New York City

Louis A. Shapiro, Hospital for Special Surgery

Louis A. Shapiro

The Value of Being a Specialty Hospital

Editors’ Note

In October 2006, Louis Shapiro assumed his current position as Hospital for Special Surgery (HSS) President and CEO. Prior to this, he served as Executive Vice President and Chief Operating Officer of Geisinger Health System’s Clinical Enterprise for five years. He began his career at Allegheny General Hospital in Pittsburgh and then joined McKinsey & Company as a leader within their health care practice. Shapiro is a Fellow of the American College of Healthcare Executives and serves on the boards of both the Greater New York Hospital Association and Crutches for Kids. He is also a member of the Young Presidents’ Organization.

Institution Brief

New York-based Hospital for Special Surgery (www.hss.edu) has been recognized since its inception in 1863 as a leading academic specialty hospital dedicated to treating people with musculoskeletal disorders and autoimmune diseases. A world leader in orthopedics and rheumatology, the hospital pioneered the modern-day total knee replacement and today performs more than 25,000 surgical procedures per year. An academic medical center, the hospital offers one of the most sought after training programs in orthopedics. An elite group of professional sports teams utilize Hospital for Special Surgery and its physicians, including the New York Knicks, the New York Mets, the New York Giants, and Nets Basketball, to name a few.

What makes Hospital for Special Surgery so special?

We’re an academic medical center, which means that we not only care for patients but also teach and do research; we only take care of patients with musculoskeletal related issues; and we do more of what we do than any other institution in the world.

The juxtaposition of those three characteristics creates an obligation to be the best in the world at what we do. That motivation to be extraordinary drives our culture of excellence and continuous improvement, and drives us to have leading outcomes across virtually every measure of performance.

What innovations are you working on to further care for your patients?

Orthopedics and rheumatology is a relatively stable industry. In the case of rheumatology, we’re looking at what causes the immune system to react in a way that causes autoimmune diseases to surface and whether interventions can be developed, not just to reduce the symptoms, which is where a lot of innovation has occurred with drug development, but also to stop those immune system responses from occurring. We’re also developing care delivery pathways for treating symptoms and reducing complications associated with pharmacological treatment of autoimmune disease.

On the orthopedic front, historically, a lot of the innovation has been in implant technology and technique, both of which have been innovated here. We’re continuing to identify opportunities for newer technologies that solve problems and add value, as well as refining existing technologies. For instance, we just developed a new wrist joint that has been introduced to the market.

A relatively new and very important area of research is a focus on outcomes research and comparative clinical effectiveness.

We’re developing patient registries that collect data on the demographics of the patient, the presenting problems, and the interventions that were deployed to treat those problems. We then track data on those patients over time so we can mine that data to determine if a treatment is effective or if we should change how care is delivered.

Because we take care of more patients for the services we provide than anyone else in the world, we can quickly accumulate a large database to study. That is going to have a major impact.

How have you maintained the doctor/patient relationship during a time when technology often interferes with that interaction?

The value of being a specialty hospital is that we’re not so large that we’ve ever lost sight of the individual. It’s also part of our strategy to provide a patient experience that is unsurpassed. That is a function of the attitude of employees who are delivering care or supporting those who deliver care, as well as our process for providing care, which allows patients to move through the system in a smooth manner. As our patient volume increases, our commitment to personalized, compassionate patient care grows even stronger.

Was real impact made in terms of what needed to be addressed around health care reform and has the dialogue been effective with regard to health care challenges?

In terms of health care reform, the underlying problems that are creating the symptoms our health care system is experiencing – malpractice, end-of-life care, personal accountability for one’s own health, and chronic disease management, as examples – tend to be political in nature and, therefore, are not being addressed in a substantive way.

Unfortunately, one of the consequences of this politicization of health care is that the solutions may not be the right ones and an easy way out is to reduce rates of reimbursement to the very people who are delivering the care.

Accountable care organizations and electronic medical records will not be a panacea for solving the problems facing the health care industry. I am hopeful but not optimistic that the current efforts will take us where we need to go. In the meantime, HSS will continue its focus and make its contribution to creating value in its delivery of care.

When you’re the best at what you do, how do you avoid becoming complacent?

I tell new employees that my expectation of them is that they wake up every day excited to come to work and give 110 percent as individuals, and as members of a team. If they take a day off from doing that, we begin to fail in our obligation to be the best at what we do.

I go on to say that it’s our collective responsibility to create the environment that allows all 3,500 of our employees to feel that way. Our strategic plan contains 12 strategic priorities, including developing a fully engaged workforce; elevating quality to the highest possible level; and providing a patient experience that is unsurpassed. So no matter how much we have already accomplished, we look to lock in that level of performance and then find what we can do next to take it to the next level. Our management systems, evaluation systems, communication systems, and compensation approaches all have that culture embedded in them.

For 12 consecutive quarters, we have been in the 99th percentile for the “likelihood to recommend” question on our patient satisfaction survey, and in any industry that serves customers, “likelihood to recommend” is viewed as the most important indicator of satisfaction and loyalty. When you add our patient satisfaction indicators together, there is likely no hospital in the country that is a better performer in patient satisfaction than we are. But we are still focused on continuous improvement in everything we do. So there is no risk of complacency.•