Editors’ Note

Prior to assuming his current post in 2002, Michael Dowling was the health system’s Executive Vice President and Chief Operating Officer. Before joining Northwell Health in 1995, he was a senior vice president at Empire Blue Cross/Blue Shield. Dowling also served in New York State government for 12 years, including seven years as State Director of Health, Education and Human Services and Deputy Secretary to the Governor. He was also commissioner of the New York State Department of Social Services. Before his public service career, Dowling was a professor of social policy and Assistant Dean at the Fordham University Graduate School of Social Services and Director of the Fordham campus in Westchester County. Dowling has been honored with many awards and recognitions over the years, including being selected as the 2017 Grand Marshal of the New York City St. Patrick’s Day Parade and being inducted in the Irish Hall of Fame. He is also is the recipient of the 2012 B’nai B’rith National Healthcare Award, the 2011 Gail L. Warden Leadership Excellence Award from the National Center for Healthcare Leadership, the 2011 CEO Information Technology Award from Modern Healthcare magazine and the Healthcare Information and Management Systems Society, the National Human Relations Award from the American Jewish Committee, the Ellis Island Medal of Honor, the Distinguished Public Service Award from the State University of New York’s Nelson A. Rockefeller College of Public Affairs and Policy, an Outstanding Public Service Award from the Mental Health Association of New York State, an Outstanding Public Service Award from the Mental Health Association of Nassau County, the Alfred E. Smith Award from the American Society for Public Administration, and the Gold Medal from the American Irish Historical Society. Dowling is Chair of the Healthcare Institute, and was an instructor at the Center for Continuing Professional Education at the Harvard School of Public Health. He earned his undergraduate degree from University College Cork (UCC), Ireland, and his master’s degree from Fordham University.

Institution Brief

Northwell Health (northwell.edu) delivers world-class clinical care throughout the New York metropolitan area; pioneering research at the Feinstein Institute for Medical Research; a visionary approach to medical education, highlighted by the Hofstra Northwell School of Medicine and School of Graduate Nursing and Physician Assistant Studies; and healthcare coverage to individuals, families, and businesses through the CareConnect Insurance Co., Inc. Northwell Health is the largest integrated healthcare system in New York State with a total workforce of more than 61,000 employees – the state’s largest private employer. With 21 hospitals, 6,675 hospital and long-term care beds, more than 550 outpatient physician practices, and a full complement of long-term care services, Northwell is one of the nation’s largest health systems with $11 billion in annual revenue.

You consistently talk about the speed of transformation in healthcare and the need to be an innovator. How do you see Northwell Health positioned today and how is the organization transforming?

We’re very well positioned because we have a very innovative culture, which permeates the totality of the organization. Everybody across the organization is continuously thinking about how to do things differently, combining what we’re doing today with a focus on what we should be doing tomorrow.

We have done a good job creating this culture over the years, and we continue to build on it because we recruit and promote the right kinds of people, both on the clinical and the non-clinical sides.

The second thing is, we have become less of a hospital-dominated system. More and more care is being delivered outside the hospital, so we have developed the largest ambulatory network of services of any health system in the Northeast United States. We have about 550 non-hospital locations, the largest of which are almost 500,000 square feet. We have a huge distribution system that provides easy access and convenience for people who want care.

We also are heavily involved in joint ventures, creating new businesses, and monetizing many of the services we have created across the organization, like many of our back-office functions. We are doing business with other healthcare organizations, but also with private equity and the investment community – we have an entire division devoted to this called Northwell Ventures.

We’re also well positioned in the educational arena. We are one of the largest academic teaching institutions in the United States with more than 1,650 medical residents and fellows, and we have developed some very innovative educational programs. Our medical school and our nursing school are very successful. The same goes for our internal corporate university, the Center for Learning and Innovation, which is continuing to grow.

We are at the cutting edge and definitely one of the leads in the Northeast in telemedicine. This involves taking the maximum advantage of growing technology to deal with the consumerism movement and also to be able to deal with the care of patients remotely. We have some very innovative, nationally known programs in this area.

In the area of talent management and succession planning, there are always things we could do better but, culturally, we’re an organization that gets bored and frustrated with tradition and status quo. When we realize the power across an organization as big as this, it can stimulate enormous innovation.

Whatever happens in Washington and at the state level with all of these new so-called reform movements, we will successfully adapt to it. We’re not going to be thrown into a catatonic state irrespective of what happens in Washington or Albany.

We are highly integrated and work closely
so that the lines of communication are consistent
and continuously open to foster innovation
throughout the entire organization all the time.

What will a hospital look like in the future?

Hospitals will be very important. Part of the problem with these discussions is that when we talk about moving business out of the hospital, people jump to the incorrect conclusion that hospitals are not relevant and that they will eventually quasi-disappear, which is completely false.

Hospitals will continue to be a very important component of the healthcare delivery system, but they will essentially be places to take care of very sick people. The so-called “easier” patients will be cared for outside of the hospital.

If one goes to one of our hospitals at the moment, they will find that they are very crowded with very sick people who are often much older because the population is aging.

How important is it for you and your leadership team to communicate your views of this transformation from the top in order to engage your people?

It’s essential. We have multiple avenues we utilize to continually do this. For instance, we recently took a group of people through the new, very sophisticated labs in our research center to emphasize the extraordinary, innovative things we are doing.

I communicate about our culture and innovative ideas when I meet with employees every Monday morning. We do it when we meet with department heads at every hospital and when we have employee meetings at each location, which we do continually.

Communication is very important, but it’s also important to fully understand that the danger with communication is believing it has already occurred. We have to practice it consistently and repetitively, and we have to provide employees at the various organizations with an actual avenue for them to be heard when they have good ideas and suggestions. We have multiple ways of doing this.

We are highly integrated and work closely so that the lines of communication are consistent and continuously open to foster innovation throughout the entire organization all the time.

Is scale critical to an organization like this?

To compete in the world we’re in, there needs to be scale. However, just collecting entities so we can say we have scale is not going to give us the same benefit as doing it in a strategic way.

We have a very integrated organization. Across the entire organization, we have common metrics and standards. We collect resources and grow organically, so we have the wherewithal and talent to do different things and scale them to a size that matters.

The trick is to have the benefit of scale with a culture of entrepreneurship that allows it to work more like a small group. It’s the balance between scale and entrepreneurship that counts.

Is the medical profession still attracting the talent it needs and do you worry about continuing to find those future leaders?

I don’t. We get 800,000 job applications every year. We hired about 10,000 people last year, so we have an unbelievable pipeline of people who want to work here.

The number of applications to medical school over the past few years has gone up dramatically. We get 7,000 applications per year for our medical school, and we only have 100 slots.

The one great thing about healthcare is that inside a big healthcare organization like ours, we have the clinical side where one could be in the research and education business; we have a care delivery business; a transportation business; a construction business; a dietary business; a laundry business; a purchasing business; and an IT business. There isn’t a business that could be thought of that doesn’t also exist in a big healthcare company, and we have to run each of these 24/7.

This attracts a lot of talent. The area that is troubling and that we’re working on is making sure that our organization represents the community better at the leadership levels. We have a very diverse community so we have to make sure that our leadership reflects that.

The trick with an organization as big as ours is to continue to promote ongoing education even after people join us – it’s not good enough to say that someone has graduated with a great degree and a good GPA. When they come in here, they have to start learning anew, because the day-to-day operations are far ahead of what most students are taught in school.

Do you consider yours as a service business?

Yes. If we’re not run like a business and we don’t keep our financials healthy to the extent that we can, especially given all the regulations, we’re going to be in trouble.

We serve customers – a patient is a customer. If we don’t deliver a good service, they won’t come back.

The experience of care doesn’t just have to do with what the doctor or the nurse does, but what the receptionist does, what the waiting rooms look like, what the food tastes like, etc.

The person who heads up our customer service for our organization used to work for the Ritz-Carlton.

With all the changes you have overseen at Northwell Health, do you still enjoy the process and are you able to appreciate your achievements or are you constantly looking at what’s next?

I look at what we’ve just done, and I’m astounded at some of the wonderful things that have occurred. While I appreciate and acknowledge what we have accomplished, I’m always afraid of complacency and that we will get caught up in our own press releases. We have to continually be looking forward and disrupting ourselves.

It’s about what we do tomorrow, the day after, and five years from now. If we don’t maintain a constant positive attitude as we look to the future, we can easily fall behind. It’s similar to sports teams, which rarely win multiple championships in a row partly because, when they win, they think they’re good and they relax. I don’t like to relax – it’s not in my nature. I like being challenged, and I challenge myself more than anyone else.

What excites me about getting up in the morning is not only the challenges we’ll have that day but the opportunities for what we can do the next day.

I have an unbelievably positive, optimistic outlook, and that reflects how I feel about the United States. Some people now are talking about how bad, dark, and dreary the U.S. is, and how it’s a terrible place, but to me, it’s a phenomenal place. Why would we want to say the place we represent is in terrible shape? We never want to do that. We want to promote a positive culture all the time.

We also still acknowledge that no matter how good we get, we can always do better.

Do you believe that Northwell Health generally represents many different cultures and ethnicities?

Diversity and inclusion is one of the things I talk to all employees about because we have a vast racial, ethnic, and religious mix of people, and I encourage them to get to know more about one another.

We live in our own little cocoon. We all grow up with our own individual and collective biases. What we don’t know about the people that live next door to us or walk side by side with us is amazing. We would be better off if we decided to take it upon ourselves to learn a bit more about others.•