The place most people call the “ER” — the emergency department — is a setting of constant testing, where life-and-death decisions are made under intense pressure. My 25 years in the emergency department profoundly shaped how I think about leadership, offering lessons that extend far beyond its walls. Those lessons matter now more than ever as healthcare undergoes rapid transformation — and as I take the reigns as chief executive at Northwell Health, which cares for millions of people across New York, Connecticut and beyond.
In the emergency department, meticulous planning is essential, but experience teaches you that no plan survives first contact with reality. A patient’s condition can change in seconds; circumstances can shift without warning. The COVID-19 pandemic made this lesson painfully clear. With no playbook, no established treatments and a surge of critically ill patients, we faced a crisis of unprecedented scale. Yet innovation flourished under pressure. We pioneered load-balancing strategies to distribute patient surges across hospitals — a reminder that agility and creativity are as important as preparation. That same mindset guides our work today as we adapt to community needs. Whether expanding cancer services or building specialty facilities like our new IBD center, the ability to pivot and rethink approaches remains vital for any healthcare leader.
Emergency physicians learn to act with incomplete information. The ability to weigh risks quickly, empower teams and adjust course as new data emerges is central to survival in the emergency department. Leadership at the system level is no different. Evolving payment models, disruptive technologies and shifting patient expectations create ambiguity every day. The leaders who succeed are those who make timely decisions, learn from them and continually reassess. Hesitation can be just as dangerous in the boardroom as it is at the bedside.
Perhaps the most enduring lesson from the emergency department is that every decision must be anchored in patient well-being. In the midst of urgent situations, it is easy to get lost in protocols and logistics. The best clinicians never lose sight of the person in front of them. As organizations, we face the same challenge. New technologies, financial pressures and regulatory demands can easily distract from our central purpose. But if patient health, safety and dignity are not at the core of every initiative, we risk losing the trust of the very communities we serve.
My own background is rooted in emergency care, but I recognize that other physicians — especially those in primary and office-based care — bring equally vital insights. Their role in prevention and chronic disease management keeps countless patients out of the emergency department. A high-functioning health system requires both perspectives: the ability to manage crises and the ability to prevent them.
The challenges before us are formidable. We face workforce shortages, uneven access to mental healthcare, under-resourced primary care and widening inequities. At the same time, we stand at the threshold of extraordinary opportunity — with new tools in data, technology and medical science. Healthcare leaders must find ways to build resilient teams, harness data and digital tools responsibly, strengthen primary and behavioral healthcare, and ensure equity is not an afterthought but a design principle.
The emergency department taught me that crises, while disruptive, also create opportunities. They test our systems, our values and our resilience. In every moment of uncertainty, there is the chance to adapt, to innovate and to emerge stronger. As healthcare leaders, we must carry that mindset forward. The industry is moving fast, and the stakes remain high. By staying prepared yet flexible, acting decisively and keeping patients at the center, we can turn today’s challenges into tomorrow’s breakthroughs.
Our commitment to patients, communities and the future of healthcare must remain unwavering. That is what leadership demands — in the emergency department and in the boardroom.
Dr. John D’Angelo is president and CEO of Northwell Health.
