Tufts Medical chief Dr. Michael Wagner says he respects nurses. Those who held a one-day strike were locked out Thursday.

More than once this week, Dr. Michael Wagner has delivered a tough message: We will not be held hostage.

His tone was typically calm and measured but his meaning unmistakable. Wagner, the chief executive of Tufts Medical Center, has taken a notably hard-line approach in his hospitals showdown with the Massachusetts Nurses Association, which this week staged a nurses strike at Tufts, the first such strike in Boston in more than three decades.

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Wagner, a 58-year-old primary care doctor who has led Tufts since 2013, is now in a position that other local hospital chief executives have avoided. He says union leaders are pursuing an agenda to grow their own ranks, and theyre hurting Tufts Medical in the process.

The union went on strike for one day Wednesday, but the hospital plans to keep the nurses out until Monday, while using temporary replacement workers.

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Somebody has to step up and say the intimidation, harassment, and bullying of the MNA has to be stood up against, Wagner said in an interview Thursday, as union nurses picketed outside his office.

A study found that more patients die and are readmitted to the hospital during nurses strikes.

Union leaders say Wagner and other Tufts executives are the ones doing the bullying by denying nurses the compensation and better working conditions they deserve. The strike began after the union and the hospital failed to agree on wages, benefits, and staffing levels for the more than 1,200 unionized nurses at Tufts.

I view [Wagner] as a very capable, very measured and thoughtful health care executive, Ellen Zane, a former Tufts chief executive and vice chairwoman of the hospitals board, said by e-mail.

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In a city of many teaching hospitals, Wagner doesnt wield the same clout as the chief executives of bigger or more prestigious institutions. But he has often spoken out about issues that he sees as threats to Tufts, even when his position may make him unpopular with politicians or other business leaders.

Tufts, with 415 beds in Bostons Chinatown neighborhood, treats many seriously ill children and adults, from premature babies to adults in need of heart transplants. Its patients include many low-income families and children. But Tufts has not enjoyed the kind of brand recognition and high payment rates of its competitors, particularly Partners HealthCare.

Three years ago, Wagner watched with concern as Partners sought a takeover of South Shore Hospital in Weymouth and Hallmark Health System of Medford. He and other Partners competitors worried the deals would make the most dominant health care network in Massachusetts even more powerful.

At Tufts, Wagner convened a meeting that included the chief executives of Beth Israel Deaconess and Lahey Health. They decided to launch a coalition that waged a public campaign to derail Partners expansion plans. Ultimately, following widespread concern that its further growth would raise health care costs and lower competition, Partners abandoned its plans.

Id call him a very, very strong advocate for the medical center, said Dr. Jeffrey Lasker, who ran the network of 1,800 doctors affiliated with Tufts before retiring last year. He loves the organization.

Wagners varied career includes three stints at Tufts. Before he was promoted to chief executive, he was chief medical officer and chief of the physicians organization there. Before that, he ran a physician-staffing organization.

A graduate of Georgetown Universitys medical school, Wagner is known as passionate but mild-mannered and as a clear communicator. Hes comfortable speaking at a podium but also enjoys digging through data and the nuts and bolts of running a hospital.

The married father of four grew up in Connecticut and now lives in Pembroke.

Jessica Rinaldi/Globe Staff

Rob Osgood, Director of Emergency Services Operations (left) held a binder containing Tufts Medical Center Work Stoppage Plan as he stood beside Dr. Michael Wagner.

As chief executive at Tufts, he has tried and sometimes failed to grow the hospitals reach. In 2014, he linked Tufts with Lowell General Hospital under a new parent company called Wellforce. This year, they added Hallmark Health to that system. Wagners growth plan focuses heavily on partnerships with community doctors and hospitals.

Wagner spent many months in 2014 and 2015 negotiating a big merger with Boston Medical Center. The talks fell apart after executives from the two hospitals couldnt overcome differences of culture and strategy.

But Kate Walsh, chief executive of BMC, said she and Wagner walked away as friends. Wagner even invited her to dinner as a goodwill gesture after their merger talks ended, she said. It speaks to his maturity as leader, she said. Hes somebody I would work with again if I had the opportunity to.

Wagner, whose base salary is about $800,000 annually, says he regularly visits different units of the hospital and meets with caregivers. Many people credit him with being rightly focused on patients.

But Evelyn Finn, a union representative at the Mass. Nurses Association who has worked at Tufts for almost 40 years, said Wagner changed when he became chief executive. He became more dollars-and-cents oriented, she said. Its unfortunate to see somebody so patient-focused become so finance-focused.

Mary Havlicek Cornacchia, another union official and longtime nurse, said Wagner despite a somewhat quiet demeanor and other Tufts executives have pursued a strategy of union busting.

The strike is expected to cost Tufts at least $6 million the expense of hiring replacement workers and could ultimately cost more. Wagners hard-line approach with the nurses union is winning him some quiet praise among other hospital leaders, even as it makes him an enemy to some rank-and-file workers. Wagner said he deeply respects nurses and the important role they play in the hospital. His criticism, he said, is directed at union officials.

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Tufts Medical CEO stands tough, says union hurting Tufts - The Boston Globe