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Joseph McDonald has been president and chief executive officer of the Catholic Health System since January 2003. McDonald spent most of his professional career working for Catholic health ministries. Prior to coming to Buffalo, he was executive vice president and chief operating officer of the Covenant Health/Fort Sanders Alliance in Knoxville.

Q: Are there too many hospitals in Erie County, considering that many seem marginally profitable and little has been done to reduce the amount of bricks and mortar?

A: CHS has done its part and more when it comes to reducing bricks and mortar. We took two hospitals off-line, Our Lady of Victory Hospital in Lackawanna and St. Jerome in Batavia, following our own assessment, not because of a state commission. CHS is the only area provider which has made the tough decisions to close hospitals.

Over the last five years, CHS has seen a 12 percent increase in the number of hospital admissions, and our emergency departments are often at capacity. CHS's market share is increasing in virtually every area of clinical care, despite the downward trend in population.

Q: Is more collaboration needed in local health care, and can it happen given the history of distrust and competition?

A: I was recruited to Buffalo to help put the Catholic Health System on solid ground over the long term. We need to continually set the bar higher to ensure and improve quality, collaborate when it makes sense but compete as well in order to deliver the best care.

We have some good examples of collaborative efforts. The Western New York Purchasing Alliance is saving millions of dollars for area health providers on the purchasing of medical products and services. WNY Health-e-Net, a Web-based transactional partnership among hospitals and insurers, has saved millions in information technology costs and is a model for other communities. As opportunities for collaboration arise for collaboration with Women and Children's Hospital, ECMC and hospitals throughout the region, we need to look at them closely.

Q: Many people suggest that having too many clinical programs in such areas as heart surgery and neonatal intensive care prevents any one program from having deep, broad and financially healthy services. True?

A: I disagree with the idea that a community this size should have only one heart program. I'm familiar with health care in many areas of the nation and I've yet to see a community of this size with one cardiac program.

CHS is the largest provider of maternity services in the region. Last year nearly 6,000 babies were born at Sisters and Mercy hospitals. The Neonatal Intensive Care Unit at Sisters Hospital currently provides care for more than 600 sick and premature infants each year born at our facilities and is nearly outgrowing the unit, which opened in 2001.

Health care consumers demand choices. Choice helps to drive up quality.

Q: What are your goals for the system this year and the next few years?

A: I came to Buffalo for one reason -- to help position this Catholic health ministry for long-term viability and growth. Catholic hospitals, their health services and their mission to the poor and disadvantaged are a vital ministry of the Catholic Church. Our goal is to create the environment of choice for private practicing doctors, focusing our efforts on providing them with world-class technology so they can best care for their patients.