As North Shore-LIJ’s president and chief executive officer, Michael Dowling oversees a healthcare network which delivers world-class clinical care throughout the New York metropolitan area, pioneering research and a visionary approach to medical education.
Michael Dowling sat down with Richard Torrenzano, Torrenzano’s CEO, to discuss the future of healthcare and North Shore-LIJ’s place at the leading edge.
Richard Torrenzano: Leadership. People say they have it. When is someone a leader?
Michael Dowling: The best definition of leadership I ever came across was someone who said leadership is about managing the present, selectively forgetting the past and creating the future.
One of the core essences of leadership is looking at everything with a new perspective, looking at everything you do to figure out how you can do it differently. We are engaged in a whole series of entrepreneurial efforts.
For example, relationships with physicians. We have physicians in this community who were at one time all small mom and pop businesses, increasingly coming into large groups. We decided we would have affiliations and relationships with them.
We would hire and create a large full-time staff of physicians. We have one of the largest groups in the United States. I think it is the sixth or seventh largest medical group in the country.
We are now also doing joint ventures. We do joint ventures with physicians and with other companies. We just did a joint venture on central sterile with a company out of England called Synergy and another joint venture with DaVita on dialysis. We are doing joint ventures for new ambulatory surgical center with orthopedic surgeons.
We are talking to many organizations, including many outside of healthcare.
RT: Can you name some of the companies outside of healthcare that you are talking to?
MD: We have worked with the Ritz Carlton, with JetBlue, with Toyota and with GE. I sent people to look at Tiffany.
You might ask why I would go to Tiffany? My wife thought it was because I was buying something for her but I went because I wanted to know, because of the way we transport very delicate materials, how they transport and track very expensive equipment and very expensive jewelry, as well as how their back office warehouse works. We looked at Wal-Mart.
It is very positive to go outside the areas you are currently in and bring in staff from those areas. You fertilize the thinking process within an organization when you do that.
We developed a relationship with Cleveland Clinic around innovation. We have a new part of our organization, under a person we hired from the Cleveland Clinic. They were hired to take advantage of our commercial real estate, academic and intellectual assets and to figure out how to create new businesses. For example, we have about a dozen in the formative stages at the moment.
We have physicians and others coming up with ideas. We have the right people here that say, “That idea is a potential revenue generator. It is a potential business.” You go out and you get partners. You create a new business and over time it will generate new revenue.
We have a very positive top-flight record in cardiac surgery. One of our hospitals is number one in New York State in cardiac surgery. Another is number one in New York State in angioplasty.
Cleveland Clinic has a phenomenal brand. It does terrific work in cardiac. They have reviewed our cardiac outcomes and found there is real synergy between what they do and we do.
We just developed an exclusive relationship with the Cleveland Clinic here in New York. We will work together, trying to figure out how to do things better, market together, sell insurance products together and more. It will lead to initiatives in other clinical areas, like orthopedics, neuroscience or maybe childhood surgery.
When you start one thing, you are never sure where it leads. You do not always wait around and figure out, “If I do this, I know that I can do the following ten things.” You are probably going to be wrong. You do this and then it leads to other things.
The fact that we started an insurance company now means that I have to develop a broader network and bigger distribution systems in geographies that we are not in. I probably would not have been thinking about that as clearly if I had not done the insurance company.
One action begets another. When you strategically work it through plans evolve. The overall strategy stays the same but the tactical plans evolve.
RT: How do you keep that type of momentum? How do you prevent complacency?
MD: You have to continually figure out how you push the edges of the envelope, to fight tradition.
You just cannot be a hostage to the present. I personally always resist people who say, “We’ve always done it this way.” Healthcare has to look at other industries and all the changes going on in the industry in total. We innovated in medical education. We have created a medical school that is quite different than most other medical schools.
RT: How has that philosophy played out in practice?
MD: Let me give you an example. We started by asking two simple questions. It was relatively easy, because we did not have tradition. We were starting with a clean sheet of paper.
We asked, “What is a physician’s practice going to look like 20 years from now? What should the physician of 2020 or 2025 be good at?”
From that premise, we developed the curriculum where for four years, you have clinical education as well as academic education. In the first nine weeks of our medical school, all new medical students get their EMTs. They become licensed practitioners. They are seeing patients from day one. They ride in the ambulances. They are going to poor communities. They understand the nature of diversity.
They have to work as a part of a team, something doctors have traditionally been very good at. They have to take orders from somebody higher than they are. If you are an EMT in an ambulance, you have to take an order from the head EMT in the ambulance. It changes the whole mindset.
We have them out in the physicians’ offices and in ambulatory sites. The tradition was to spend two years, typically for most medical schools, in the classroom and then in year three be put into a tertiary campus, a hospital. That is not where the bulk of care is going to be delivered in the future.
By being entrepreneurial in the way we develop the curriculum, I believe very strongly we also attract an entrepreneurial type of student, somebody who wants to take risks and wants to push the edge of the envelope, someone who wants to do something in a different way.
RT: You run a large hospital with a lot of employees, and a lot of risk. What are the one or two things that trouble you, which you worry about, and you do not sleep well over?
MD: The things I worry about? Everything is a progression. I am impatient. I worry about not being able to make progress as fast as I would like to make it. Then I realize that if you go too fast in certain areas, you can also get yourself into difficulty. Every time you go into something new, you are experimenting. I also worry about complacency.
I worry that when you are running an organization, people get comfortable, especially if you are perceived as being relatively successful.
When you sit and look in the mirror, and think you are successful, that is a very dangerous place to be. You should always look in the mirror and say to yourself, “Yes, we did pretty well, but we can do a heck of a lot better tomorrow. There are an awful lot of things we did yesterday that are not good enough.” That keeps you fresh.
It is like the athlete who wins a championship and decides not to train anymore because they are obviously good. They do not win it the second year in a row. You find very few professional teams that win the championship every year.
When you are successful, or are perceived to be successful, other people want to bring you down a notch. You have to have that edge, that desire to drive yourself a little bit faster, better, improve and never be completely satisfied with what you are doing. When I meet with all new employees every Monday morning I tell them that there is a benefit to being a little bit unhappy. When you are unhappy, you do something about it.
It’s like the guy who looks in the mirror and says: “I am a gorgeous looking human being.” If that’s you, you will never go to the gym and work out, right? If you look in the mirror and you say, “Oh crap,” you are going to do something about it, potentially, or at least enhance your interest in doing something about it. It is the same overall globally. You have to be on edge all the time.
RT: If you look back at your career, who are the one, two or three people you admire because they had that edge? Maybe they played a role in how you think about the world.
MD: If I go way back, I think one of the people, and this would appear to be very Irish, but one of the people who had a huge influence on me was my mother. She did not have a professional career. She did not have any formal education, but she was always pushing. She would say, “You can do it. Read this.”
I remember when I grew up in Ireland, we did not have much materially. I read Shakespeare. I read books by Zane Grey. I read Churchill. For whatever reason, she was able to make those available. She was helping to expand my mind.
When I read books by Zane Grey, I could visualize the United States, the western part of the United States, even though I had never been there. When I now go to the western part of the United States, I am thinking, “Oh yes, he wrote about this.” This is where that gives you that extra drive to continue to educate yourself.
The other person I worked with for years and years, who was somebody who pushed and pushed, was Governor Mario Cuomo. When you work closely with him, you had better be on edge all the time. If you go to sleep for five minutes, he will find that five minutes, especially when you are young and you do not have an awful lot in your portfolio before that, and he throws you into something and you say to yourself, “I never did this before.” You knew that he understood that you could do it, even though you had never done it.
This is why in this organization, I often put people into roles who have never done it before.
I recently appointed a person to head up all of our human resources, and I chose somebody who has never done HR before. They come into it fresh. They are not constrained by the so-called HR traditions. They look at it from the operating point of view and they say, “This does not make any sense.”
When you are put into different roles, you dig deep down and you pull it out. You figure out how you can get it done. You should never be completely comfortable when people put you into a new role. Mario Cuomo did that.
There were many others. You are influenced by every interaction you ever have. You are a combination of all the interactions you have had with the multitude of people that come in contact with you. You do not realize it at the time. You meet with employees and you are affected by it. You learn something. You meet with different and diverse groups of people, and we are now in one of the most diverse communities in the world, so you meet with people from all different parts of the world.
All of those interactions affect you. They influence you. You can use it in a positive way. Many people use some of those interactions in a negative way. That is unfortunate. That has been part of the problem we have with some things going on in society. Let us use it in a positive way. Let’s take the good that comes from all of these interactions and figure out how we can benefit from it all.
There is not a day that goes by that I do not go home thinking about something that somebody said to me, that makes me think about something I had not thought about before. You have to stay mentally alert and fresh to be able to utilize all of that information.