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 and the final two years as Commissioner of the New York State Department of Social Services. Earlier, 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. He 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, the 2012 B’nai B’rith National Healthcare Award, the Ellis Island Medal of Honor, 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 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, the Deming Cup from the Columbia School of Business and the Gold Medal from the American Irish Historical Society. For 13 consecutive years, Modern Healthcare has ranked Dowling on its annual list of the “100 Most Powerful People in Healthcare,” including the #2 ranking in 2020. He was also ranked #44 among large company CEOs in the U.S. and was the nation’s top-ranking healthcare/hospital CEO on Glassdoor’s “Top CEOs in 2019” list. Dowling is past Chair of the Healthcare Institute and the current chair of the Institute for Healthcare Improvement (IHI). He is a member of the Institute of Medicine of the National Academies of Sciences and the North American Board of the Smurfit School of Business at University College, Dublin, Ireland. He also serves as a board member of the Long Island Association. He is past chair and a current board member of the National Center for Healthcare Leadership (NCHL), the Greater New York Hospital Association (GNYHA), the Healthcare Association of New York State (HANYS) and the League of Voluntary Hospitals of New York. Dowling 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. He also has honorary doctorates from Queen’s University Belfast, University College Dublin, Hofstra University, Dowling College and Fordham University.

Institution Brief

Northwell Health (northwell.edu) delivers world-class clinical care throughout the New York metropolitan area, pioneering research at the Feinstein Institutes for Medical Research, and a visionary approach to medical education, highlighted by the Zucker School of Medicine at Hofstra/Northwell and Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies. Northwell Health is the largest integrated health system in New York State with a total workforce of more than 75,000 employees – the state’s largest private employer. With 23 hospitals, more than 830 outpatient facilities, including 220 primary care practices, 52 urgent care centers, home care, rehabilitation and end-of-life care services, Northwell is one of the nation’s largest health systems with $14 billion in annual revenue.

How do you define Northwell Health’s purpose?

Our role is multi-dimensional and, too often, not fully understood. At our core, of course, we are a comprehensive and integrated organization dedicated to the promotion of individual, family and community health. We strive, as outlined in our new marketing campaign, to “RAISE HEALTH.”

We are also a major economic engine – the largest private employer in New York State with 75,000 employees. Just think of the implications of such for families, for local businesses, for contractors, for vendors and for government. We are a business with an extraordinary positive impact and as a not-for-profit, that impact stays local. We hire about 150 new employees each week and the career possibilities are unlimited. You can become a doctor, a nurse, or a respiratory therapist. If you want a career in finance, in technology, in real estate, in supply chain or in the food business, we can provide the opportunity. Few industries have such diversity.

We are also much more than hospitals and do much more than just treat illness. Through our outpatient facilities, our home care and our community health initiatives, we focus on wellness and prevention. We all know that if we do a better job at helping people stay healthy and out of the hospital, it results in better outcomes overall. We also, of course, have to understand the importance of individual behavior and responsibility.

We also play a major role in education as one of the largest academic teaching entities in the U.S. We not only have a very creative medical school and nursing school, but we also do a tremendous amount of work with schools to provide career options for kids. These “career days” introduce the health professions to high school students nearing their collegiate studies. We also sponsor what we call a “Spark Challenge” for students with a specific focus on STEM and over 1000 kids participate.

And, of course, through our Feinstein Institute for Medical Research, we invest in promoting new discovery and finding cures and the next generation of treatments and medications to fight disease.

Finally, I would say that as a major “business” we have an obligation and responsibility to be a leader in the broader community by tackling larger societal issues – all of which, in one way or another, impact overall health. What we say and how we act as leaders matters. This is why we have taken an advocacy role in issues such as gun violence which is a public health issue, veterans, immigration, etc., and I expect to become more involved in the area of climate change and environmental health.

I see my role as twofold. I have an inside role to successfully manage and lead Northwell and I have an outside role to address these larger issues, but also to promote a sense of positivity and optimism in the community at large which is more critical now than ever. We all need to unify and not be at war with one another.

There is a current debate now on the future of New York City. I believe that what business leaders say and more importantly how they and their organizations act is going to have a big influence on New York City’s recovery and future. We need to be community influencers in a positive way by resisting division and partisanship. We need to give oxygen to hope and unity.

Are the societal issues that Northwell Health is committed to addressing all health related?

Everything, in one way or another, relates to health. We are influenced, health wise, by everything that goes on around us – be it political, social, demographic or economic. Current divisive and negative political partisanship, I believe, has an impact on people’s sense of health and well-being. People are happier when they see a common purpose, believe in a better future, work as part of a team and share a common mission.

What is health? It is not just physical; it is mental and emotional as well. Just think of economic distress like unemployment. We know that one of the best ways to positively address a person’s health is to have a job, to be able to contribute and support their families. This is why the overall health impact of COVID is so problematic. We may not see the totality of the impact today, but we will see it in the future.

I tell our employees – nurses, doctors, etc. that no matter how stressful and difficult it has been, and still is, we are the lucky ones. We are working, supporting our families, have a mission and a sense of purpose. We all have neighbors who have lost their jobs, can’t pay rent or put adequate food on the table and the business they relied on may be disrupted forever. That affects health. Perspective matters.

How critical is emotional and mental health to a person’s physical health?

It is critical since so much physical health results from emotional and mental health issues. You must look at the totality of a person’s wellness. We spend a tremendous amount of time and effort around employee engagement since we know that in order for our employees to be physically healthy, they need to be emotionally and mentally healthy, which relates to how they feel at work, how they are part of a team, and how we take care of them. Our employee engagement scores over the past nine months as we dealt with COVID have greatly improved. These scores are prepared by an independent agency the industry uses and show that we are at the 91st percentile. It shows that even during a crisis, if you focus on the health and well-being of your employees, they will be more engaged and healthier, which means they will be able to perform at their best which, of course, leads to improved customer service. It’s also important for leaders to be on the front lines with our people, walking around and talking to them about how they feel and what they need. This is motivating and inspiring, and I believe it is critical for any leader to touch the flesh – you can’t Zoom it or Microsoft Teams it. I do this on a regular basis which is good for my overall health.

Do business leaders need to place more of an emphasis around their employees’ health and well-being and to understand that this is not only the right thing to do, but also a business imperative?

This certainly needs to be a continuing focus for business leaders. Many CEOs delegate this to others in the organization which is a big mistake. I know employees and even middle-level managers at hospitals around the country who have been working at their jobs for years and have never met the CEO. That is not helpful. Some become CEO and they get a nice title, big office, new furniture, and start to think about how successful they are. Success doesn’t happen by sitting in your office, it happens by being out in the field and being with your people. The successful CEOs walk the factory floor and spend time with their teams since this is the only way to really know what is happening in the company. One of the worst things that can happen to a CEO is that they begin to believe what they read about themselves and they lose touch with what really matters – being with the employees, listening to their concerns, taking care of them, and constantly communicating the mission. Motivated employees want to belong to a purpose, a cause – not just work for the organization.

How do you feel the future of work will be impacted by the pandemic?

We are moving to a world where technology is allowing us to work remotely. Much of this is productive, but if it becomes only that, then we are making a huge mistake. People need other people to be around them. As we move forward, we need to use technology when appropriate, but we also need to intensify the human connection. We need to have people come together to share thoughts, exchange ideas and build connections. I believe that one of the big challenges going forward is finding the right balance between the human element and technology. The organizations who find that optimum balance will thrive.

Hospitals are thought of as being in the business of treating illness and taking care of patients, but you refer to hospitals as being in the customer service business. Will you discuss Northwell Health’s focus on customer service?

Some traditionalists don’t agree with me, but I firmly believe that we are in the customer service business. How we connect, how we relate, how we listen to customers (patients) and their families is at the core of what we do. The world has changed. The old thinking was that the patient was subservient, and the provider (doctor) was all knowing. Patient input and partnership was essentially non-existent. Patients today are more knowledgeable, have more access to information and wish to be a partner in their care. Rather than asking the question, what’s the matter with you, we now ask, or should ask, what matters to you? Some years ago, I recruited an executive from the Ritz-Carlton, Sven Gierlinger, to lead our customer service efforts and to help modify the traditional mindset. He has done a terrific job. He truly understands how important service and convenience are and what staff education is needed. I remember what Sven explained in one of our first meetings. The subject was initial impressions and he explained that how you are greeted and treated in the first few minutes of an interaction makes all the difference. That’s what people remember. Yes, we are in the service business and we need to get so much better at it. Excellent service is a distinguishing characteristic of great organizations.

What do you see as the role of the hospital in the future in order to meet the challenges facing healthcare?

Some people argue that hospitals and hospital beds will be less needed and less important in the future. I disagree. There will be an increasing need for high acuity, specialized hospital beds in the decades to come. Just think of the demographic changes such as aging. In many ways, we have a crisis of success. Our ability to keep people alive longer, resulting in increasing end-of-life healthcare treatments, will necessitate the need for inpatient care, especially intensive care. The overall role of hospitals in the continuum of care, however, is changing and will continue to change. Hospitals which were once the core of care delivery are now becoming just one component. This may be confusing to non-healthcare viewers so let me explain. Ten years ago at Northwell, hospital care was over 80% of everything we did – it’s now just 50 percent. We now have hundreds of non-hospital facilities doing work that was once only done in the hospitals. This shift will continue, especially with the advance of new technologies. Hospitals are evolving to places that deliver babies and provide intensive care to the growing population of individuals, especially the elderly, with chronic illness. They will continue to be an essential part of our healthcare system. Also, let’s remember that during COVID, hospital bed capacity was key. We had to dramatically increase the supply of beds to meet demand.

Are medical schools doing an effective job at being innovative with the curriculum in order to prepare the next generation of leaders in the industry for the future of medicine?

You are never effective enough. It’s always a race against what’s desired. There are pockets of excellence, but I think that schools, not just medical schools, need to constantly reconfigure and transform to adapt to and create the world of the future. Education is a catalyst for change. We at Northwell have been in the forefront, I believe. We have a unique curriculum in our medical and nursing school that revamps how students are trained. This has been written about many times. Our goal is to create competent, caring, transformative leaders and practitioners.

Is the industry doing an effective job at attracting the numbers of people necessary to address the challenges facing healthcare?

There is no shortage in the number of individuals who desire to enter the healthcare arena. We need to identify the future needs of the industry so that we can adequately direct and prepare them. Let me identify just a few areas. We need more geriatricians and people who understand the emotional, mental and physical issues associated with aging. We need experts in chronic care management, in technology and data analytics, in behavioral health and, of course, in primary care overall.

The promotion of health requires the commitment of everybody, not just those who work in clinics and hospitals. Individuals themselves must take responsibility. So must the food industry, schools, etc. All business leaders, irrespective of the nature of their particular business, have a responsibility. This must be a community effort.

You wrote a book, Living Through A Pandemic, as you were dealing with COVID in real time. How important is it for the industry to remain focused on the lessons learned in order to be best prepared for future crises?

In writing the book, we started each chapter with “lessons learned.” I have a fear that when COVID recedes, we will tend to forget and revert to the old ways of thinking. That would be disastrous. Other crises will occur again in the future and we need to be much better prepared. For example, we should never again be struggling to acquire the necessary PPE and be so dependent on other countries for its production. We need to increase our investment in science, in the creation of a coherent emergency management infrastructure at the federal, state and individual business level. The list is large, but with proper leadership it can be done.

As has been well-documented, COVID highlighted the disproportionate effect on certain populations of color. This is a challenge that now must be forcibly addressed.

There is much debate about the future of New York. As someone who is so deeply committed and invested in New York, what is your outlook for New York’s future?

I am optimistic about New York’s future. New York is a resilient place and a special place. It will be very important to have the right political leadership to lead it into the new future. Business leaders need to commit to the city, not try to find other pastures elsewhere. If you believe in New York, stick with it and rebuild it – don’t leave it and then complain about it. That is not leadership. New York City is the “City of Dreams.” It will always be so.