Joe Roach began his tenure as the chief executive officer at Eliza Coffee Memorial Hospital on July 28.

He said he's met with employees, physicians and other community leaders about his vision for the facility and the future of health care in the Shoals. He spoke with the TimesDaily about what he sees as the challenges and opportunities of running the facility, which is owned by RegionalCare Hospital Partners, a private hospital organization headquartered in Brentwood, Tenn.

Q: What's your management style?

A: I've been telling our employees it's somewhere between Attila the Hun and your mother. My job is to find out what motivates our employees and go from there. Some might need an arm around the shoulder and a quiet word; others might just need a quiet word. Some might need a boot in the butt. I prefer to manage by the situation, but what I do is going to be motivated by the circumstances. I'm an individual who doesn't look behind; I'm going to go forward. I'm not concerned about the way things were before. The way I see it, I have two jobs to do here. One is to build a new hospital, and the other is to recruit new physicians.

Q: One of the goals for RegionalCare is to recruit 70 physicians to the Shoals during the next 10 years. How do you see being able to do that?

A: We hired two new physicians just last week. One is an interventionalist cardiologist, who will start immediately, and the other is a general surgeon, who will start in a year. We're recruiting them a year in advance. Ultimately, I'd like to be able to sit here a year from now and tell you we've got 20 new physicians on staff. We've also hired a full-time physician recruiter.

Q: In what areas are we lacking physicians?

A: Internal medicine, primary care and reconstructive plastic surgery are the biggest holes we have to fill now. We're losing most of our breast cancer surgery cases because we can't do the reconstructive piece after a mastectomy. Neurology is another huge hole that we've got to fill.

Q: Do you think you'll have trouble marketing the area to physicians?

A: We have to identify the right kind of physician, those who are young with young families who are looking for a particular lifestyle and good schools. We've got a great story to tell here; we just have to tell it. I have my own experience with this. When RegionalCare asked me to consider this position, they asked me to come here first. They wanted to know if I could live here first, and then we'd talk about the job.

Q: What about the proposed new hospital? What is your time line for the certificate of need (CON) that must be obtained from the state before a new hospital can be built?

A: The CON and physician recruitment would be co-equal as far as my priorities go. Right now, we're gathering the documents for the CON. We still have to retain an architect. The best-case scenario is that we'd be ready to go in six months from filing. But we expect a bit of a bloody fight, which could mean it would be drawn out to 18 months, which would add a year to the cycle. Our current plan calls for 30 to 42 months of construction.

I've been in CON battles before. Tangentially, I expect Huntsville Hospital to fund Keller in their fight against this. (Helen Keller Hospital in Sheffield is involved in an affiliation agreement with Huntsville Hospital that allows Keller to harness some of Huntsville's purchasing power as a means to realize savings.) Technically, we meet all the criteria for relocating to a new facility with the State Health Planning and Development Agency. But you can't negate the politics that go into this, and that's where the fight will be.

Q: What are your thoughts about Keller and working with that organization?

A: I'll leave any decision for Keller to join up to (RegionalCare CEO) Marty Rash and (RegionalCare Chief Operating Officer) John Rutledge. If Keller decided to join, that would be great, and it would mean a change in the scope of the project. If it doesn't happen, we still have a job to do. It's not for me to tell the board to go one way or the other. My job is to focus on physician recruitment and to build a new facility.

It would be nice to be a one-hospital market. As it is, we put the physicians and patients in the middle of where their loyalty lies. With one hospital, we eliminate that and any inefficiencies.

Q: Speaking of Huntsville, do you see their presence as encroaching on the Shoals health-care community?

A: To the extent out-migration of patients has on us, Huntsville is significant. But our out-migration is unusually large, and we don't have a good mechanism to track it. We're relying on industry metrics and anecdotal information.

A community like this should lose 10 to 12 percent in out-migration, but we're losing as much as 20 to 40 percent, and we know illnesses aren't up. Our goal is to keep the cases here that can be treated here. All of this business is leaving here, and Huntsville isn't having to work for it.

We have to be able to compete on price, quality and service, and if we don't exceed those expectations, then that is a reason to leave. You can't blame Huntsville, but we have to be able to take some of that business back. That's my job.

Q: Have you looked at any locations for the new facility?

A: We have a couple of spots in mind, but I've asked Marty not to tell me where they are until we file the CON. I want to be honest when people ask me where it's going to be when I tell them I don't know.

Q: When do you expect to file the CON?

A: In the next six months, but it could be sooner, or it could be later.

Q: There's been talk that there won't be a separate board at Shoals Hospital. What can you tell me about that?

A: Initially, there had been the idea to have a board at each facility. It was the medical staff that suggested, if we were going for the single hospital concept, why not start with a single board? So there will be four physicians from Shoals Hospital on the board, four from Coffee and four members from the Shoals area. With my presence, it will make 13.

Q: What about the fiscal plant at Coffee as you found it when you arrived? Were there any challenges or major changes you had to make?

A: As part of the asset purchase agreement, we've said we'd spend $33 million on the existing facilities over four years. But we don't want to put all our money into things we won't be able to take with us to a new facility. We did have to replace a chiller in July and the electrical switches in the building are being changed out. The previous administration did a good job of keeping things up and running, but it's not the ideal way to do health care. Having three facilities is inefficient as well. We've got IT at East, and to get me up and running meant getting in a car and coming to Coffee. If there was a problem, they had to come back. It's inefficient, and I'm used to the idea of people working in a cluster.

Q: We sometimes get calls from people who've had a bad experience or might have a complaint. How will you deal with those problems?

A: At the time we recognize the problem, we want to go about rectifying the problem. How fast can we correct the problem once it's been pointed out to us? We're in a predominantly human business, and we're not perfect. But if we'd made a mistake, we need to be honest with ourselves about it and fix it.

A phone number to a patient ombudsman will be set up within the next 60 days for these complaints to be logged. All of the documentation associated with the problem will go through me and everyone involved on staff, from ER docs to radiology to pathology. It will help us keep track of the issues, and the goal, if the complaints are valid, will be to correct the problem within five days.

Michelle Rupe Eubanks can be reached at 256-740-5745 or michelle.eubanks@TimesDaily.com.