A decade ago, Ron Girotto, president and CEO of the Methodist Hospital System, came out of retirement, soon after Tropical Storm Allison flooded much of Houston, knocking the big Methodist Hospital building in the Texas Medical Center out of commission for 44 days.

Girotto, who worked at Methodist for 22 years before his current stint, plans to retire — again — at the end of the year, and says that, at age 70, he's leaving for good this time.

In the last decade, he's seen Methodist through a fractious break-up with Baylor College of Medicine and a reinvention of the hospital's mission to include research and education. Under his leadership, the hospital system has experienced unparalled growth, with a large new outpatient building in the medical center and expansion to outlying areas, and positioned itself for the vast changes in health care on the horizon.

Under his guidance, Methodist has also landed on the list of Fortune magazine's "100 Best Companies to Work For" in the United States the past six years.

During a recent interview in his offices at the TMC flagship, Girotto talked in length about some of those changes, Methodist's future and his own. Some excerpts:

CultureMap: Why did you come back to Methodist?

Ron Girotto: Because I was asked to. We had changed to an integrated delivery system model (with a three-pronged focus on hospital, physician system and insurance provider) and that strategy wasn't working. I was asked to come back because I was (involved with) the model before that and also to get ourselves back to the basics.

CM: When you took the job, did you realize that the Methodist relationship with Baylor College of Medicine was in trouble?

RG: No. Literally, I was treading water.

Strategically where they saw their future didn't fit with the relationship that we had. So in 2004, we were served notice. That was a real transition point for us. We had to make a fundamental decision. Were we going to be a huge community hospital that resides in the Texas Medical Center or something different? We chose a different route. We transformed ourself into an academic medical center, by our definition. Instead of one initative of taking care of sick people, we were going to have three missions: Taking care of sick people, focus on translational research and medical education.

We wanted to establish a residency program. Now, we have our 28th residency program and we have seven fellowship programs on top of that, with 180 residents (through an afflilation with Weill Cornell Medical College in New York). Projections are there is going to be a huge shortage of physicians in the next five to 10 years. We think we're playing a huge role for this country and Texas, which has a shortage of doctors already.

Our research is focused around our six centers of excellence. When you start from a clean slate, ground floor, ground zero, you're not bound by any traditions. To be able to move the way we did, we had to have collaborations. We are now in the top 25 in NIH sponsored grants in the United States and we have over 700 clinical trials.

CM: Do you see working more closely with Baylor in the next 5-10 years?

RG: We don't take one institution to target. Five years ago, we were virtually doing nothing with Rice. We do a lot with Rice now, along with the University of Houston, MD Anderson, UT and Baylor College of Medicine. We collaborate with all of them significantly. We encourage relationships with any and all. No one is precluded from doing any collaboration with anybody and we strongly encourage it.

CM: The way you describe it, it seems that something that looked so bad turned out being good for Methodist.

RG: Yes. Unquestionably yes. And I can't speak for them but I would think Baylor College of Medicine would answer the question in the same way. They have gone off into new venues. They provide more clinical care at the Texas Medical Center than anyone else. They have a huge clinical presence. We had that clinical presence but we had no research and education. So if you look at it in aggregate, what's happening in this community has been a huge step up for all of us. Both institutions have thrived.

CM: There's a perception that Methodist is a place for rich people or, at the least, people with insurance.

RG: I know that perception. The fact of the matter is we all have to file certain information (about providing indigent care) to the state of Texas. If you took our information and compared it to anybody, you are going to find the percentage of our business is greatest. Our $117 million (in charity care) on basis of revenue is higher than our competition. It shows up in all of our emergency rooms thoughout the system. It is the fastest growing part of our business, without a doubt, that and Medicare.

(A Methodist spokesperson who sat in on the interview pointed out the hospital also makes $10 million in annual grants to 30 community-based organizations throughout Houston.)

CM: Do you feel that everybody should be insured?

RG: Absolutely. We are strong advocates of health care reform. There's no way that just because you have a preexisting condition I'm not going to employ you or insure you.

CM: So as an institution, are you a supporter of the health care law?

RG: I am supportive of health care reform. I can't say I'm supportive of the new law because I don't know what it is.

CM: Everybody is supportive of health care reform in principle. How do we go to that next step of making it happen?

RG: The first thing is to understand what you're trying to change before you just launch a change. What we're dealing with today is uncertainty. We're looking at 2014 which sounds like a long way off but it will here at the blink of an eye. You don't know what you are going to face at that time. How are the exchanges going to work, for example? Studies predict 90 million people will change their form of insurance — one-third of the population. What does that mean? We don't know what that answer is.

The thing that good about health care reform it brings a focus on quality and patient safety. Processes are going to change.

CM: Methodist regularly shows up on surveys of the best places to work; in the most recent Fortune magazine ranking , it rated No. 3 for hiring of minorities, No. 4 among the nation's large companies and No. 10 for work-life balance among the 100 companies listed. How did that come about?

RG: (After Tropical Storm Allison), I spent a lot of time with the head of pastoral services. The question was how do we create a culture that reflects who we are. It came down to let's get back to the basics. We're in the business of helping others. We came up with values to focus on, an acronym ICARE (Integrity, Compassion, Accountability, Respect, Excellence) in everything we do.

Somewhere between 2003 and 2005 (when Methodist first made the Forbes list), it began to change. It became the culture. Not a board meeting goes by that the word values doesn't come up. You say it in every communication you do. It finally takes over and becomes who you are. It makes an enormous difference in who we are and how we operate.

CM: What's in your future?

RG: The last time (I retired), my wife and I got way too busy. Having been through this once, we're going to take a much as a year (to decide). Whatever I do, it will be missionary-type work. It will be sweat work. I don't want to sit on a board.