Gennaro J. Vasile's abrupt resignation as chief operating officer of Johns Hopkins Hospital is a sign of major changes to come at the institution, its chief executive said yesterday.

Dr. James A. Block said there will be "changes in executive responsibility and organization" as the Hopkins Health System undergoes a reorganization designed to make it more efficient.

Dr. Vasile's resignation this week was the result of a "disagree ment" between him and Dr. Block "about how we would proceed and what roles would be played" by Hopkins facilities and leaders, Dr. Block said.

One of the issues concerned "who would be responsible for what components of the system," he said.

He described in mostly general terms the efforts under way to "integrate" the activities of the two hospitals that Hopkins runs with other health services it operates now -- such as home health care and skilled nursing -- or will provide in the future.

A key Hopkins' goal is to be able to offer a complete range of health services, not just hospital care, fully covering patients' needs.

Hopkins is going to meet the "new demands of the marketplace," Dr. Block said, referring to pressure from insurance companies to hold down prices and manage care more efficiently.

Dr. Block declined to be more specific about his disagreement with Dr. Vasile, whom he hired in 1992 to run day-to-day operations.

Dr. Block said he has not decided who will replace Dr. Vasile.

Dr. Vasile, who is scheduled to leave tomorrow, declined through a spokeswoman to be interviewed.

Dr. Vasile has had a key role in reorganization planning, which Hopkins terms "re-engineering."

Although known as a tireless worker who often logs 14-hour days, Dr. Vasile also alienated many colleagues with what they described as an abrasive management style.

"He had a style that was pretty rough," said one source who didn't want to be identified. "He was not well liked and there was an uprising within."

Some Hopkins sources said yesterday that several senior executives took their complaints to Dr. Block with the goal of ousting Dr. Vasile.

A Hopkins spokeswoman would not comment on that assertion, and reaffirmed Dr. Block's explanation for the resignation -- differences over direction of the institution.

When he worked in Binghamton, N.Y., as president of United Health Services before coming to Hopkins, Dr. Vasile was a "driven person," said Floyd Metzger, who worked for a competitor and later went to work for Dr. Vasile.

"He is goal-oriented, and he works extremely hard, and therefore expects the others working with him to work equally hard to achieve that vision," he said. "He was considered an innovator. I also think he was considered somewhat of a threat by those who didn't want changes."

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