michael j. dowling, president & ceo, north shore
DESCRIPTION
Pursuing Success - Lessons LearnedTRANSCRIPT
Pursuing Success – Lessons Learned
October 9, 2014
West/North West Hospitals Group Conference
Michael J. DowlingPresident & Chief Executive Officer
North Shore-LIJ Health System
PROPRIETARY AND CONFIDENTIAL INFORMATION. DO NOT DISTRIBUTE 2
North Shore-LIJ Health System
PROPRIETARY AND CONFIDENTIAL INFORMATION. DO NOT DISTRIBUTE 3
Insurance Enterprise
Educational
Enterprise
Research Enterprise
Community Health Enterpris
e
Community benefit
Access and education programs
Veterans’ programs
Children’s programs
CareConnect
Risk
Capitation- bundled payments
Product offerings
Joint product offerings
Employer products
Population health
Bioelectronic medicine
Clinical research management
Health services/ outcomes research
GME/CME
Medical School/ Elmezzi
CLI
Clinical Enterprise
Inpatient facilities
Ambulatory/ outpatient
Long Term/ Home Care
Hospice
Joint ventures
Medical transport
Medical Group
North Shore
Ventures
New businesses
Consulting
Partnerships
Shar
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A
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serv
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Cli
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Support Structure
Health System Enterprises
Services supporting the health system enterprises:
Partnerships
The System Today
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• Largest provider of health care in NY State – one of the largest employers• Major academic teaching center• Major commitment to research – The Feinstein Institute• Single governance – not just a collection of distinct, individual entities• Administratively and clinically integrated; Service Line approach to care delivery• Single system-wide management – clinical and administrative• Densely populated; competitive and diverse environment• Provides full continuum of care• Possesses insurance license and capabilities to take risk and sell products
An Integrated System
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Health System Growth & Integration
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• First organization in the region to form a health system and subsequently grew into the region’s largest integrated health system
• In 2002, established the industry’s first corporate university – The Center for Learning and Innovation
• Opened the first allopathic medical school in New York State since 1963 – Hofstra North Shore-LIJ School of Medicine
• First healthcare provider in New York State to create a wholly-owned health insurance company – North Shore-LIJ CareConnect Insurance Company, Inc.
• Opened the first freestanding emergency center in Manhattan – Lenox Hill HealthPlex
• Opened the first freestanding laboratory in New York State in 1998 and now has the largest health system-based integrated laboratory operation in the northeast
• Established a first of its kind collaboration with the U.S. Department of Veterans Affairs to provide coordinated behavioral health care to veterans and their families under one roof
• First private hospital system in New York State to post its hospitals’ quality performance data on its website
• First health system in the New York metropolitan area to receive the National Quality Healthcare Award from the National Quality Forum in 2010
• First health system to receive The Joint Commission’s Codman Award in 1999 for achievement in the use of process and outcomes measures to improve organizational performance
A History of Firsts
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Source: 2013 SPARCS, Based on discharges & patient origin
*Service Area-Manhattan, Richmond, Queens, Nassau & Suffolk
27% Share – 15 points greater than closest competitor
27% Share – 15 points greater than closest competitor
2010 Market Share 29% Share – 17 points
greater than closest competitor 29% Share – 17 points
greater than closest competitor
2013 Market Share
Source: 2010 SPARCS, Based on discharges & patient origin
NS-LIJ27%
NY-Presby
12%Mt Sinai/
Continuum11%
CHS-LI10%
HHC9%
Winthrop / S. Nassau
6%
All Other25% NS-LIJ
29%
NY-Presby
12%Mt Sinai/
Continuum12%
CHS-LI9%
HHC9%
Winthrop / S. Nassau
6%
All Other23%
Service Area Market Share
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• New businesses• Consulting• Partnerships
• Taking risk• Treating illness & promoting health • Innovative partnerships
• Expanding geography• Creating alignment• Innovative relationships
• Promotion of interdisciplinary learning• Pioneering discoveries• Innovative educational programs
• New markets• Joint ventures• Innovative delivery models
• Consolidations• Conversions• Centers of Excellence
• Quality and patient safety• Efficiency and productivity• Employee/patient engagement
• Physician leadership• Succession planning• Continuous learning
Health System Strategy
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Management CapabilitiesInformation Technology
•Meaningful Use Consulting•ICD-10 Consulting•Patient Portal Development
Compliance/Risk Management
Strategic Planning
Human Resources
Emergency Management
Real Estate & Facility Services
Payer Relations
Centralized Services
Purchasing •NSLIJ Alliance GPO•Accounts Payable Management Services•Supply Chain Management & Advisory Services
•Warehousing Management & Advisory Services•Integrated Distribution Center •Customer Contact Center Management & Advisory Services
•Contract Development Consulting•Risk Advisory Services•Provider Owned Health Plan Advisory Services
•Property Management Advisory Services•Capital Project Business Planning & Management•Construction Management Advisory Services
•Training & Consulting•Disaster Management & Advisory Services•Security/Investigations
•Site Management
•Payroll Management & Advisory Services•Talent Acquisition Management & Advisory Services•Compensation Strategy Advisory Services
•Certificate of Need Advisory Services•Program Planning
•Compliance Advisory Services•Risk Advisory Services
•Security/Audit Consulting
•Bundled Payment Advisory Services•ACO Advisory Services
•Leasing Advisory Services•Maintenance & Engineering Services•Design/Architectural Advisory Services
•Biomedical Engineering•Safety/Regulatory Compliance Advisory Services
•Staffing Services•Benefits Advisory Services
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NetworkDevelopment
Clinical Capabilities•Post Acute Acquisition/Integration Advisory Services
•Hospital Acquisition/Integration Advisory Services
•Voluntary Physician Integration & Alignment
Pharmacy Services
Perioperative Services
CoreLaboratory
Education/Training
•Krasnoff Quality Management Institute
•Dashboards/Performance Improvement Tools
•Telehealth Management & Advisory Services
•The Center for Learning & Innovation
•The Patient Safety Institute
•Bioskills Education Center
•Laboratory Cooperative Services
•Reference Testing Services
•Laboratory Management & Advisory Services
•Perioperative Management & Advisory Services
•Synergy Health True North Central Sterile
•Vivo Health Pharmacy (Retail)
•Repackaging Services
•Compounding Services
•Skilled Nursing Facility Advisory Services
•Hospice Care Management & Advisory Services
•Home Care Management & Advisory Services
•Inpatient/Ambulatory Rehabilitation Management & Advisory Services
•RegionCare Home Infusion Services
•Health Home Management & Advisory Services
•Root Cause Advisory Services
•Regulatory Advisory Services
•QI Advisory Services
Patient Transport
•Dispatch & Ambulance Operations & Advisory Services
•Air Medical Transport Management & Advisory Services
•Institute for Nursing
•Academic Advisory Services
Clinical Transformation & Quality Management
•Clinical Pathway/Protocol Development
•eICU Management & Advisory Services
•Advanced Illness Advisory Services
•Laboratory Information Systems Advisory Services
Post Acute Services
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• Collection of entities or an “integrated system”• The philosophy of one• Understand what’s not negotiable
1. Clarity of Purpose: What’s the Goal
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• Outside versus inside-out• Changes perspective on access; service; convenience;
engagement; employee authority; etc.• Challenges tradition of provider-centric
2. Create a Customer-Focused Organization
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• Creates broader perspective: modifies strategy• Medical intervention only one component of health
3. Think Health – Not Just Medical Care
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• Build outpatient/ambulatory network• Care outside hospital walls
4. Avoid Being Hospital Centric Only
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• Governance of the whole: not just under parts• Be clear of Board’s role vs. management’s role
5. Avoid Constituency Governance
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• Administrative and clinical• Authority to make tough decisions on programs;
consolidations; personnel; etc.
6. Create Single “System” Leadership
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• Quality• Service• Access• Financial
7. Standardized System-Wide Metrics
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• Leadership at all levels• Builds culture• Matrix organization: managing paradox
8. Choose Leadership Carefully
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• Bureaucracy• Empire building• Keeping “wrong” people• Silos: lack of teamwork
9. Avoid Self-Inflicted Wounds
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• Leadership development: all disciplines• Succession planning• Respond to needs of “new” workforce
10. Invest in Talent Management
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• Create healthy “internal” competition• Promote face to face communication at all staff levels
11. Emphasize Transparency and Communication
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• Government must give maximum “freedom” to operate and meet regional needs
• Align financial incentives• Reduce/eliminate unnecessary rules and regulations
12. Promote Changes in Role of Government