Joseph McDonald sits at the forefront of the healthcare world.

As CEO of Catholic Health System, the Tennessean with a strong southern drawl oversees the second-largest hospital system in Western New York, with more than 8,500 employees, three hospitals and over 980 affiliated doctors.

He joined Catholic Health 10 years ago, just a few years after the 1998 merger that created the integrated system. The self-described “Irish Catholic, Southern liberal Democrat” is now responsible for leading the system through healthcare reforms, and was recently granted a contract extension through 2020.

He oversaw Catholic Health’s recent decision to build a new headquarters in downtown Buffalo at the end of the Kensington Expressway. He also was recently re-elected to a rare second term as chairman of the Healthcare Association of New York State.

Q: You’ve been here for 10 years. What’s it been like, and what have you seen?

A: What I found when I got here was a couple of things. It was an organization that needed to pay attention to the blocking and tackling of trying to rediscover what makes Catholic healthcare strong. If you look at Catholic hospitals across the country, their strength is nursing care, it’s compassion, it’s patient-centered. Those are the things that’ll come out.

We also do a pretty good job of bringing new technology, and Catholic institutions are known to be pretty fiscally well-run. They’re tight-fisted, and that may come from the founding sisters that started all these institutions being tight-fisted.

So I found an organization that was really still thinking about what it meant to be a system... It was an organization that wanted to do better. It had lost money every year since it came together. It’s balance sheet was, frankly, depleted.

Q: How would you characterize the healthcare market?

A: It’s competitive, but it’s pretty typical as far as competition. I need strong competitors. Because if you don’t, all you typically do is meet the minimum requirement by the state, and that is a prescription for mediocrity. So I believe we’ll all benefit from competitors.

It’s not a sleepy little market. I’ve been in more competitive markets, and yet I think it’s got a good balance of competition, too, at a lot of different levels. But I don’t think there’s a reluctance, if there’s a common issue... for us to collaborate and work on stuff like that together.

The other jewel this community has is Roswell. Roswell is a spectacular organization and it’s not easily replicated by anybody. We do a lot of oncolcogy care, but they also do some upstream work that we don’t do. So that’s why I’m very interested in making sure that Roswell has a strong and powerful future, because our community really needs to keep them strong.

Q: Is there duplication?

A: When I first got here, there was a discussion about whether there was too much duplication. We’ve taken older technology offline. We haven’t built brand new hospitals or wings, but our approach is different.

It’s called clinically integrated systems. You’re taking waste and redundancy out of the system. It’s really formalizing the referral relationship and communication covenants between various parts of the healthcare system, so that patients get prompt care, not repetitive tests.

Q: Is it a medical arms race?

A: Most of what we’re doing is replacing 15-year-old technology with the current technology. That’s 85 percent of our technology, reinvesting proven technology.

As an organization, we typically are not first-movers in technology. I’m a second-mover guy. I want the technology proven, and usually 3.0 is a better product than 1.0.

Q: What’s the relationship between providers and payers?

When it comes to negotiations, we’re like a bunch of stiff-necked Irishmen. We argue, and we fuss and cuss, but ultimately, once we get our agreement, then they can bank on it.

Q: What challenges does Catholic Health face?

A: Being a Catholic ministry, there are some strengths, especially in an area that has a significant Catholic profile. But there’s significant ethical challenges that we have to deal with all the time... We try to walk consistently with where the church teaches and what science demands, but it’s not necessarily always a straight putt. It’s complex. Another challenge is that we are not going to run away from the poor.