Growing better, not bigger: 5 questions with HSS CEO Lou Shapiro

Lou Shapiro has been CEO of New York-based Hospital for Special Surgery since 2006. After leading the organization for over a decade, he knows the 154-year-old hospital has to keep both eyes toward the future and outline long-term plans for success.

Under Mr. Shapiro's leadership, HSS has grown its reputation as an international leader in musculoskeletal procedures. It attracts patients from around country and the world, performing 30,000 surgeries per year.

Earlier this year, he distributed a company playbook to every one of HSS's 5,000 employees titled Your Personal Guide: Roadmap to 2020. He talked with Becker's about how he plans to stay competitive in an increasingly consolidated healthcare landscape and what it means to grow better instead of bigger.

Note: Responses have been lightly edited for length and clarity.

Question: First of all, why was it important to you to distribute this roadmap to every employee?

Lou Shapiro: The output of an organization is the byproduct of all the people in that organization rowing in the same direction. You have to be committed to the organization's success and be all in. If people feel an ownership of the plan and feel that they understand what the organization is doing, and feel that they have an important role in it, you will have success.

We walk the talk. We've created an energy that emanates from all 5,000 people who are part of the HSS family, committed to what we're trying to do here, which is being the best in what we do. Everyone is inspired by that and they feel a sense of ownership in fulfilling that obligation of purpose. To do that you need to communicate frequently with people and work together, and as we rolled out the strategic plan I felt it was very important for everyone to feel ownership of that.

Q: The idea of "growing better" is emphasized heavily in the handbook. What does this mean and how exactly do you plan on doing that?

LS: In an environment moving from volume to value, the hypothesis at the core of our strategy is bigger isn't better. The only thing that's better is being better. I'm not implying that it's bad, I'm implying that the jury's still out on whether bigger means better or if bigger just means bigger. There's a lot of organizations that aren't the best at what they do, or aren't better than a lot of others in the marketplace, so they're investing in being bigger as a way of trying to have influence in the marketplace or get economies of scale so they can make investments. In some cases organizations are trying to use their scale to make improvements through their system, but I think the jury is still out on that. Time will tell.

The underlying notion here is that we will be successful as long as we are better than anyone else who does what we do. It doesn't matter if we're bigger — that's not going to help us be distinctive in the marketplace. This organization is leveraging its distinctiveness in its space and is focusing on winning as a result of the value we provide and as a result of being better. That's cornerstone No. 1 of what we're doing.

Q: The playbook also highlights the importance of regional and market expansion. Can you tell me what plans HSS has for this kind of growth? .

LS: It's very important that anything we do with our name on it has the same caliber care as if people came to the main campus. We are building our delivery system throughout the regional market organically — nothing overly sophisticated. Our market strategy is about delivering HSS caliber care closer to where people live and work so not everyone needs to come into the city for care.

In the case of our collaboration with Stamford (Conn.) Health, we previously built a de novo outpatient center there, and our collaboration with them is built around the development of inpatient care at the new hospital they've built. It's the same concept though, emphasizing the same characteristics that made us successful at our main campus: people, culture, medical staff development.

Q: It's made clear in the playbook that the HSS Innovation Center is central to the hospital's vision for the future. What exactly is the HSS Innovation Center and why is it important?

LS: HSS has a very long history of innovation, including the modern knee replacement. The hypothesis for the Innovation Center is that HSS is the largest musculoskeletal institution probably in the world, certainly in the U.S., and it has an academic medical center foundation. That means we not only take care of patients but have significant teaching programs and research. So the goal of the Innovation Center is to partner our scientists and clinicians to identify knowledge that can be exported to the marketplace without patients needing to come here for care to benefit from it.

Today HSS gets paid for what we do, and we want to leverage our knowledge so we get paid for what we know. The knowledge is a result of what we do and the volume of our care. Historically that knowledge has been used to get better — you do the same thing over and over again, you learn from that and you get better, but we want to deploy it to the marketplace through innovations in technology, care delivery and science.

Q: Can you tell me a little more about the HSS Global Ventures project?

LS: HSS Global Ventures is about exporting our knowledge to the world through partnerships with other organizations who want to build HSS-like delivery systems in their market. It's really our focus for out-of-market growth. Our partners could be another health system or any other organization that wants to bring the HSS value proposition to their community. We're doing that either through long-term advisory relationships like we have in Brazil and South Korea, as well as places where we are building new facilities where we feel like we have the right partner we and can replicate what we're doing here.

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