A key to the culture of St. Joseph Hospital in Towson can be easily gleaned from a bronzed list of its leaders posted in a hallway. Their names all begin: "Sister M . . . ."
But like a lot of things in health care, the tradition of the Sisters of St. Francis of Philadelphia has given way to practicalities.
For the first time in the hospital's 130-year history, a "Mr." is in the executive suites. Mr. John S. Prout, to be exact, is the first lay person to run the hospital since it opened in a house on Caroline Street amid a smallpox epidemic in 1864.
Mr. Prout takes over at a time when one of the things St. Joseph prides itself on, patient care, is being redesigned in the wake of growing price pressures at hospitals across the country.
His challenge, he said in an interview last week , is to emerge from the current turbulence with his hospital's loyal following of patients, its strong relations with doctors, and its good reputation for nursing care intact.
The hospital has a low-key image. Its prices are below average and the breadth of its sophisticated medical offerings unusual. In 1993, it was one of the five busiest surgery centers -- inpatient and outpatient -- in the state.
Mr. Prout, 45, who became president and chief executive July 1, succeeded Sr. Marie Cecilia Irwin, who retires this fall after 40 years as a hospital executive, including 20 at St. Joseph. Trained as a nurse, she focused on improving patient care.
Precisely because he is the first lay leader, Mr. Prout said he expects to spend more time and effort integrating the hospital's mission and values into daily activities. With a nun in charge, everybody knows what the place stands for, he said.
Now, "with all the changes, we need to articulate it more clearly, because those are the things that set us apart," he said.
(Although Mr. Prout is the first chief executive from the outside, he also could be the last -- there are sisters being groomed for CEO positions at St. Joseph and 11 other hospitals in the Franciscan Health System all the time, the system's office in Philadelphia says.)
Mr. Prout joined St. Joseph as chief operating officer in February 1993, and moved to Baltimore from the Midwest, where he has been a hospital executive since earning a master's degree in hospital administration from Washington University in 1974. Before joining St. Joseph, he was second-in-command of a 406-bed Catholic-sponsored hospital in a Chicago suburb. But nothing in his 20 years in the business prepared him for the environment now unfolding in health care, he said.
Hospitals used to provide "this much care," he said, stretching his arms out about a foot wide. Now they provide "only this much," he said, shrinking them back about six inches. As a result, hospitals are now attempting to get involved with the patient before and after the hospital visit.
The questions being asked by medical researchers and the public are different, too. The debate over when to begin rehabilitation for a hip replacement used to focus on one or two days after surgery. Now studies are showing patients can recover sooner if they start exercising three weeks before surgery.
Mr. Prout is taking a hands-on approach to the redesign of patient care, which he says is being undertaken from the patient's point of view rather than from what's best for the hospital. Now the hospital is asking what role it should play in a person's health -- not just illness -- and how it can work with other partners to do it most efficiently.
The hospital has hired the accounting firm of Deloitte & Touche to help it restructure and expects to reduce the ranks of middle management and nursing staff, as other hospitals have, in the next 18 months.
Above average in size, with 460 beds, St. Joseph is also unusual in the amount and sophistication of specialty medical care for a community hospital. Mr. Prout calls it a hybrid.
The hospital is one of a select group in Maryland that are managing to attract more patients from a shrinking pie. It also is among the most profitable. St. Joseph earned $7.4 million on revenues of $131.6 million in 1993.
The hospital's growth is the result of historic specialties and doctor loyalties. Its doctors, patients and board members often have long family ties to the hospital.
"Its personae in the marketplace was that of a hospital with a very caring attitude toward patients," said William E. Hooper, a marketing consultant, chairman of the hospital board and former president of W. B. Doner & Co., the advertising firm.
"The presence of the nuns and the whole attitude of the staff affected the culture of the hospital," he said. But it wasn't until he joined the board, said Mr. Hooper, whose father-in-law was once chief of obstetrics at St. Joseph, that he realized the hospital offered "not just good quality medicine but also, the high end of technology."
St. Joseph was the first community hospital in Maryland to offer open-heart surgery, and its 10-year-old heart center is one of the three largest in the state, with more than 900 patients a year.
Its unique center to treat conditions associated with dwarfism, called the "Little People's Program," was brought to St. Joseph by a doctor whose father trained at the hospital. A retina institute was started by a former professor from Johns Hopkins' Wilmer Institute in the late 1980s, and outpatient centers for radiation oncology and digestive disorders opened in 1992.
At the same time, its prices tend to be below the state average. Heart surgery is priced 20 percent below competitors, Mr. Prout said, partly because St. Joseph doesn't have residency programs usually associated with sophisticated medical services at teaching hospitals. In November, St. Joseph lowered obstetrics prices to below the rate at nearby Greater Baltimore Medical Center, its main competition for newborn deliveries.
In the past six months, it also introduced what it believes is the first program of its kind to manage obstetrics patients before and after their hospital stay, including pre-natal home visits. "The obstetric patient is not here very long, so we have to look at the family before the baby is born," Sister Cecilia said.
A similar program already existed for heart patients.
But now the hospital is going through a "pretty demanding assessment of where we put our resources," Sister Cecilia said.
In an interview, she said Mr. Prout was hired as the hospital's chief operating officer because he had 10 years' experience as a hospital executive in markets such as Chicago, giving him an opportunity to master the business, and also because he set up programs to train employees in a Catholic hospital's mission.
Believing that the hospital's "value system is a function of the strong presence of the Sisters of St. Francis," its trustees engaged in intense discussion before turning to a lay person, Mr. Hooper said. While Mr. Prout shares those values and was the board's unanimous choice, Mr. Hooper said, the board also decided to increase the number of sisters on the board -- they will now have six of the 14 seats.
Sister Cecilia said Mr. Prout will operate under the same expectations as she did -- to serve the patients.
"In our tradition, we see the leader as the servant, as well as the steward and the visionary. It's really important -- we are here to minister, to the patient through our employees. If we take care of our employees, they will take care of our patients," Sister Cecilia said. "It's for real. That's the legacy I leave John."