INTRO COMMENTS: Hello and welcome to Modern Healthcare’s Next Up, the podcast for emerging healthcare leaders. My name is Kadesha Smith. I'm your host, and I’m also the CEO of CareContent, a digital strategy agency for healthcare organizations.
As I record this, our country is experiencing another spike in COVID-19 infections. Many states are reporting new cases that resemble the pandemic’s initial peaks. There’s a renewed urgency about public health precautions like mandating masks and restricting business operations to prevent people from coming into close contact. Meanwhile, many of you are probably listening to this while you’re sitting right next to your kid who’s doing e-learning because they’re still not back in school.
Returning to normal can seem so far away, but if we’re ever going to get there, we have to reflect on what we’ve learned so far. Today, we’re finishing our conversation with Michael Dowling, CEO and President of Northwell Health in the New York City metro area. Northwell Health was in the center of the epicenter when the COVID-19 pandemic first ravaged the NYC area.
The private health system’s 23 hospitals and 800 outpatient facilities treated nearly 50,000 COVID-19 patients before July 1. But the difference between Northwell Health and many other health systems is that they were prepared.
In the first part of our conversation, Michael Dowling explained why they were ready and what steps they took to serve as many patients as possible early on. He shares his most trenchant lessons learned in a new book titled Leading Through a Pandemic: The Inside Story of Humanity, Innovation, and Lessons Learned During the COVID-19 Crisis.
Here in the second part of our conversation, Michael Dowling discusses the mindset that the strongest leaders need to navigate crises like COVID-19. It’s one thing to check all the emergency preparedness boxes, but it’s quite another to mentally stay on point — even as you’re surrounded by tragedy and uncertainty.
SPONSOR MESSAGE: Before we get to our discussion, I’d like to acknowledge our sponsor, Masimo.
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MODERN HEALTHCARE: Now, let’s get into part 2 of our conversation with Michael Dowling, CEO and President of Northwell Health in the NYC metro area about leading through a pandemic.
MODERN HEALTHCARE: So, let's talk about the health systems or the healthcare organizations that don't have the advantage of being in a major health system. They don't have other facilities that they can transfer patients to or a reliable transportation network. What take-home message would you offer to senior leaders of the smaller, independent, maybe even rural hospitals who are not part of a system, and they need help?
MICHAEL DOWLING: Develop relationships with other health systems or other single hospitals that are not part of your own organization, but that are in the catchment area. It could be 50 miles away, 100 miles away. Develop those relationships, because those can be very, very helpful when you need them. Also, develop relationships with the local community-based organizations, with non-healthcare organizations, and develop those trusting compacts with those individuals. If you are a single hospital and there is a big system not far from you — develop a relationship with that system so that you know the people, and you're not part of them, but when a situation of course you can call up and say, “I need help.”
And if there is that trusting relationship, as I said before, people will always come to help in a crisis, and they will definitely come to help if they know you. And if they understand you. Start working those relationships early on — don't try to do it when a crisis hits.
MODERN HEALTHCARE: The way you describe the first six months of you onboarding a leader, it basically sounds like they were a student. They just need to be a student for that time period and learn as much as they can. And I'm sure that, in a pandemic like this, all leaders have been challenged to learn something new.
MICHAEL DOWLING: All of us are students all the time.
MODERN HEALTHCARE: Yeah.
MICHAEL DOWLING: We all learn. I mean, I've been in this business a long time. I gotta tell you — I learn every day. The people you worry about are the people who think they know it all. You're a perpetual student. You should continually lead, continually study, continually try to learn more. Look for those organizations that do unique things, and try to find out why is it that they do those things uniquely? What is unique about what they do? What best practices exist now?
A good leader is a person who is a continuous learner. During the pandemic, we learned an awful lot about ourselves, and we learned about ourselves individually. We were a good team here, we bonded an awful lot more during this crisis. Clinical disciplines that used to always work together a little bit, during COVID, they had to work together completely in an integrated fashion. So, that integration occurred even more so during COVID. The other thing during COVID is, we innovated very quickly, and we became very creative. We did things overnight and, in the normal times, it would have taken us three months to do, because we would analyze it, we would do business plans, we would analyze it to death.
In a crisis, you just have to do. And we did it very, very effectively. So, one of the lessons is, how do we bottle that energy, that creativity, that innovation that we've found that exists during a crisis, so that we can use it when there isn't a crisis? And there are many lessons here, but I think those of us that have gone through this, I believe that we are going to be better people because of it. And I think our organizations will be better organizations because of it. Because now we will do things differently, and we have a much broader, much deeper understanding and perspective of life, and of our role and responsibility in the community.
MODERN HEALTHCARE: Talking about you personally, as the CEO of the system, what skill did this pandemic sort of force you personally to learn?
MICHAEL DOWLING: I've always spent an awful lot of time dealing with frontline staff and new employees that come into the organization. I have, for the last 20 years, met with all new employees that have joined our organization, and we usually had about 200 a week. The lesson here is — well, there are two lessons.
One is that I've got to do more of this. I got to be on the front lines more than I am today, and I think I'm out there quite a lot. But you've got to be very visible as a leader. There are leaders who hide. They use the computer as a means of communication. They stay in their office. You’ve got to be out there physically walking the front lines continuously. That's one lesson.
The second lesson is, I learned that there is amazing talent in people that you don't see in the normal times and amazing talent in the organization that blossoms during a crisis. So, how do you mine that talent going forward, better than we've done pre-COVID? I found out an awful lot about people that I thought I knew well. But I found an awful lot more about them during COVID. I also found out that when people complain about burnout, during crisis, we work around the clock all the time. Burnout did not become an issue for us because the commitment and the obligation that we had to take care of people in that circumstance was so great that our own concept of burnout was put in the, in the rearview mirror for a while.
MODERN HEALTHCARE: Wow, and that's because the commitment was so strong.
MICHAEL DOWLING: Sometimes, people begin to think of that in circumstances, "Oh my god, my situation is kind of — look how bad it is, etc, etc." Well, when you're in these circumstances, you realize your own circumstance is not that bad. Seeing the opposite, and you're saying, “Boy, am I lucky, am I fortunate.” And for everybody in healthcare right now, we are in many ways — despite what we went through — we're better off than most people in most other organizations.
First of all, we're working. We have jobs. We are needed in the community. When I look around at other businesses that have laid off tens and tens of thousands of people, many businesses completely closed, some businesses never opening up again. The employees in those places, they have a problem. Compared to them, we're in great shape. So, this is the other perspective that we've got to understand. We are very, very fortunate for what we do and how we do it. And not everybody gets to make a real difference in life. When you're in healthcare, you get to make a real difference.
MODERN HEALTHCARE: Yeah.
MICHAEL DOWLING: And if you're interested in making a real difference, then become a healthcare leader, because you can extrapolate that and make even a greater difference for so many more people than you ever imagined.
MID-INTERVIEW SPONSOR MESSAGE: We’ll continue with our discussion with Michael Dowling in just a moment, but first, I’d like to pause again to thank Masimo, the sponsor of this podcast.
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MODERN HEALTHCARE: And now, here are more thoughts from Michael Dowling.
MODERN HEALTHCARE: The book dedicates a full chapter to the role of policymakers and how excessive regulation can hinder patient care. A lot of that excessive regulation kind of went away during the pandemic, but we're wondering now, you know, what is it going to look like once this pandemic is behind us? Tell us your thoughts on, sort of, what is a healthy relationship between the healthcare systems and the state and local legislators and then even the federal legislators as well. What should that look like going forward.
MICHAEL DOWLING: Well, I mean, let me give you — my background is a little different than many because I did spend 12 years in government. I was the head of Health and Human Services in the state of New York. I was the top guy for the governor on health and human services for many, many, many, many years. I have a little different perspective. And I work very, very closely with the governor in all of the COVID issues in New York.
Again, it goes back to something that I've said a couple of times. You have to understand government. You have to understand that there are good people in government. This is a learning everybody's got to go through. There are good people in government. A government can become bureaucratic and become, you know, you can complain an awful lot about it. But it does a lot of good work, and there are very good people, and you've got to get to know who those people are. You've got to understand the bureaucracy of government, just like our bureaucracies in each of our organizations. Again, it's relationship-building, people in government.
And I'm recalling now, when I was in government, I always wanted advice from people on the front lines. But I would accept that advice more readily from people I knew and people I trusted and people who came not with just criticisms, but who came with some suggestions about how to make changes. If you're in government, you get criticized all the time. And everybody comes in, they hammer the table, they scream at you, they tell you you don't know what you're doing, but they have nothing constructive to offer. You have to be able to offer constructive solutions.
And one of the things that we have to offer now, which I'm working on with the governor here in New York, is that a lot of the regulations that were dispensed with during COVID were absolutely instrumental in allowing us to be innovative and creative. Many of those regulations which have existed forever, many of them don't need to continue at all. They impede change. And so what we've got to be able to do now is explain to the government people rather than going and saying, you know, “Regulations are stupid.” You've got to be able to identify which ones we should no longer have and have a collaborative, productive, constructive working relationship with the people in government. So, I think that's part of our responsibility.
Government is going to be a huge player, is a huge player, will always be a huge player, and probably will increase as a huge player in healthcare provision. It is our job to make sure that, as they increase their role or decrease their role, we have influence in figuring out, and in helping them do it and do it the right way.
MODERN HEALTHCARE: We think we're at the height of the pandemic. We don't really know, but I'm looking forward to seeing how the government responds, especially at the state level, and you've been so close to this for the last few months. I'm going to ask an off the cuff question because this is something that I loved about the book.
I love how often you quote nurses. I love how often you went to nursing leadership and said, “What do you think?” And all throughout the book, you are highlighting the nurses and the women frontline workers, giving their expertise and sort of guiding the path of how the health system was going to navigate this pandemic. And, as you know, there was some criticism nationwide about nurses being sort of left out of the initial planning.
Why was that so important to you to make sure that this was not just, you know, executives sitting around making decisions? Nurses had to be involved as well.
MICHAEL DOWLING: Well, if we had executives just sitting around making decisions, we would have a complete disaster.
MODERN HEALTHCARE: Okay.
MICHAEL DOWLING: Yeah, you want a lesson for craziness — just have executives only do it. A member who does the work in health care — it's the doc, it's the nurse, it’s the respiratory therapist, it's the social worker, it's the environmental person. Those are the troops. You cannot run a health system or a hospital without nurses. Nurses do about 80% of the work. We've got 18,000 nurses at Northwell. And so we have a nursing institute, we have key nursing leadership, but also the nursing leaders on the floor. So, if you want to know what's going on in any of the hospitals, you've got to go to the floor, and you’ve got to talk to your nursing leaders.
Remember, what do most doctors do when they come to see a patient? And I've been a patient a number of times. The doctor comes in, asks the nurse, “How's the patient doing?” The nurse is the one who's there all the time. Nurses are influencers. Nurses make great leaders. And so if you want to be connected to reality, you have to have a close relation with nurses, and of course with physicians, but nurses are key.
So, staffing, for example, when we were going through the COVID issue, staffing becomes the most difficult problem. And that was led by my HR department, which is led by a physician assistant. My HR person is a PA. He and the head of nursing are working with all the nursing leaders around the health system, were the people that primarily determined how the staffing needs are going to be met on an ongoing basis 24/7. So, the reason I was out on the floors of the hospitals and the ambulatory sites all the time, it was to, you know, show my respect to the people on the front lines who actually did the work. My job was relatively easy. They were the ones that showed the courage, the compassion, the dedication to do things that were extremely difficult at the beginning when we knew little about the disease. And nurses were the destabilizing force.
MODERN HEALTHCARE: I believe in the book you said they are the Marine Corps.
MICHAEL DOWLING: Yes.
MODERN HEALTHCARE: I think that's a great analogy for them.
MICHAEL DOWLING: Absolutely.
MODERN HEALTHCARE: So, final thought, because as we said, we're really looking at sort of up-and-coming leaders and what they can learn from this to prepare for when they're in the leadership position that they're aspiring to and this happens again. If you could pick your successor today, knowing that he or she would face a similar pandemic, what are the top three traits you would look for?
MICHAEL DOWLING: I would look for somebody that has an unbelievably positive, upbeat, inspiring attitude. Attitude is key. A positive attitude is key.
Second is, I want somebody that is absolutely committed to the frontline troops and the front line staff, and who is big into talent development, talent management, etc, inspiring the best of your people and who can develop followership. I would look for somebody that has a mindset for innovation, who sees that the status quo is one of our toughest competitors. You've got to be breaking the rules continuously if you want to move forward.
And lastly, is you want somebody that is always committed to doing the right thing. And not just doing things right, but doing the right thing. And be able to go home at night, look in the mirror and say, "Today I did good. Today I did well. And today I did what was right." And sometimes, doing what's right will get you in trouble, maybe financially, maybe otherwise. But you have to continually do it. Those would be some of the criteria that I look for. And that's how I operate here. And those are the kinds of people that I have on my senior team, and in my up-and-coming team, that I think can carry an organization to the next level because all of us have to do an awful lot better than we have, than we've been doing in the past. And one last point.
MODERN HEALTHCARE: Yeah.
MICHAEL DOWLING: You want somebody that is absolutely committed to dealing with the inequities in health care. COVID demonstrated that the poorer communities, the African American community, minority communities, are disproportionately affected. And you need a leader that makes that a priority.
MODERN HEALTHCARE: That is fantastic. Thank you so much. And I think another thing I love about the book is that you don't just say, "Do this, do this." But you actually give bulleted lists about here's what to do. It's very much, you know, a step by step, sort of, if you're focused on emergency preparedness, here's what you should do. Step one, step two, step three. So, thank you for making this a book that's accessible for people who are action-oriented, and for people who want to know, what do I do if I want to reach this goal?
MICHAEL DOWLING: We have enormous potential to do things so much better. And this goes to the point I made earlier — a good leader is never satisfied. You know, you just don't sit back and relax. I think that's what makes good leaders different from not-so-good leaders.
MODERN HEALTHCARE: Thank you so much for sharing this with us.
MICHAEL DOWLING: Thank you. It's been a pleasure.
OUTRO COMMENTS: Thank you, Michael Dowling, for sharing that wisdom. I love that he outlined the requirements for his current leadership team and his up-and-coming leadership team. Because what’s helped your health system be successful in the past may be different from what will help in the future. Very good food for thought.
Again, I’m your host, Kadesha Smith, CEO of CareContent. We help health systems reach their growth goals through digital strategy and content.
We’d also like to again thank our sponsor for this episode, Masimo.
Look for more episodes of Next Up at modernhealthcare.com/podcasts, or subscribe at Apple podcasts or your preferred podcatcher. If you’ve enjoyed the previous episodes of this podcast, please submit a review on your preferred podcatcher. Thank you again for listening.