And didn't get recognized. In fact, Sack sat through the registration process and waited his turn to be seen by a doctor.

"I was very well taken care of," he said of his experience. "I had a good indication of what happens when patients arrive here. I was more than satisfied and that's saying something because my expectations are very high."

As a health care delivery system, Hallmark is celebrating its 10-year anniversary. And while experiences such as Sack's are more and more common among patients these days, that wasn't always the case in 1998 when communities were terrified that their local hospitals were on the verge of closing.

With facilities such as the Boston Regional Medical Center in Stoneham on the verge of closing like Simms and Choate hospitals before it, Sack said the boards of trustees for LMH, Melrose-Wakefield, Malden and Whidden hospitals met to discuss the possibility of merging before it was too late.

The newly formed Hallmark Health had to face changes in federal reimbursement, a looming debt and the challenge of providing services to a dwindling number of patients.

"In the early years there was a $26 million operating loss," Sack said. "It was a great challenge and people were saying that this would either be the best or worse thing the [board] had done. I applaud them for staying with it."

And facing some very unpopular decisions, Sack added, such as the closure of the Malden Hospital in 2001 and the selling off of the Whidden in Everett to what would eventually become the Cambridge Health Alliance.

"Now, 10 years later, we're growing," Sack said. "Our focus is to provide a high quality of services and positive patient outcomes and we need to do those as effectively as possible."

But that means making changes, Sack added, especially when it comes to the Melrose and Medford facilities. Although the LMH campus is surrounded by trees and some landscaping, it is still situated in a neighborhood, although it isn't shoehorned into a city block the way Melrose-Wakefield is.

Sack said facing such tight quarters has been a challenge when it comes to new growth, which is why the organization has moved services into other buildings and formed the Reading Medical Center or the Malden Family Health Center.

He said finding space in other communities is a way to alleviate the current pressure the thriving system is facing, but it won't solve the long-term problem.

"We're getting to the point where we have to focus on rebuilding both hospitals and making sure we have the necessary resources to go on for the next 20 or 30 years," he said. "The buildings we have now are 1980s construction."

Growth is a good problem to have, Sack admitted, because it means that Hallmark is able to provide more services to patients right in the own community, services they may have otherwise had to travel into Boston to receive.

"Our proximity to Boston is a pleasure because our patients have access to some of the best hospitals in the world," Sack said. "But it's a double-edged sword because it means we're competing for the same primary care services that people need on the local level."

With a more mobile, consumer-minded society, Sack said it's important to promote all the programs and services which Hallmark offers. Ironically, 10 years ago the organization was trying to push a united health care model under which it was operating whereas these days, Hallmark wants to get back to its roots.

"Hallmark Health is the not-for-profit entity that provides the business umbrella under which we operate," Sack said. "But now we're trying to promote the identity of our hospitals and the people who work there."

Just five years ago, Sack said Hallmark was operating to the exclusion of the individual hospitals and now the organization is trying to flip that around in order to reconnect with people in surrounding communities.

"Sometimes all you can do is go back to what was," Sack said. "It's going back to basics in my mind. We haven't changed what we're trying to accomplish. We still want to assist people and we think we can do that in their own community hospital. We want that hospital to be there in a 100 years so we have to create a sense of stability."

Sack, who arrived at Hallmark five years ago, is straightforward in his approach to community hospitals.

"I really think health care is locally delivered," he said. "You can pay for it globally, but it's all very local."

He said now that communities understand Hallmark didn't swoop in, buy their beloved institutions and change them, there's a sense of trust and confidence that the organization and its leaders are working to not only provide the best services, but keep one eye on the financial future.

Sack said Hallmark has paid off its debt and as a result, its bond ratings have risen in the past several years. Additionally, the organization has won numerous excellence awards and been mentioned in national journals, all of which strengthens its reputation.

"Our reputation is definitely much stronger," Sack said. "I don't think we would have won awards if we had a bad reputation."

And part of raising awareness of that growing reputation is to reach the very people who use the facilities. Over the past few years, Hallmark employees, who work in "Teams," have worked in their communities, whether to promote health care at town and city events, support local programs, or lend a helping hand.

It's just another way to stay in touch with what's happening locally.

As the chairman of the committee on public affairs for the Massachusetts Hospital Association, Sack said he is passionate about encouraging other hospitals to stay connected to their communities.
"Some people feel that they provide services and that's all they need to do," Sack said. "I feel it's a missed opportunity not to get involved."

Hallmark Health is stable. In the first years after the merger, the system couldn't always say that. But after working hard to pay debts, consolidate and add new services, Hallmark is now at the point where it's time to look to the future.

During the past year, Sack said the organization has created some strategies around five basic cornerstones: people, financial conditions, growth, services and quality.

He said investing in employees, recruitment of physicians and keeping an eye on serving patients through new programs and services as well as keeping the organization financially sound will lead to growth. And, of course, providing consumers with the highest quality facilities, services and staff.

"It's straightforward," Sack said. "But it's not simple. We have Boston and they're trying to do the same thing. If they're more successful than we are, we're in trouble."

But Sack is confident. He said his goals are to start rebuilding the physical plants of LMH and Melrose-Wakefield, but that means bonds to borrow money. Additionally, the organization still has to live up to its mission as the preferred provider for residents north of Boston.

"We want to simplify it so that people can remember who we are and what we do," Sack said. "Because when people remember, they'll come back and that will make us stronger."

With that in mind, Sack said Hallmark has been looking at what services it can further provide.
"We have an aging population with more chronic diseases," he said. "We've found that incidents of heart disease, cancer and diabetes are growing in our communities and we're trying to provide those services."

And, he said, there is always the challenge of finding more physicians.

"Massachusetts is not a welcoming area," Sack said. "People move to other states because it's a less expensive. So it becomes a challenge to replace our doctors, but it's something that's incumbent on us to do."

But that's in the future. Sack said Hallmark is currently enjoying its 10-year anniversary through a series of planned events.

In December, Hallmark held a symposium to thank members of the original Board of Trustees who had the foresight to merge four weak hospitals in order to turn them into one strong organization. At the February annual meeting, the Board of Trustees as well as the Board of Corporators met.
In May, during Hospitals Week, which also coincides with National Nurses Week, there will be a celebratory event at the Institute of Contemporary Art in Boston, which will also serve as a fundraiser.

Sack said despite the celebrations, he's already thinking about where Hallmark is going.
"I predict we'll be a different organization in three years," he said. "We have goals about how we're going to grow as an organization and I think we'll be one with sustainability."



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