Weathering a pandemic: Five lessons in leadership from Northwell CEO Michael Dowling
Situated in and around New York City, Northwell Health weathered the COVID-19 pandemic at one of its sharpest global peaks. The influx began with just a single COVID patient in March, but by April 7th it had risen to over 3,400. Some of Northwell’s facilities needed more than 200 extra beds to accommodate them all.
It was a stunning display of the toll the disease was taking on the public. And Michael Dowling, Northwell’s CEO, saw much of it firsthand.
“I spent most of my days on the ICU floors, talking with staff, observing patients,” Dowling says. “It’s been a year none of us will forget too quickly.”
Nor should we, he believes. In a recent presentation to The Governance Institute, Dowling explored some of the lessons that he and his Northwell colleagues learned over the course of the coronavirus outbreak.
Here are five of his best pieces of advice for ensuring that the pandemic is not just a traumatic experience, but also an instructive one.
- Embrace preparedness
While the coronavirus struck Northwell’s community with particular acuity, the organization was also uncommonly well prepared for it. This was largely because of another unforgettable episode in the history of the city and the nation: 9/11.
“In a strange way, Northwell was fortunate as an organization,” Dowling explains. “After 9/11, we had planned extensively for unforeseen negative events, and in many ways that built resilience right into our organizational structure.”
This specific outbreak was impossible to foresee; its odds of occurring were improbably slim. But Dowling emphasizes that, over the long run, a similar disaster is not just probable—it’s inevitable.
“The question we should all be asking ourselves is, what can we do over the next few months to prepare for the next outbreak—or the next natural disaster?” Dowling says. “We don’t know what the next crisis will be, but it will happen.”
With that in mind, organizations should spare a thought for extreme negative events, and build in structures to manage them.
- Pursue integration
Many healthcare organizations are structured as confederations of autonomous components. Facilities, units, and even managers operate independently of each other. It’s an approach that works well enough in normal times—but not in the middle of a crisis.
“COVID broke down healthcare siloes, whether organizations were ready for that or not,” Dowling says.
The coronavirus forced coordination on an unprecedented scale. As infection numbers rose, health systems had to stretch their scarce resources nearly to the breaking point. Longstanding models of delivery, staffing, and supply-chain organization were totally upended.
How painful this would be would depend, in large part, on the degree of integration within each organization. A collection of disparate components, sometimes working at cross-purposes, would struggle with these challenges. But organizations like Northwell, which possessed a well-integrated organizational structure, managed the transition to crisis mode with minimal friction.
Northwell already had an integrated transport system, so transferring patients was relatively seamless. It already had a unified staffing system, so reconfiguring staff assignments wasn’t an enormous hurdle. To achieve the same results, Dowling encourages other organizations to pursue a similar level of unification.
“You need that system-ness idea,” he says. “You need the whole to be more than the sum of its parts.”
- Take care of your staff
No one needs to be reminded that this has been a punishing time to be a frontline healthcare worker.
Long hours, social isolation, and extreme physical danger have become part of every-day life for the nurses, techs, aides, and physicians who walk the hospital floor. It’s no exaggeration to call their efforts heroic.
For Dowling, looking after the well-being of these healthcare heroes became his first priority as a leader.
“We talk about the importance of executive leadership, but at the end of the day, the real work isn’t done by people like me,” he says. “It’s done by people on the front lines. Your focus has to be on maintaining their safety and their morale.”
Going into the crisis, Dowling had a head start in cultivating relationships with Northwell’s care teams. For his entire tenure as CEO, he devoted hours each week to meeting every single newly hired staff member, and spent considerable time walking the floors of Northwell facilities.
The result was that Dowling had real, meaningful relationships with these workers. “They felt like they could talk to me, and I felt like I could understand their problems a little better,” he says. “It made me better able to give them what they needed.”
Dowling’s advice to leaders, therefore, is not to wait for a crisis to get to know employees. Start now, and keep the effort up. It will pay enormous dividends before too long.
- Inequities matter
More than any event in recent memory, COVID-19 has exposed the inequities of the American healthcare system.
Disproportionate rates of infection and mortality have fallen along (sadly) predictable demographic lines. Vulnerable minority groups—low-income people, people of color, and those with chronic health issues—suffered the brunt of the coronavirus’s impact. Dowling believes that organizations should not meet this state of affairs with complacency.
“It’s time to start asking tough questions of ourselves,” he says. “How should we be working with vulnerable populations? What do we need to do to ensure that social inequalities don’t lead to inequitable healthcare outcomes?”
For its part, Northwell began exploring this set of problems in the immediate aftermath of COVID-19’s worst period in New York. Since then, it has begun work with leaders in 11 vulnerable areas, assessing what it can do to bring about healthcare parity across the entire community it serves. Dowling pleads for other organizations to follow suit.
“We can’t wait on outside intervention,” he says. “We have to start by assuming that it’s our responsibility, and then asking, ‘What can we do about it?’”
- Don’t lose sight of the good
Finally, for all the grim news that has emerged during the COVID-19 pandemic, Dowling highlights one important positive fact: healthcare organizations have risen to the occasion. The pandemic has revealed some of the American health system’s frailties, but has also showcased its resilience.
“We have witnessed an extraordinary outpouring of creativity and resilience among our health organizations,” Dowling says. “It has demonstrated just how much we are capable of.”
Too many lives have been lost to the coronavirus, and too many continue to suffer from its effects. Without the valiant efforts of America’s healthcare workers—from its frontline staff to its executive leadership—the toll would have been that much worse. Dowling’s final lesson is a reminder to leaders not to forget that.
“This has been a very hard time for all of us,” he says, “though it’s also shown me that we’re in a wonderful business—and I, for one, feel grateful to be a part of it.”