Frank Sacco vertical head shotAfter 28 years at the helm, CEO Frank Sacco leaves South Florida-based Memorial Healthcare System well-prepared for the future. The five-hospital network is the third largest public health care system by revenue in the country and prides itself on being able to fund all its uncompensated care through hospital revenues, using no tax dollars for patient care. Sacco recently spoke with H&HN about growth strategy and building solid board-CEO relationships.

You have combined steady growth and financial strength over the years. What does a CEO have to do to keep both goals moving forward?

SACCO: You have to have a collaborative team. It starts with governance in the role of a policy board, trustees who you can bounce ideas and who will help you find the right strategic direction. And then, you really have to have a management team that is empowered to follow that strategic direction. For the most part, my job was to pick people for that management team who were smarter that I was and worked well together as a team. Then, my job was to push them out of their comfort zone. Certainly, as you grow, you need discipline and to watch your finances, but more important than that, you need buy-in from the vast majority of the staff. To get that ,you have to communicate, communicate, communicate. You have to connect the “whys” because, if you get confusion, you stall.

Memorial is now one of the nation’s largest public health system by net patient revenue, at $1.8 billion. What strategies and philosophies drove that growth?

SACCO: First of all, culture beats strategy every time. If you put the patient at the center of every decision, everything else falls into place. That’s how you get buy-in from the staff. Putting patients and their families first is self-rewarding; it becomes the magic bullet. Otherwise, you can lose your sense of purpose. Then, we combined several strategies through the years. We looked at the community to see where the growth was, then we positioned ourselves not just to put a box where it seemed there would be growth, but to put the right services where they were needed. Filled the right niches. We went from one hospital having 3,000 births a year to three hospitals handling 12,000 births a year. There was a need for a children’s hospital and we branded the Joe DiMaggio Children’s Hospital in 1992. Later, we saw a need for a first-class rehabilitation hospital, and we became the third busiest rehab hospital in Florida. When we replicated services in the community, we did it intentionally. When we entered entirely new niches, we did that intentionally.

You’ve seen several board members come and go at the health system. What advice do you have about how a CEO and trustees of a system should work together?

SACCO: Well, you have to develop trust first and credibility with the board, and then you have to maintain it with constant communication. But also, be sure that the board members understand and stay in their roles. They are a policy board, and weigh in on strategy and, of course, have oversight of the financial picture. Many times, I’ve seen board members who didn’t know their roles when they started. I’ve always tried to sit down with them and ask, “What is your agenda?”I let them know that things work best without an agenda, with trustees who are willing to hear both sides. A board that gets too deep and micromanages means you have ineffective leadership and you’ll lose good managers. There needs to be a balance. I’ve been fortunate to have some really good leadership throughout the years; people who have defined the perfect role of a trustee.