Editors’ Note

Lou Shapiro assumed his current position in October 2006. Prior to this, he served as Executive Vice President and Chief Operating Officer of Geisinger Health System’s Clinical Enterprise. He began his career at Allegheny General Hospital in Pittsburgh and then joined McKinsey & Company as a leader within their healthcare practice. Shapiro is a fellow of the American College of Healthcare Executives, former Chair of the Greater New York Hospital Association Board of Governors (2014-2015), and on the board of Crutches 4 Kids.

Institution Brief

New York-based Hospital for Special Surgery (HSS.edu; HSS) is the world’s leading academic medical center specializing in orthopedics, rheumatology, and their related specialties. HSS provides care to patients from all 50 states and more than 100 countries and – through the HSS Education Institute – provides education to medical professionals in more than 150 nations. The HSS Research Institute spans molecular and translational science to advance diagnosis and treatment, and the HSS Innovation Institute accelerates the invention of breakthrough devices and practices. HSS is the first hospital in New York State to achieve its fourth consecutive designation as a Magnet™ Hospital by the American Nurses Credentialing Center, the gold standard for nursing excellence. It is the only hospital in New York State that has maintained a significantly lower infection rate than the state average for hip replacement five years in a row. HSS is the official hospital of the New York Giants, New York Mets, New York Knicks, New York Liberty, and the New York Red Bulls. It is also the official hospital of New York Road Runners for the New York City Marathon. In 2013, HSS was named the first National Medical Center of the United States Olympic Committee’s (USOC) National Medical Network. HSS is also one of only three hospitals in the United States designated as a Medical Center of Excellence by FIFA.

Will you highlight how having a clear focus and mission differentiates HSS?

I believe the greater the complexity and rate of change in a market, the greater the imperative of clear focus and mission. It helps to simplify, align, and energize. It’s best when that clear focus and mission is centered on something that can be differentiated by quality, which creates a dynamic where ever-higher quality becomes a highly motivating, never-ending pursuit for the entire organization. At that point, focus and mission become purpose and really drive culture.

When we peel the onion back and look at HSS, there are a number of things that we have going for us that may be indicative of organizational success.

These include a laser focus on doing one, valuable thing really well. Organizations that do just one thing should be able to do it better than organizations that do many things, regardless of the industry. Our one thing is musculoskeletal healthcare. It’s a broad topic, but it’s a high-value and focused topic.

Second, we focus on talent as a priority strategy. Unless one is in a completely people-devoid industry, talent is important, so recruiting and retaining the best and brightest individuals at all levels, in all jobs, is critical.

Third, we surround talent with everything they need to be successful, like technology, process, and culture. HSS surgeons are the best in the world at what they do, but they will tell you that the HSS ‘ecosystem’ is a big part of their success.

Fourth is giving aspiration and inspiration to our talent. If we’re not reaching for something that might seem to be unreachable, then the organization is not going to be able to go as far as it can. If we’re inspired by what the organization is working to accomplish, it allows us to continue to move forward.

These are reasons why HSS is in the unique position it’s in and why it has many opportunities available going forward in spite of all of the turmoil in the external environment.

HSS is an institution with a long history and heritage, but there is such a focus on innovation at its core. How important is that, and will you touch on the developments in research that take place at HSS every day?

The status quo, regardless of what we have accomplished and the position we’re in, is unacceptable. Organizations that are just trying to stay the way, intentionally or unintentionally, are going to die. The world is changing too quickly.

We are working to transform our business model from its status as an academic medical center with leading patient-care teaching and research whose core competency is to take care of patients who have musculoskeletal problems. We look to transform our organization to an enterprise that is musculoskeletal-focused but also leverages the massive knowledge that is derived from being the largest and highest-caliber organization of our type. In doing so, we will also positively change the industry.

We’re trying to do this by doing three things: constantly challenging the status quo, focusing on what we do at our core, and relentlessly pursuing ‘better.’ We work toward continuous incremental improvement regardless of the level of performance we have achieved and create increased value for everyone who either accesses or pays for care. This is how we define leadership.

Emanating from that leadership position is the process of leveraging our knowledge. We are working to do that in two ways: one is through replicating our business model globally where possible and appropriate, both domestically and internationally, and helping others benefit from the knowledge that we have created based on our leadership position. We advise other organizations that do what we do, but help them do it better. Alternatively, we may partner with an institution to introduce an HSS model of care in another geography. This must be at a level where we can ensure that we can replicate efficiency, quality, and financial performance because, without financial performance, we can’t afford to invest in quality.

Second is innovation, which is based on utilizing our highly-leveraged knowledge that results from our leadership to develop new services and products that we can get out to the world to benefit human beings without them needing to come here for care. That can be through innovation in care delivery, through digital health solutions we disperse for the treatment of the complex problems that we deal with at HSS, or through sharing technology that comes out of our life sciences and research area.

Our focus on healthy longevity is very exciting. The success of the healthcare industry in combatting things like cancer, cardiovascular disease, and brain disease is causing people to live longer. However, as people live longer, their musculoskeletal systems are breaking down and contributing to a massive decline in quality of life. Our challenge is to reverse or slow the aging process associated with the musculoskeletal system. This comes down to issues related to genomics and biologics in stem cells and other research that will help us understand why bone and tissues break down and how we can stop that from happening so that people who live longer can remain healthier.

These are all examples of the innovation that is emanating from the leadership position we provide at our core. If we can accomplish all of these things, it will reflect the new HSS and what we mean when we talk about our transformation.

How important is prevention and wellness, and can more be done to educate people about how to guard against many of these issues?

We’re spending more time on those activities and trying to educate the public. Obesity and lack of appropriate exercise is an issue. Some of our physicians will say that exercise is the best medicine.

We started a sports injury prevention program that is focused on children. We received a several-million-dollar gift that is significantly focused on the sport of soccer and the epidemic of ACL injuries in children. This is an exercise in understanding issues that could be prevented as children perform sports.

There is also other research being done on the impact of different cycles of biochemistry in people which might make them more prone to injury. We’re looking upstream to avoid problems downstream. It’s one thing to fix the problem in the best way possible after it occurs, but it’s much better to go upstream, whether it be through science or health and wellness, to prevent it from occurring in the first place.

Wellness and prevention could be the silver bullet to fix the healthcare industry in the U.S.

Do you get concerned that technology will interfere in the doctor/patient relationship?

We will do everything in our power to make sure that doesn’t happen here. At day’s end, technology is an enabler, although there is an application of technology that provides some degree of separation between the patient and the caregiver.

Telemedicine and remote monitoring should be viewed positively as enablers but, overall, healthcare involves people who are providers taking care of people who are patients. This person-to-person relationship is very important. The people who are patients want to make sure they feel the people who are providers are taking care of them.

The care element should not get lost as the industry goes through difficult changes based on economic pressures or technology evolution.

How do you define what makes an effective leader in the CEO role?

There are different ways to characterize leadership. There are three things good leaders need: to love what they do, to be inspired by what they do, and to desire to be a part of making things happen that allow them to achieve their goals.

A leader’s job is to create an environment that allows other leaders within their organization to check off those three boxes. We have to hire the right people, onboard them the right way, and create an environment where they can do what they love. For them to be inspired by what they do, we need to have a purpose-driven organization where people exude pride when they hear what the organization is trying to accomplish. Part of making this happen involves creating an environment where everyone knows their role as an individual and as a member of the team and knows where the organization is going.•