In this edition, I speak with Frank L. Smith Jr., who served as president and CEO of Franciscan Companies for 21 years and vice president of St. Joseph’s Hospital Health Center for 23 years. He current serves as a consultant at Franciscan.

KNAUSS: Tell me a little bit about your background and how you ended up in health care.

SMITH: I came to Syracuse in 1970 to go to college at Upstate Medical University. I attended the College of Health Related Professions and received an associate degree in respiratory therapy. In 1971, I was allowed to work clinically, so I started offering patient care at St. Joseph’s Hospital. In 1972, I graduated from Upstate and worked at St. Joe’s for a year. I was later hired by Upstate Medical Center to be an instructor and I was working on my bachelor’s degree in health care administration at Empire State College. I subsequently earned a master’s degree from Syracuse University.

While at Upstate, I went from an instructor to assistant professor. I was also the clinical coordinator for the College of Health Related Professions respiratory care program. I was tenured and promoted to associate professor. In late 1983, I was asked to help St. Joseph’s Hospital as a consultant. There were some changes they wanted to make in their respiratory care program. As a result of that consulting work in 1984, I gave up my tenured position at Upstate and came on as a full-time employee at St. Joseph’s Hospital Health Center. At that time, I was director of the Respiratory Care Department.

Part of my plan, based on a paper I wrote when I was in graduate school, was preparing hospitals for prospective reimbursement. This included setting hospitals up with home care, durable medical equipment, and a lot of ambulatory care programs that hospitals traditionally didn’t have. St. Joseph’s gave me the green light to do that. It promoted me to assistant administrator. With Dr. Thomas Aiello, a pulmonologist, I started Franciscan Health Support, which was the first of Franciscan’s companies. This program was specifically designed to reduce the length of stay for patients who had chronic pulmonary disease in our hospital, which was a big problem back in those days. It continues to be a big problem.

We looked at what was available in the community, and we added a clinical touch to it. We had registered respiratory therapists going into the homes, providing their services 24-hours, 7-days-a-week on call, with a pulmonologist who was also our medical director. If we hit a problem, we could call him. We were quite successful in reducing the length of stay and providing high quality care so that people could have an improved life at home. As a result, the program kept growing. We ended up creating joint ventures with several hospitals, including Lourdes Hospital in Binghamton and St. Elizabeth’s Medical Center in Utica.

Subsequently, we set up little companies with several other hospitals in the area: Oneida, Carthage, Lewis County, and Auburn. We’re the preferred provider for just about every hospital in this area, and this region. At that point, I wore two hats: I was the vice president for St. Joseph’s Hospital, and I was the president and CEO of Franciscan Companies. About two years ago, I gave up my VP job and just focused on my job at Franciscan Companies, because I knew I was getting ready to retire. There were some things that I had to do, and wanted to do, for Franciscan.

I’m still working on some projects with Franciscan Companies now, but in January of this year, I retired. They asked me to stay on and help with the transition, and to work on some projects. My forte is strategic planning and development. I’m working with a person who is going to be doing that for Franciscan, and we’re doing a lot of different special projects. So that’s how I got here after 45 years in health care.

KNAUSS: What about health care made you so passionate to stay in it for so long and continue to do the kind of work you’re doing?

SMITH: I had a very traumatic experience when I was 10 years old. My little sister died of cancer. She was only 17 months old. It had a profound impact on my entire family, and my older sister became a nurse. She was very motivated and wanted me to also get into health care. At that time, I wanted to be a policeman — my father was a policeman. I’d come from Rome, which is a small town. At that time, you either worked in the mill, became a policeman, a teacher, or a fireman, or went to college. My mother and my sister didn’t want me to be a policeman so I ended up going to Upstate. It changed my life.

KNAUSS: What drove you to administration and management roles in health care?

SMITH: I quickly realized that the boss makes the decisions. That’s the bottom line. To eliminate barriers, to get done what needed to be done, I wanted to be the boss, but I never considered myself a boss. I considered myself the leader. I engaged my staff and colleagues to assist me, but I wanted to be able to have the ability to say, “this is what we have to do” and do it. I didn ‘t want to have to go through a bunch of barriers to get it done.

KNAUSS: Speaking of leadership, if I were to walk out of the room and ask a handful of people that you’ve managed over your career, how would they describe your leadership style?

SMITH: My employees have been very open with me over the years. I think they know that I’m very humanistic; I firmly believe that family comes first. I’ve always supported my employees in their personal lives as well as their professional lives. I’ve had to make the hard decisions, but they were fair decisions whenever I had to make them. I think they know me as being fair and very loyal. They know that I expect that loyalty back in return. Their job is to make me look good. If they make me look good, I can make them look good.

 KNAUSS: Did you take on leadership roles from an early age?

SMITH: I’ve been working since I was 13. My father was a policeman and wasn’t paid well for the work that he had to do, and my mother wasn’t well. I had five sisters and I was the only boy. So, working hard has always been my priority. I decided very early on that no matter what I did, I was going to be the best at it. When I worked at a gas station, I came in at 9 p.m. and cleaned the gas station, cleaned the men’s room and the ladies room. It was the cleanest men’s room and ladies room in the city of Rome. I delivered papers and I was the best paperboy in the city. I worked in a store and I was the best bagger and best stocker in the city.

I’ve always been known to be a high achiever. I require very little sleep; I sleep about three or four hours a night. I read tremendous amounts of material just because that’s what I do at night. I’m dyslexic. A lot of people didn’t know that about me and I didn’t really learn to read the right way until I was in graduate school.

KNAUSS: Tell me a little bit about what you look for when you hire and how does that contribute to the culture that you’ve developed?

SMITH: It depends on the position. If I’m looking for a clinical physician, I look for an individual who is passionate about patient care and passionate about his/her patients. I told the following to every employee who came to work for me when I was hiring: “I want you to treat every patient as though it’s somebody you love. If you love somebody, you would do whatever you had to do to help them, and that’s the way I want you to treat your patients. They didn’t ask to be sick. They didn’t ask to be in that position. Their lives have been turned upside down. Our job is to help them and make them as comfortable as possible, and improve the quality of their life the best we can.” I told this to every employee at every orientation.

I look for people that are compassionate and really have the skills. They wouldn’t even be talking to me if they didn’t have the skills. It’s the same thing with management and the other positions. I wouldn’t waste my time talking to somebody that I wasn’t serious about hiring. What I look for from them is loyalty, because if they are loyal then they will want to do the best they can to make me look good and the organization look good. That’s what it takes. We’re a team and I tell everybody that you don’t have to know everything. Ask the question. Don’t sit back and not know something or not do something right because you don’t know the answer. Ask the question. We’re a team. There’s no such thing as a bad question or inappropriate question. With education being my background, I learned that a long time ago. Students that were asking the questions were the ones that were interested and really wanted to know more.

KNAUSS: What is the biggest frustration you’ve faced in your career?

SMITH: The biggest frustration that I’ve had working in health care all these years has been the lack of understanding people have about health care. Their perception of health care has been primarily perceived from watching television or reading a book, or maybe some intimate experience that they had. Health care has been so highly regulated over the years, especially in New York State and very highly regulated by the payers over the years. It’s very difficult for a health-care provider to strive for the best and do the best, and be able to break even. No money, no mission. I’ve always been frustrated with that.

My oldest son had an opportunity to go to medical school. The kid is brilliant. He went to an orientation and they talked about managed care. He came home and said, “Dad, I’m not going to become a doctor. I don’t want you discouraged.” He says, “I’m going to go into computers. I can help people more. I don’t have to worry about somebody telling me how to do my job, not worry about telling me how much they are going to pay me and not worry about having to harm anybody or do something wrong. I’m going to do that.” That always bothered me, but it’s the truth.

It’s very easy to point a finger at a doctor, nurse, or therapist and say they made a mistake. Well, nobody goes to work in health care and tries to make a mistake. We go to work trying to help somebody, but things have turned. The downside of health care is everybody expects it, but nobody wants to pay for it.

KNAUSS: What’s the one main point of differentiation for Franciscan Companies?

SMITH: It’s our culture. It’s more than a job. The people are here because they really want to help people. We’re a family. We treat each other like we’re family. We have our differences, but we’re a family. When one of our family members has a problem, we all have a problem. We do everything in our power to help that individual. We’re the same way with our patients. Our patients get 100 percent of all the resources we have available. That includes our physicians who are medical directors. We have five of them that we utilize to help us with our patients, to make sure we’re doing everything the best we can. I think that the culture is critical. A lot of people say we’re a family. A lot of people say we’re compassionate. A lot of people say we practice what we preach.

KNAUSS: How do you spend your free time?

SMITH: I spend as much time as I can with my wife, my children, and my grandchildren. Everybody knows that I’m a Disney World fanatic and I go to Disney World probably once a month or so.

KNAUSS: Come on, really?

SMITH: Yeah, I really do. I used to have a house down there. Instead I bought a timeshare with Disney World and it has been seventh heaven. It forced me to take vacation time, which I rarely did early in my career. Now I have a place to take my grandkids and I love it. You wake up in the morning and you don’t have to think about what you’re going to do today. You can go to any park. You can go to any pool. You can do whatever you want. You don’t have to have a plan.

About the author: Jeff Knauss is co-founder of the digital marketing agency, Digital Hyve, and has always had a passion for learning about successful executives and their stories. He also is a current board member of Byrne Dairy, the Food Bank of CNY, and Loretto Foundation. For more on Knauss, check out www.digitalhyve.com.