Being a healthcare leader right now is downright ridiculous. Not only are leaders expected to deal with the deadly and financially devastating COVID-19 pandemic, but also social injustice, systemic racism, and other biases within their organizations. This is enough to overwhelm even the most experienced leaders.
Thankfully, there are several women and men who have emerged as the calm, level-headed exemplars of leadership that we so desperately need.
There is of course, Dr Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases who has been the voice of science and data throughout this pandemic. There is also Chris Gregoire, the former Washington governor who helped to bring Seattle’s communities together when that city was hit hard by the outbreak.
In Canada a number of public health leaders (most of them women) have become the voice of reason and reassurance for the nation. First among them is Dr. Bonnie Henry, British Columbia’s provincial health officer. She led the way in beating back the coronavirus without the need for widespread shut-downs.
Another great leader in this pandemic has been Michael Dowling, CEO of Northwell Health. Northwell Health is the largest integrated healthcare system in New York state and it was one of the first systems to experience the full force of the pandemic. Northwell hospitals suffered through staff shortages, insufficient PPE, clinician burnout, confusing/contradicting operating procedures and a whole host of other issues.
Michael Dowling, Northwell’s CEO, a charismatic leader who cares deeply about staff and the community they serve, helped guide the organization through those challenging weeks. Like the leaders mentioned above, Dowling practiced authentic leadership. He never showed frustration, stuck to the facts, always found time to listen to staff, and stayed positive no matter how dire the situation seemed. [See: Tips for Being in the COVID-19 Spotlight for more on this topic with Dowling].
I recently had the opportunity to sit down with Dowling via web conference to get his thoughts on the formidable challenges faced by healthcare leaders.
Broadening Capacity AND Access
Dowling has recently been tasked with “re-imagining” the state’s healthcare capacity post-COVID. This is no small challenge in such uncharted territory. One particularly thorny problem is balancing healthcare’s capacity with the need to broaden access.
According to Dowling, we need to put more focus on lack of access to quality care that so many people have experienced during this pandemic. “Healthcare needs to provide more services in underserved areas, plain and simple,” said Dowling. “This will require a lot of moving pieces of healthcare to come together, and while that might sound daunting, it’s necessary, and it’s something we can do if we slowly take small steps together and avoid viewing it as a politic issue.”
A key step to addressing this issue is taking a hard look at the data after the COVID-19 passes. This means potentially delving into areas that make people uncomfortable like the variation in patient outcomes by age, race and socioeconomic status.
“We can all learn how to be comfortable being uncomfortable,” stated Dowling.
Dowling had made an appearance on Face the Nation in April. In that interview he brought up the staffing challenges of COVID-19 and discussed the fact that they were deploying staff from other states who had come to New York to help.
“This just makes sense,” said Dowling. “When there is a large forest fire, firefighters come from around the country to help.” There are no laws that prevent firefighters from practicing in a neighboring state, yet in healthcare we have exactly those types of restrictions in place. Luckily lawmakers and the various associations recognized the severity of the pandemic early on and removed that barrier. This resulted In a larger, more flexible pool of available staff.
“Some of those rules should be relaxed permanently,” Dowling said. “It makes no sense to have doctors sitting idle in one state while next door people are dying because there aren’t enough specialists. We had to break the rules for COVID but, doing so allowed us to respond more effectively.”
Dowling personally met nurses from Florida in the hallways of Northwell hospital’s and heard first-hand how they felt “obligated to come and help”. He feels that it was these travelling healthcare professionals that helped New York City weather the storm. Now that Florida is experiencing record-breaking COVID-19 infections, there is now an opportunity for New Yorkers to return the favor.
Temporarily relaxing certain healthcare rules also allowed 200 bed hospitals to spring up overnight. This would have been impossible with all the regulations governing the opening of new facilities. But this is exactly what was needed to ensure there was enough capacity to handle the potential influx of COVID-19 patients.
Physician burnout has been a growing concern for years. With the pandemic, however, there is a potential for catastrophic repercussions as physicians are placed under tremendous mental, physical and financial stress. Dowling stressed the importance for healthcare leaders to demonstrate support and understanding for physicians facing those challenges.
“Physicians want to be able to take care of patients,” he shared. “They don’t want to be encumbered by stupid rules and regulations that don’t add value.”
This was an obvious statement on the amount of time doctors spend documenting rather than providing care. Letting doctors “be doctors” (as opposed to experts in regulations, documentation clerks, and procedural nuances) would undoubtedly reduce a lot of frustration.
While Dowling understands the need for regulations, he believes not all of them are necessary, and that some prevent physicians from doing what they do best and most efficiently. He put forward the notion that we have made providing care overly complex and that care can be much simpler than it is today. He cited an example of staff using a Post-It Note rather than the “cumbersome EHR” to quickly share vital information about patients amongst the care team. “The Post-It had just five pieces of information about the patient. That was all the physicians and nurses needed to know. With just that Post-It, they exactly how to properly treat the patient.”
Trust in Healthcare
When I asked Dowling whether he felt that trust in healthcare had eroded or strengthened during the pandemic, his optimism remained steadfast. He emphatically stated that trust in healthcare has risen, not fallen.
He pointed to how the public has come out each night during the lockdown to show support for front-line healthcare staff by cheering and banging pots. He also made note of the food and supplies that have been graciously donated, the inspirational signs that have suddenly appeared at hospital entrances and video tributes that companies have produced in lieu of standard TV commercials.
Dowling emphasized, however, that healthcare leaders must not take this trust for granted. “Our job is to maintain and earn that trust.” he said.
When I brought up the Black Lives Matter movement and the issue of systemic racism, Dowling was quickly stated “We have a race issue in healthcare – no matter what we may want to believe.” He believes that healthcare leaders need to have those difficult conversations and deal with the glaring problems in healthcare organizations. He also believes that these should have been a priority long before the murder of George Floyd.
Dowling pointed to a number of related issues including: sexism, ableism, ageism and inequality for Asians, Hispanics, Indigenous and other visible minorities. In his perspective, the problem needs to be addressed right from the top – by senior management, leadership teams and board members. “We need to take the opportunity to make permanent change and engage with communities in ways that are culturally appropriate for everyone. But most importantly we need to put in systems in place that bridge the divided and treat people equitably.”
One step that Dowling has taken (long before it became a national news story) was create and support Employee Resource Groups (ERGs). These voluntary, employee-led groups help to foster a diverse, inclusive workplace. Northwell has ERGs for Hispanic physicians, Asian, African Americans and many more. Leaders not only need to help create a safe space for ERGs to exist, but they must listen and act upon the recommendations raised by these groups.
Dowling summed it up nicely when he said: “We all have a responsibility to do what we can to not allow this moment to fade away. We need to act now to make permanent change.”
Dowling touched on so many important challenges in our conversation, but I would have been remiss if I didn’t ask him if there was a healthcare technology that he was excited about. His top pick was data analytics. “Data is the ultimate silo buster,” explained Dowling. “If we can just put all the data together we can gain so much insight from it. Data lakes have the potential to transform operations and clinical care. That’s a priority for us in the next few years.”
This article is part of the #HealthIT100in100