Stalking snook and redfish in the shallow waters of Sarasota Bay requires utter concentration from the fly-fisherman-a welcome mental vacation for G. Duncan Finlay, M.D. After five years of overseeing a $400-million budget and 3,000 employees, the former president and CEO of the Sarasota Memorial Health Care System says he's ready to play a little.

"The first week, I'm going to goof off-play tennis and golf, and go fishing," Finlay said a few weeks before his May 1 retirement. "I'll be involved in some business ventures and will do some consulting. I will be available to the new CEO and the hospital."

Finlay declined to discuss his business plans, but shared candid views on the tougher aspects of hospital leadership. He came to the top post at Sarasota Memorial after a national search elevated him from an interim assignment to the job. Previously, he was vice president of medical affairs at Sarasota Memorial after practicing medicine since he arrived in Sarasota in 1972. His medical specialties are pulmonary and sleep medicine, and he founded the hospital's Sleep Disorder Center.

During Finlay's tenure as CEO, Sarasota Memorial achieved a number of superlatives in the healthcare business, including being ranked in 2004 as one of the top 50 hospitals in the country in seven of 17 categories by U.S. News and World Report.

"The thing that's the hardest: the absolutely infinite and unpredictable problems that walk in the door every day, the kinds of things you just can't be prepared for," he says.

"The toughest issues [as CEO] were the financial management of a budget of $400 million. I have to chuckle about it," he says, reflecting on his earlier years managing a one-man practice.

Finlay readily acknowledges the patient safety problems that beset the hospital in 2004. "On the one hand, we're recognized as one of the best hospitals in America; on the other, we had patient safety issues," he says.

In the end, and despite the challenge of public and media scrutiny about the hospital's difficult year, Finlay believes the organization's response to the problems-such as a new computer system for physician order entry, which is being used mostly in large university or Veterans' Affairs hospitals-will make it a leader in the field of patient safety.