By Published On: May 31st, 2016Categories: HEP

Michael DowlingMichael J. Dowling is President and Chief Executive Officer of Northwell Health (formerly the North Shore-LIJ Health System). With 21 hospitals, more than 450 outpatient physician practices and a full complement of long-term care services, Northwell Health is one of the nation’s largest health systems, with nearly $8 billion in annual revenue. Michael 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. Earlier this month, Mr. Dowling spoke to the audience of the HEP Annual Meeting about issues affecting large hospital systems, the healthcare industry in general, and the Hofstra Northwell School of Medicine.

We’ve highlighted a few key passages below. A link to the full recording is available here.

On the unforeseen consequences of success in healthcare:

For anyone here who knows anybody with a heart disease of any kind, back in the 1970s there was not much anyone could do for you other than tell you to go home and rest. And just imagine what we can do for you today. I will argue that what we are suffering from these days is not a failure in healthcare but a crisis of success. We have been able to do so many things to keep people alive for so long that we now have a real problem figuring out how to afford it. Part of the problem with the cost of healthcare is that we can do a lot more than we could ever do before. Because of the success in healthcare people are living longer, therefore the costs go up. Therefore we’re suffering from success not failure.

On straddling two contradictory payment methodologies: 

The new model and the financial incentives are happening in some places but not others. You’re living in this world of paradox where you have a lot of your business working one way – fee for service – and other parts of your business working the very opposite way on value and some other parts of your business doing both at the same time. Just think of having a large workforce where you’re trying to get people to understand how to deal with that ambiguity where the incentives are aligned in one place but not aligned in another place.

On the challenge of local change management:

Change in some environments is so difficult because we are the engine of economic growth in many communities in New York. We are the biggest private employer in New York State. [In some of] those communities [we are] the only source of economic development. It’s the only employer, only place for jobs, there is nothing else. In broad swaths of that community other than healthcare. When you talk about why doesn’t this happen or that happen why don’t we close this? Because you’re dealing with people’s livelihoods in those communities. That’s why the politics of healthcare and healthcare change is so dramatically difficult. Brooklyn is going to be a wonderful example of this. Watch what is happening there over the next 12 months. This issue is going to percolate to the top in the press in New York.

On the key pain points and opportunities for large health systems:

  1. Growth, scale, and integration: It’s one thing to have a multiplicity of entities as part of an organization, but you’ve got to integrate them so they all work together. We have 22 hospitals now. We work as if they are all one. They’re all integrated with the same metrics, same leadership across the board. All back office functions are consolidated. I like to say that we run the organization as a business – it has a mission, but you’ve got to run it as a business.
  2. Care Management Infrastructure: Big organization in the healthcare space has to be very good at building a CMI so you can manage people’s care along the continuum. It’s not episodic care anymore. You’ve got to be able to manage the person’s transition and navigate it through the whole process of care from beginning to end.
  3. Quality Outcomes: We have to get better at figuring out how to compete on outcomes. What I mean by outcomes is it is not process. Just because you leave a hospital alive after surgery doesn’t automatically mean it was successful. What we should be measuring over time for example is if you leave the hospital after having hip replacement that you can return to work as a contributing member of society within a certain period of time. Not just 30 days after you leave a hospital. We need a whole new definition of what quality means.
  4. Consumerism: We’re a service industry. We need to be better about the consumerism movement. With all of the new technologies out there, the consumer will have much more access to information.

On disrupting the medical education paradigm:

We started from scratch. We had no history. We did the curriculum very differently. We went around the country and overseas and looked at where the most innovative things were going on in medical education. Remember we have a clean sheet of paper. I didn’t have bureaucracy to break down. I wasn’t a Harvard where you have 100 years or more of history that you have to tear apart before you can do something. We came up with a curriculum that does a couple of things:

  1. In most medical schools traditionally, you spend the first two years in classwork and you spend the second two years in a tertiary campus. We decided in the first nine weeks every medical student is trained as an Emergency Medical Technician (EMT). They are now a licensed entity in the state of New York. We now put them on our ambulance service (because we have the largest medical transport system on the east coast). We have them on the ambulances working with other EMTs and going into people’s homes from Day One. If they go into a person’s home in the ambulance and the patient needs to be picked up and taken to the hospital, then the medical student follows. If they have to go to the operating room, they will follow [the patient] into the operating room. They get hands on direct contact with the actual receiver of the care from Day 1.
  2. We have no lectures. It’s all small group sessions. We have no multiple choice questions or exams. We test in a simulation center. We have one of the largest simulation training centers in the US. So every 12 weeks they have to go into the simulation center just like pilots who are trained to fly planes. There is a scenario set up based upon their learning and they have to go in and demonstrate that they can actually do it. The school doesn’t encourage memorization. You don’t need to memorize anymore. All you have to do is Google it. What you need to be able to do is analyze, diagnose, understand, know how to do things rather than memorize.
  3. Everything is in teams.

The result has been that we now get between 8,000 and 9,000 applications a year for 100 slots. In the tests that they have taken so far, they come out way ahead of most other schools. Of the 16 schools in New York, we are now ranked number three in terms of the quality of the students, and we’ve only been in business seven years.

On teaching millennials:

They learn differently, assess differently, analyze differently, and appreciate differently than most of us in this room learned. The biggest challenge in any industry and especially in healthcare is changing how we create a learning experience that is different from what we’ve done in the past. I like to tell people that once you get your degree these days that you begin to forget what you learned immediately and relearn. In our organization, we put people into positions that they’ve never done before. Every administrator in every one of our hospitals has never before run a hospital. I would not hire a person that has been running a hospital for 15 years because I’ll get a hospital from 15 years ago. I won’t get a person with 10 years’ experience, I’ll get a person with one year of experience 10 times.

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