Michael J. Dowling gave a presentation on lessons learned from building North Shore-LIJ Health System into an integrated health system. He discussed 10 key lessons: 1) having clarity of purpose as an integrated system rather than a collection of entities, 2) creating a customer-focused organization, 3) thinking about health rather than just medical care, 4) avoiding being just hospital-centric, 5) avoiding constituency governance, 6) creating single system leadership, 7) standardizing system-wide metrics, 8) choosing leadership carefully, 9) avoiding self-inflicted wounds like bureaucracy, and 10) investing in talent management.

1. Pursuing Success – Lessons Learned
West/North West Hospitals Group Conference
October 9, 2014
Michael J. Dowling
President & Chief Executive Officer
North Shore-LIJ Health System

2. North Shore-LIJ Health System
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3. Insurance
Enterprise
Education
al
Enterpris
e
Research
Enterprise
Communi
ty 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
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Clinical
Enterprise
 Inpatient
facilities
 Ambulatory/
outpatient
 Long Term/
Home Care
 Hospice
 Joint
ventures
 Medical
transport
 Medical
Group
North
Shore
Ventures
 New
businesses
 Consulting
 Partnerships
Support
Structure
Shared Support Services
 Administrative services
 Clinical services
 Support services
Health System
Enterprises
Services
supporting the
health system
enterprises:
Partnerships
The System Today

4. An Integrated System
• 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
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5. Health System Growth & Integration
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6. A History of Firsts
• First organization in the region to form a health system and subsequently grew into the region’s largest
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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

7. 2013 Market Share
29% Share – 17 points
greater than closest competitor
All Other
25% NS-LIJ
Winthrop /
S. Nassau
6%
Source: 2013 SPARCS, Based on discharges & patient origin
2010 Market Share
27% Share – 15 points
greater than closest competitor
NS-LIJ
27%
NY-Presby
12%
Mt Sinai/
Continuum
Winthrop /
S. Nassau
6%
Source: 2010 SPARCS, Based on discharges & patient origin
*Service Area-Manhattan, Richmond, Queens, Nassau & Suffolk
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11%
CHS-LI
10%
HHC
9%
29%
NY-Presby
12%
Mt Sinai/
Continuum
12%
CHS-LI
9%
HHC
9%
All Other
23%
Service Area Market Share

8. Health System Strategy
• Consolidations
• Conversions
• Centers of Excellence
• New businesses
• Consulting
• Partnerships
• Taking risk
• Treating illness & promoting health
• Innovative partnerships
• New markets
• Joint ventures
• Innovative delivery models
• Expanding geography
• Creating alignment
• Innovative relationships
• Promotion of interdisciplinary learning
• Pioneering discoveries
• Innovative educational programs
• Quality and patient safety
• Efficiency and productivity
• Employee/patient engagement
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• Physician leadership
• Succession planning
• Continuous learning

9. Management Capabilities
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Information
Technology
•Meaningful Use Consulting
•ICD-10 Consulting
•Patient Portal Development
Purchasing
Centralized
Services
Payer
Relations
Real Estate &
Facility Services
Emergency
Management
Human
Resources
Strategic
Planning
Compliance/
Risk Management
•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

10. Clinical Capabilities
•Root Cause Advisory Services
•Regulatory Advisory Services
•QI Advisory Services
•Institute for Nursing
•Academic Advisory Services
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Network
Development
•Post Acute Acquisition/Integration Advisory Services
•Hospital Acquisition/Integration Advisory Services
•Voluntary Physician Integration & Alignment
Education/
Training
Core
Laboratory
Perioperative
Services
Pharmacy
Services
•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
Patient
Transport
•Dispatch & Ambulance Operations & Advisory Services
•Air Medical Transport Management & 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

11. 1. Clarity of Purpose: What’s the Goal
• Collection of entities or an “integrated system”
• The philosophy of one
• Understand what’s not negotiable
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12. 2. Create a Customer-Focused Organization
• Outside versus inside-out
• Changes perspective on access; service; convenience;
engagement; employee authority; etc.
• Challenges tradition of provider-centric
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13. 3. Think Health – Not Just Medical Care
• Creates broader perspective: modifies strategy
• Medical intervention only one component of health
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14. 4. Avoid Being Hospital Centric Only
• Build outpatient/ambulatory network
• Care outside hospital walls
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15. 5. Avoid Constituency Governance
• Governance of the whole: not just under parts
• Be clear of Board’s role vs. management’s role
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16. 6. Create Single “System” Leadership
• Administrative and clinical
• Authority to make tough decisions on programs;
consolidations; personnel; etc.
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17. 7. Standardized System-Wide Metrics
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• Quality
• Service
• Access
• Financial

18. 8. Choose Leadership Carefully
• Leadership at all levels
• Builds culture
• Matrix organization: managing paradox
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19. 9. Avoid Self-Inflicted Wounds
• Bureaucracy
• Empire building
• Keeping “wrong” people
• Silos: lack of teamwork
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20. 10. Invest in Talent Management
• Leadership development: all disciplines
• Succession planning
• Respond to needs of “new” workforce
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21. 11. Emphasize Transparency and Communication
• Create healthy “internal” competition
• Promote face to face communication at all staff levels
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22. 12. Promote Changes in Role of Government
• Government must give maximum “freedom” to
operate and meet regional needs
• Align financial incentives
• Reduce/eliminate unnecessary rules and regulations
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