president-support services; both former vice presidents are eligible to apply for the new post.
Factors affecting hospitals today underlie the new structure, DeSilva says.
With meager federal and state reimbursements, and the need for construction and renovations, hospitals must find ways to do more with less without affecting quality, he says. Hospitals and health systems also must adjust to the move from inpatient to ambulatory care, and the needs of an aging population.
Technological innovations and increasing hospital and health system affiliations also are part of the mix.
Leaving room for tomorrow’s changes while dealing with today’s needs is a strength of the new structure, and of DeSilva, several medical chiefs say. That is DeSilva’s forte, Nanko agrees.
“He’s certainly strong with operations and day-to-day stuff,” Nanko says, “but I think his strength is out in front, preparing the organization for where the market is going, or as I said (about) Phoenix, even directing where the market is going.
“He’ll be able to make the same things happen here–the same good things.”
The structure also drives decision making down the organizational chart, DeSilva says. Health care executives sometimes are guilty of building layers and not allowing employees to assume responsibility.
“I thought all presidents wanted to solve problems,” Nanko says, but DeSilva is different. People who come to him with problems they have not tried to solve on their own are not let off the hook.
“(The reorganization) puts a lot of challenges on the employees, more responsibility, but I think they want to take it,” says John Jurik M.D., immediate past president of the medical staff.
At the same time, DeSilva’s position atop the organizational chart has not put him out of reach, several medical staffers say.
“Overall, I think the (structure) can be misleading,” says John D’Souza M.D., chief of the clinical laboratories. “My impression is that he is very accessible to everybody.”
DeSilva also is adept at keeping the lines of communication open in the hospital triad of board, administration and medical staff, Jurik says, and is especially attuned to the medical staff–the people on the front lines.
DeSilva’s style takes some getting used to, says Nanko, who was a candidate to run Mercy Healthcare’s long-term health care division when he first met DeSilva in 1990. During the search process Nanko drove from Sacramento to Phoenix for a mid-afternoon interview.
At the meeting DeSilva asked Nanko to prepare a presentation on the future of geriatric care for the senior management staff–in two hours.
Yet Nanko says of the five CEOs he has worked under, DeSilva is the only one he would want to work under again.
DeSilva has eased up a little bit over the last few years, Nanko says. He used to be unable to sit still for more than five minutes; during meetings he would get up, walk around, talk to his secretaries.
“I learned how to act with Joe,” he says. “I was able to (pare) a half hour (to) one hour of meeting material down to two minutes.”
As a busy doctor, D’Souza says, he appreciates DeSilva’s ability to grasp complex problems and make decisions quickly. DeSilva’s meetings often last only 15 to 20 minutes, and his thinking is clear within the first five.
Both the medical staff and the board at Genesee have impressed DeSilva with their knowledge, interest in the community and cooperation with each other, he says. Board members have been particularly helpful in preparing his transition into the community.
DeSilva is the product of a lengthy search by the hospital’s board. His experience as a health care executive at several institutions, and with managed-care environments and integrated health care delivery systems, led the hospital to hire him, says Wilkens, co-chair of the board’s search committee. His membership and fellowship in organizations, such as the American College of Healthcare Executives, also impressed the board.
DeSilva’s new position brings him into another integrated delivery system, Greater Rochester Health System Inc., which includes Genesee, Rochester General and Newark-Wayne Community hospitals, among other organizations. His new post as CEO of a hospital and not of a system as he was in Arizona is not as far removed as one might think, he says.
“Genesee (is) as complex, if not more complex, than where I came from in Arizona,” he says.
Greater Rochester Health System will be making an impact within 12 to 18 months, DeSilva predicts. At Genesee, the new management structure should be in place in 60 to 90 days.
The board did not give DeSilva a specific charge to overhaul the structure, Wilkens says.
“The board had no particular mandate, no specific set of expectations when I came here,” he says. “They were looking to bring in a CEO who had experience (and a) different point of view than they would find if they recruited from within Rochester.”
The opportunity at Genesee was only one factor in DeSilva’s decision to leave Arizona. He also wanted to return to the Northeast.
DeSilva was born 54 years ago in Lowell, Mass., the son of factory workers. Of four siblings–three of them girls–DeSilva was the only one to attend college. He received his undergraduate degree in economics from Boston College in 1974, and an MBA degree from Massachusetts’ Babson College in 1980.
DeSilva’s background is in lab management. Hospital CEO Richard Mangion took DeSilva under his wing when he expressed an interest in health care administration, and in 1978 gave him his first opportunity by appointing DeSilva associate administrator of Harrington Memorial Hospital in Southbridge, Mass.
DeSilva met his wife, Anita, when she was head nurse in the recovery room of Burbank Hospital, also in Massachusetts.
In 1980, he became executive vice president and chief operating officer of Beverly Hospital in Beverly, Mass. There he worked under CEO Robert Fanning, whom he describes as probably the most significant mentor of his career.
After son Adam was born, DeSilva and his family moved to Ohio where he became senior vice president and chief operating officer of University Hospital of Cleveland in 1985. Son Jeffrey was born during the family’s stay there.
DeSilva took the Phoenix job in 1989; now back in the Northeast, he finds Rochester his ideal locale.
“This community has a great sense of tradition,” he says. “It’s very family-oriented, and that’s the environment to be in.”
As soon as he becomes more settled in his job and in Rochester, DeSilva plans to become involved in community activities as he did in Arizona with the Phoenix Art Museum, Boys and Girls Clubs of Metro Phoenix and Homeward Bound, an organization he chaired serving the homeless.
DeSilva has a generous heart that not everyone gets to see, Nanko says. Nanko’s opportunity came when he was developing a hospice program for Mercy Healthcare, and DeSilva told him of trying times caused by the aging of his parents. But the proof of DeSilva’s charity is in the time and money Mercy Healthcare puts back into the Phoenix community through projects such as free immunizations for 17,000 elderly, and free nursing home beds for 10 to 12 people each year who cannot afford to pay, Nanko says. Any time budget cuts threatened one of these projects, DeSilva said hands off.
“If Genesee is really a community-based hospital, people don’t need to be worried,” he says. “(DeSilva’s) not going to lose that perspective.”
Nor should they worry about his commitment to Rochester and the hospital itself, DeSilva says.
“I came here with the full intention of forming a partnership with the board, medical staff and employees,” he says. “I’m making a strong commitment to staying in Rochester and at Genesee Hospital until the end of my career.”
Says Nanko: “(DeSilva’s) heart and soul has always been east. He came to Arizona for the opportunity, (but) I think he’s at home in Rochester.”
[Rochester Business Journal Profile, 3/17/95]

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