On Mark Eustis' first day as CEO of Fairview Health Services, the Interstate 35W bridge collapsed into the Mississippi River.

Since then, he says wryly, things have gotten better.

Four months into the job, Eustis, 56, talked to the Star Tribune about how he will lead Fairview as it embarks on its biggest expansion in a decade. The state's third-largest health system, Fairview owns seven hospitals, including the University of Minnesota Medical Center, and a chain of primary care clinics.

Now Fairview is a partner in building a new hospital in Maple Grove and is poised to buy Columbia Park Medical Group.

Q You came from Ascension Health in St. Louis, a much bigger organization than Fairview. Why did you move?

A Ascension Health is in 20 states and is the largest nonprofit health care organization in the country. I oversaw the Great Lakes and mid-Atlantic regions. I thought I'd retire there. Then the call came from [Fairview]. I grew up here, went to Edina High School, and have an undergraduate degree in business and a master's in hospital and health administration from the University of Minnesota. At Ascension, I was on the road most of the time, meeting with boards. The travel gets pretty old. I missed being where the care was delivered. Coming to Minneapolis, I began to think again about a regional health care system that's big enough to make a difference but not so big you can't feel the difference.

Q What sealed the deal for you?

A The history and tradition and culture of Fairview and the complexity of offering the whole continuum of care from the academic health center to the community hospital. I have a strong sense we haven't recognized all of that potential. For example, we have one of the best cancer centers at the University of Minnesota, involved in cutting-edge cancer research. How do we extend that to patients at Southdale?

Q What are your goals for Fairview?

A I spent the first 90 days here asking questions and listening. In 10 years, we want to be America's best health care system. The key goals are exceptional clinical care, exceptional experience for patients and families and effective and efficient use of resources. Everyone's involved in Six Sigma [quality-enhancement methodology] or [Toyota's] Lean [Manufacturing] these days. Our operating margins are about 2 percent now. We need to be able to get to 5 percent to have the capital to support [our goals].

Q Why have the different entities within Fairview operated so separately?

A There's been integration but mostly around the business. We contract centrally with insurers and for information technology services and [medical] supplies. But we haven't spent as much time around integration of the clinical part. The leadership for [Fairview] Ridges or Southdale or Red Wing is responsible for their own bottom line. Maybe we need an overall executive for, say, oncology services, who creates the growth strategy but leaves the day-to-day running to the hospitals. And we need a group of physicians who are strongly aligned.

Q How much of an issue is that?

A It's an issue. We have about 600 physicians who are part of University of Minnesota Physicians. About 300 are salaried Fairview employees and the rest are independent physicians. We need to figure out how these three groups relate to each other. It's about economics but it's also about staffing levels. It's about adding a new partner. It's about who does hospital rounds and when can I take a vacation and quality of life.

Q What do you see as the big challenges facing Fairview and health care in general?

A Doing more with less. Replacing aging infrastructure, which doesn't have great returns. Knowing the reimbursement isn't going to get better but probably worse with the federal budget [deficit]. And how to continue to grow a healthy bottom line.

Q Where do you see Fairview in 10 years?

A We'll likely be bigger. We'd like to extend across the state rather than just the 13-county [metro] market.

Q In which direction?

A Everywhere. I talk about this within Fairview and they say [feigns shock] We'd have to talk to Mayo! Well, yeah. We'd have to partner with people.

Q You're about to acquire Columbia Park, your biggest transaction since the merger with the university's medical center a decade ago. Are you looking at buying others?

A We expect to finalize Columbia Park by the end of the year. We're actively engaged in thinking about other large medical groups.

Q Care to mention any names?

A No.

Q What has surprised you since you've been back?

A There's more competition in the market than I expected. I don't know if it gets us better health care. When I left Minneapolis, there were closer relationships, a sense that we were all here for the good of everyone. I don't get the same sense now. It's not very nice. You know, not Minnesota nice.

Chen May Yee • 612-673-7434