5 important questions for healthcare leaders from North Shore-LIJ CEO Michael Dowling

Leaders can ask themselves a few questions every day to determine whether their organizations can, or will, make it to the other end.

At the Becker's Hospital Review 6th Annual Meeting in Chicago, Michael Dowling spoke about the old and the new in healthcare. Mr. Dowling has led Great Neck, N.Y.-based NorthShore-Long Island Jewish Health System as president and CEO since 2002. His time with 19-hospital North Shore-LIJ has been marked by action. The health system has entered into strategic alliances with the Cleveland Clinic, Hackensack University Medical Center and Montefiore Medical Center to increase innovation and improve patient care. Under his leadership, the system also formed the Center for Learning and Innovation, launched CareConnect health plan and earned recognition for diversity, among other achievements.

Mr. Dowling started with talk of the ACA, ACOs, IPAs and PHOs — but not for long. "We love terminology," he said. "I'm not going to talk about any of these things." Instead, he focused on the questions leaders should ask themselves and things they should remember day in and day out.

First thing to remember? Not all is new. Despite healthcare's penchant for exaggerating change, complexity and ambiguity, Mr. Dowling said there are some familiar forces at play that people only dress up and repackage as new. "You can argue there are a lot of new things going on, or you can argue that it's not very new — that it's a variation of the old," he said. "We have to be very practical about the current discussion."

He added that healthcare leaders should get out of the business of self pity. "We shouldn't feel sorry for ourselves. A lot of us say, 'Oh my God, how could this be happening. Look at all the unpredictable things happening all the time.' These are happening in every industry," he said, mentioning media, banking and travel as industries that have faced disruption and become more global in scale. "It's the nature of business."

Here are five questions Mr. Dowling recommends hospital and health system leaders pose to themselves and to their colleagues.

1. Is my organization a disruptor in the marketplace or is it being disrupted? This question leads to several others. Is innovation part of your  organization's DNA or is it the exception? Are you evaluating strategy, or is strategic evaluation an attempt to protect what you've got? Is innovation reaching the organization at every level? "The whole organization has to change, not just pieces of it," Mr. Dowling said.

2. How am I promoting creativity in an environment increasingly dominated by a culture of regulation, standardization and compliance? If they let themselves, leaders can easily spend the majority of their days reacting to regulatory demands. But Mr. Dowling said executives must be creative to rightfully retain their titles and responsibilities. The question becomes how to best create in a climate of continuous compliance. "How many of you feel that if you think about doing something completely new and different, you have to be surrounded by a bevy of lawyers?" He said the regulatory constraints on healthcare, and the way in which they stifle innovation, should be addressed on a policy and advocacy level.

3. Am I looking at the world from inside out or outside in? Mr. Dowling illustrated how hospitals make decisions or build strategies around the convenience and preferences of staff and faculty. "We like to do surgery Monday through Friday but not necessarily on the weekend," he said. "We like to close up at 5 p.m. in some of our offices. How many of you have been in meetings where faculty says, 'Well, we can't do that on Sunday.'" Expecting patients to only attend to their healthcare Monday through Friday from 9 to 5 is absurd, said Mr. Dowling. This old, closed-off mindset will hinder even the most prestigious hospitals or health systems.

To move further of the bubble and see your organization the way a patient might, he recommends leaders and employees walk into their hospitals with the mindsets of consumers. The place where employees report to work every day is also the place where people come when they are feeling their worst or most vulnerable. Shortcomings become less noticeable when you see them every day, but if you walk in with the mindset of a patient, you'll see the hospital in a different light. "You'll see a dirty garbage can, or paper on the floor, or a security guard not paying attention, or valet walking slowly to get somebody's car," says Mr. Dowling.  

4. Is my organization in the health business or medical care delivery business? The two are hardly synonymous. "If you are in the health business, you need to be in the business of exercise, behavior, lifestyle issues and social status," he said. Medical care, on the other hand, is a subset of health. Hospitals that operate under the "medical business" philosophy will never be able to improve population health. He also said it is easy for hospitals and health systems to forget their status as the largest employers in their regions. "You're often at conferences talking about employers, yet in our own areas we are the employer," he said. If health systems cannot improve population health for their own employees, how can they be expected to do it with other people?

5. How am I addressing the need for a new generation of leadership in our organizations? Mr. Dowling said leaders cannot move to a new era of care delivery with skills taught 20 years ago. Healthcare is adopting a new culture. "It's not about what I control, but what I influence. It's about how I work together as a team," Mr. Dowling said.

Within this last question is another one: "How many in organizations are crating cadres of high-profile players to succeed each one of us?" The turnover rate for hospital CEOs was 18 percent in 2014, the latest year for which data is available. This high level of change makes mentoring and professional development all the more critical.

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