SAN ANTONIO — The Shriners will continue treating children in all 22 cities where they operate hospitals, but some of the facilities might be downgraded to outpatient surgical centers and the sale or lease of real estate will be explored, the nonprofit's new CEO said.

"We've not changed who we are. We will always take care of children the best we can," said Douglas Maxwell, the newly elected CEO of Shriners Hospitals for Children.

But he said the 22-hospital system will need to be "right-sized," with some of its orthopedic facilities likely to be turned into outpatient surgical centers. Florida-based Shriners International also will explore selling or leasing some of its hospital real estate to reduce its $856 million operating budget, Maxwell said.

The 1,300 Shriners who are members of the hospitals' governing body rejected a proposal last week to close six facilities permanently.