As the largest health system in New York, Northwell Health has been in the thick of the battle against COVID-19 for weeks. The system has seen nearly 40,000 patients since the pandemic started and created capacity for 1,900 new beds. Northwell President and CEO Michael Dowling says he is hopeful that the entire healthcare industry will use the lessons learned from the pandemic to build a more collaborative and responsive delivery system. He spoke with Modern Healthcare Managing Editor Matthew Weinstock as part of our new webcast series, “The Check Up.” Look for next week’s installment with the head of Atlantic Health System’s hospital division, Amy Perry. The following is an edited transcript.
MH: Can you provide an update on things at Northwell? You’ve started to see a little bit of a plateau and maybe even reduced admissions, right?
Dowling: For the past 12 days or so, the numbers have been coming down. At our height, we had about 3,500 (COVID-19) patients in our hospitals. We saw, in total, about 13,000 patients in our hospitals, and about 40,000 when you include the ambulatory and the treat-and-release in the EDs.
Right now we have about 1,500 and the trend is continuing to go downward. We will have a lot of patients for a long time, but I believe we will continue to decrease. We’re in a much better position today than we were two weeks ago. It’s more manageable, it’s not as hectic. We’re not trying to create new beds every day, which we were in the height of the crisis. .
MH: What lessons can you apply in the fall when there’s a potential resurgence?
Dowling: We were a little fortunate here at Northwell, because years and years ago we put together an emergency management system to deal with crises like this. We have a built-in infrastructure in our health system, and we used it for Ebola, for H1N1, SARS, etc.
We are, right now, putting plans together for the specifics of what it is we might have to do in the fall, if this ramps up again. But we are in a much better position, having gone through the serious crisis over the past six weeks.
It’s all about beds. It’s about staff, which is the biggest issue. It’s about PPE. It’s about testing. And of course, we’re much more attuned to the needs of testing today than we were at the beginning when this whole thing happened in March.
MH: Dealing with 23 hospitals, more than 70,000 staff across the system, what’s that been like for you, just trying to manage morale?
Dowling: A couple of things. One is that the staff issue is by far the most difficult, because you have all of these staff, but you’ve only got X number that can deal with the crisis on the front lines. The intensive-care staff, the primary-care docs, the nurses, etc. We have about 800 ambulatory locations. So it’s not just the hospital system; 50% of our business is nonhospital. We also closed a lot of our ambulatory sites and moved staff into the hospitals.
We have a daily dashboard and HR did a terrific job on this. We were able to move staff around, because we work as a system. We brought in staff from around the country. We brought in agency staff, for example. Intermountain Healthcare was extraordinarily helpful. They sent a lot of staff here over the last couple of weeks. I visited with about 35 of them last week who were leaving to go back to Intermountain. So I want to thank them.
That kind of help among systems is something where … I am going to have an ongoing continuous relationship. … If we’re in trouble, they help us. If they’re in trouble, we help them. Because distance doesn’t make much of a difference here. You can move staff around. It was complicated every day, but we succeeded in making sure that we were able to do it well.
One last point. We have a medical school and a nursing school and a (physician assistant) school, so we did our graduations earlier. And we brought our staff out, and used those medical students and those nursing students on the front lines for certain roles that we needed. We used the constellation of all the staff working together. One of the lessons here is that there was unbelievable interdisciplinary work going on. I was on every floor of every hospital … and I would come across the cardiac staff working on the front lines with the ICU staff.
This silo between disciplines … in a crisis like this, it just breaks down. That interdisciplinary nature of how we work together is a lesson. I hope that we don’t ever fall back to the old way.
MH: Healthcare is notoriously slow at adopting change. So how do you ensure that you keep those silos broken apart?
Dowling: It’s part of the culture. It’s not just the staff and the disciplinary part of it. We created almost 1,900 new beds during this crisis. We were creating 200 beds a day. And if, during normal times, I would say to the staff, “I need you to open up 200 new beds,” I would have a lot of analysis, I would have business plans, I’d have a lot of gnashing of teeth, and, “Oh my God, we can’t do it.” Yet in a crisis, we did it overnight. When we had a problem with (ventilators), instead of going around screaming about not having enough vents, we took the bypass machines and converted them to vents, and did it in a couple of days. When we didn’t have enough swabs, we went to our 3D printing capability and we created swabs.
That kind of speed of innovation, that speed of creativity, is something that we’re going to do our best to make sure that we enhance going forward, which means that we have to break down some bureaucracy that obviously grows in organizations over time.
MH: How do you think the collaboration across health systems can continue?
Dowling: Let me deal with it from two perspectives. One is the collaboration inside our system. And if there is one logic that demonstrates the benefit of systems, dealing with the coronavirus crisis proved it. If we were individual hospitals, we would have been dead. I can give you an example. Because we’re very integrated, we were moving, every day, 60 to 70 patients, from some of our hospitals to others. Our hospitals in Queens or Manhattan got swamped. … Because we have a central transport system, (we were) able to move patients 50, 60, 70 miles away, to other areas.
Then there’s the collaboration among the big systems in New York, because I worked very closely with the governor, which he asked me to do. The five big systems, we started to get together every other morning, virtually, the CEOs only. We would talk, we would collaborate, we would share information. Northwell ran the (Javits New York Medical Station field hospital) during this crisis, which helped ease the burden on some of the other hospitals.
That collaboration was very beneficial, and I’m hoping—given the sense of camaraderie that developed between us, despite the fact that we will always be competitive, which is good by the way—that there are areas where we can actually work together.