Editors’ Note

Michael Dowling is one of healthcare’s most influential voices, taking a stand on societal issues such as gun violence and immigration that many health system CEOs shy away from. His leadership has been invaluable to Northwell’s consistent expansion and prominence. In March 2020, he successfully navigated the health system through the first COVID-19 epicenter in the U.S., detailing Northwell’s experiences in a book entitled, Leading Through a Pandemic: The Inside Story of Humanity, Innovation, and Lessons Learned During the COVID-19 Crisis. Overall, Northwell has treated over 300,000 COVID patients – more than any other U.S. health system.

Prior to becoming CEO in 2002 and joining Northwell in 1995, Dowling 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 State Department of Social Services. Earlier, he 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 the Ellis Island Medal of Honor, the Presidential Distinguished Service Award for the Irish Abroad, the Alfred E. Smith Award from the American Society for Public Administration, the National Human Relations Award from the American Jewish Committee, and the Foreign Policy Association Medal award. In 2017, he was selected to serve as the Grand Marshal of New York’s St. Patrick’s Day Parade. In 2022, he was named the most influential leader in healthcare by Modern Healthcare, ranking #1 in its annual list of the “100 Most Powerful People in Healthcare” making it the 16th consecutive year he was featured.

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, the Healthcare Association of New York State, 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 the prestigious Queen’s University Belfast, University College Dublin, Hofstra University, Dowling College, and Fordham University.

Institution Brief

Northwell Health (northwell.edu) is a clinical, academic and research enterprise with a workforce of more than 80,000 and annual revenue of $15 billion. Northwell is the largest healthcare provider and private employer in New York State, caring for more than two million people annually through a vast network of more than 850 outpatient facilities, including 220 primary care practices, 52 urgent care centers, home care, rehabilitation, and end-of-life programs, and 21 hospitals. Northwell also pursues pioneering research at the Feinstein Institutes for Medical Research and a visionary approach to medical education highlighted by the Zucker School of Medicine, the Hofstra Northwell School of Nursing and Physician Assistant Studies, and one of the nation’s largest medical residency and fellowship programs.

What do you feel are the key characteristics of a leading health system?

All health systems are different. Many of the health systems around the country cover a broad geographic area. Northwell Health operates in a clearly defined geography which allows us to integrate services so that we can share ideas, staff, and leadership. This element of integration is very important, and it is part of the culture of the organization. This allows us to provide seamless, consistent service and treatment throughout the health system. Culture to me is very important – it is about how you think, how you feel, how you act.

As a leading health system. it is also important to not only be focused on financial return, but also on a high degree of mission work which may not always be about financial gain, but is a benefit to the community. Northwell is very inclusive and community focused, and we get involved and take a lead in addressing issues that impact the community.

As I look to the health system of the future, it is about more than just being involved in the core business of providing treatment and medical care. Leading health systems are also focused on sustainability such as greenhouse gas emissions. It is about having a broad definition of health. Health is a lot more than just delivering medical care, which is why Northwell has made a commitment to addressing issues such as gun violence and immigration since these are public health issues.

Another characteristic of a leading health system is consistency of leadership, which allows for a consistency in strategy. We have not changed our overall strategy at Northwell in more than 15 years. The topics and the initiatives may change, but the overall direction of the health system has been consistent.

A differentiator for Northwell is that we offer the full range of care delivery, from birth to end of life. Many health systems have certain areas of focus or specialties, but we have been consistent in our focus to address the totality of a person’s health.

We also have a close relationship between the front lines and the CEO’s office. I meet every month for dinner with a range of frontline staff and I meet all new employees since I believe it is critical to be close to the front lines to develop a level of cohesiveness. The CEOs office is important, but the most important part of the organization is at the front lines with those who are delivering care and treating patients every day.

Is there one Northwell culture or do the different hospitals and locations have their own distinct cultures?

There is a common Northwell culture. We have to create a system culture where there are certain expectations about behavior and personality, but that does mean that there are not some specific traits to a specific location. The Northwell culture is about how we treat each other, how we treat patients, and how we treat our communities. While this may be implemented a little differently in Staten Island than it is in Northern Westchester, the overall goals are the same throughout the health system.

How do you balance the pressures for financial results with the need to address and invest in public health issues?

This is the test of leadership. You need to balance both – you must have a strong balance sheet and financial return to be able to do the other things you need to do as a leading health system. We are not going to walk away from our commitment to the community and addressing public health issues. We may need to modify our efforts, but leadership is about finding the balance between the bottom line and fulfilling your commitments to the community.

It is very easy to be one dimensional. If you are running a company where your only focus is on the bottom line, in my view that is easy since you eliminate anything that contradicts that focus. Leadership is about maintaining and increasing the bottom line while still doing the things that are important in the community and for society.

How do you define effective leadership?

It is easy to be a leader in the good times. The real test is if you are an effective leader in the bad times. I often get asked by staff about the major challenges we have going forward, and my answer is that we do not have any challenges. We have opportunities, which is a different way of looking at it. If you look at it through the lens of challenges, you are looking at it pessimistically. If you look at challenges as opportunities, then you are being optimistic. It reminds me of when I was on 60 Minutes during COVID and was asked about the future. I said that we were going to beat COVID and that there was no retreat.

In difficult times, the true nature of organizational culture comes through. This is not just about leadership at the top level; it about leadership at every level. This is a test of the organization’s culture – is there a unity of purpose, are people committed to work together – this is all part of the culture of the organization.

In my view, it would be very boring if you did not have challenging times. The reality in healthcare is that if you are a doctor or a nurse in the emergency room, you are dealing with bad things every day. You are dealing with traumatic situations – life and death. It is crisis every day. Organizations that are not in healthcare do not face this, and while they may lose a client or the business may not be performing well, they are not dealing with life and death situations daily. This builds a grit and resilience in healthcare that is critical to help sustain you during challenging times.

What do you look for when hiring talent?

I am looking for people who do not accept the status quo, who have a positive attitude, and who are continuously looking at how to make things better. If you speak with our people at any of our locations, you will find that they are focused on what they need to do today in order to be better tomorrow. It is about continuous improvement. When you hire the right people, and put them in the right positions, it allows you to adapt and be flexible as you focus on the future.

Northwell Health has a mission statement to “Raise Health.” What does this mean to Northwell?

This means that we are one of the key organizations whose sole purpose is to improve the human condition. We do much of this through medical care delivery, but we can do an awful lot more by going upstream. Raising Health means that every endeavor you are involved in – whether it is providing a job opportunity, improving housing, dealing with food insecurity, or providing educational opportunities – has the potential to improve the human condition. This is a global message. We need to be very good at treating illness and also at preventing illness. Raising Health is about more than what doctors and nurses do clinically – it is also about what doctors and nurses can get involved in and talk about to make a difference in the human condition.

What impact has the medical school at Northwell made for the organization?

It has made a major impact. The medical school has elevated the organization and elevated our brand. We are one of the largest academic teaching places in the United States, and having a medical school is a big component of that. The curriculum we developed is helping us educate the doctors of the future. We do not believe that you just take students, put them in a classroom and lecture them about what the world is like. We believe that a student who visits a patient’s home and travels out into the community to see the circumstances that impact health is going to be better prepared to succeed in the industry. This also helps us prepare the next generation of nurses with the teaching and curriculum taking place at our nursing school.

The medical school is about 13 years old, and we are reviewing the curriculum and looking at what the next iteration is and how we continue to change to stay ahead. This is the benefit of starting a medical school from scratch since we did not have to knock down old bureaucracies and ways of thinking. We were able to create a new culture and a new thought process.

Will you discuss Northwell’s commitment to building a diverse and inclusive workforce?

We have a way to go in this regard, and we will look very different in five years because of what we are doing now. This is about making sure that our people are looking where they may not have been looking, and seeing what they may not have been seeing. People tend to look for what looks like them. People hire people like them. I am always telling our people to stop looking where they have always been looking. It is about looking at it differently and identifying people that you may not see all the time. It is then critical to provide opportunities, increase responsibility, and promote.

It is also critically important the way that you enhance the concept of inclusion. How do we educate each other about the other person? If you work in any of our divisions at Northwell, you will find people from multiple countries, multiple religions, multiple ethnicities, multiple backgrounds. It is critical to have our people collaborate and interact because the more I know about you, the more I become inclusive.

What has made the industry so special for you?

When I get up in the morning, I wonder how I can make a bigger difference today than yesterday – that is the drive. I always feel I can do better. That opportunity is huge for me. I come to work every day to improve people’s lives and the health of the community at large. Healthcare is an industry where you make a difference.