Executive Spotlight—Northwell Health's Michael Dowling on 'good politics' and perseverance in health leadership

Northwell Health President and CEO Michael Dowling believes a key part of working with someone—whether they be a colleague, political opponent or a patient with unmet needs—is finding common ground and empathizing with their experiences and viewpoints.

Although easier said than done, the executive says his unique road into the healthcare industry has helped him tackle public health and operational challenges alike with an open mind.

Dowling said he grew up in “pretty extreme poverty” in Limerick, Ireland, due to health issues affecting both of his parents. In addition to working from an early age to help support the rest of his family, Dowling left home at 16 for England and later America with the hope of earning enough money to attend college.

In between a flurry of different jobs—steel factory worker, construction, Manhattan dockhand and plumber—Dowling said he gravitated toward health and human services volunteer work during his undergraduate studies due to an “understanding that in certain circumstances there is a need for others to step in and provide assistance” to those in need.

That interest continued during his graduate and professorship years at Fordham University, more than a decade leading and advising on health and social programs within New York state government and a brief stint at Empire Blue Cross/Blue Shield. He joined North Shore University Hospital (which eventually became Northwell Health) in 1995 as chief operating officer.

“When I’m out there and I see people suffering because of lack of housing, healthcare or food, I feel I can understand it better than most because I experienced it,” Dowling said. “I was there, I have an understanding that’s what the world is like. I’ve seen the underbelly of society and the elite side of society. It gives me, I think, a more robust view of the world from many different angles.”

Personal hardships have informed Dowling's unique view of the world, along with decades of observing state governments' "wars" against epidemics of AIDS, drugs and homelessness. This has helped him develop the resilience leaders need to put out fires and persevere through challenges—for instance, the roughly 350,000 COVID-19 patients he said Northwell Health has treated over the course of the pandemic.

Still, Dowling attributed several victories over the years to a “broader perspective on life” that helped forge connections and drive progress.

“The world is made up, and every organization is made up, of multiple constituencies,” he said. “Part of the role of the CEO is to get all of the various constituencies, which can be at odds with each other, to work together, to coalesce around common values and common programs and common missions. You get to understand the politics of what it’s like to run an organization—and politics not in the negative sense. Politics is in many ways all about how you get people of different views to work together and share a common mission. That’s how I define good politics.”

Fierce Healthcare caught up with Dowling for a deeper dive on leadership’s role in finding compromise, remaining committed to long-term organizational goals and Northwell Health’s priorities for the years to come.

Fierce Healthcare: Can you share some examples of these "good politics" you’ve seen over the years?

Michael Dowling: There are multiple ones. In [New York state] government at the time I was there, you had a Democratic assembly and a Republican senate, and we wanted to initiate a program around the coverage of children. We called it Child Health Plus, at the time.

Of course, every constituency under the sun from medical constituencies, religious constituencies, all delved into this. So I had to stay quiet for a bit of time, a long bit of time actually, to get the groups … to come together and finally agree to pass legislation to provide coverage for all children up to the age of 13. That became a very important piece of legislation that since then has been expanded and is a core part of the safety net of New York state.

Here at the health system, we brought together multiple hospitals from different locations, different histories, different cultures. What you try to do is you try to figure out how to maintain that which is good locally for each of them but at the same time build a system culture, so that overall they’re joined by a common mission, even though they retain some of their uniqueness because geography of one location is very different than another.

I spend a lot of time on this, and it means developing relationships, getting to know people, understanding where people come from, understanding the position from their side so they can understand your side, and having perseverance and looking long term. We’ve successfully done that, I believe, where we have a very team-oriented, collaborative, entrepreneurial culture. But it takes time. Relationships are important, the types of people you hire are important.

There are multiple examples like this. And one last point is you never get these things completely right. Everything is about improving what you’ve got to make it better. You’ll never reach the ultimate perfection in these things, but you’re always moving toward that. It always requires readjustment, renewal on an ongoing basis so long as the core mission and core set of values are the same.

FH: Could you describe some more recent Northwell initiatives that lean on these values of common ground and persistence?

MD: Not that long ago we started a very unique medical school because we wanted to look at how we train physicians and do it differently than we did previously. We created a very unique curriculum, so we had to get the regulatory body to agree on this as well as the physicians and the other various constituencies to agree. But we ended up with a very unique medical school that others have come here to look at. It has become an influence in medical education nationally; people look at our model to advise them.

We’ve been taking the lead on the issue of gun violence. I went public four years ago, roughly, stating that gun violence is a public health issue and all healthcare organizations should see it as such. I advocated strongly that healthcare organizations take a leadership role here. We see the effects of gun violence each and every day in our facilities and we created a major center for gun violence prevention here. We’re doing an awful lot of advocacy, a lot of research, working with a lot of community-based organizations and continuing to educate people about gun safety and violence prevention. And that requires bringing multiple constituencies together. Of course, there are people who will argue healthcare should not be involved in this—but my view is that they’re absolutely wrong, that healthcare has to be involved because it is a healthcare issue.

The other big issue today is we’re working on a program on Black maternal mortality. It’s about three times that of whites, so we’ve put together a very multidisciplinary team of people from various departments across the organization to work together to see what we can be doing over time to reduce that mortality—what kinds of interventions we need, what kind of predictive modeling we can do to anticipate who has a higher risk of early mortality.

FH: The Black maternal mortality program you’re referencing was just launched a couple of months ago. Has Northwell seen any early traction in this area?

MD: It’s still young. So many of these things take a long time, and part of the problem is that a lot of people look for instantaneous gratification. They want to see the results immediately … and that sometimes results in people adopting a program, getting tired after six months or a year and then moving on to something else. Part of the essence of leadership is having a lot of perseverance and sticking with it long-term.

With maternal mortality, we’ve created an organization, we’ve brought the various departments together, we’re developing AI tools to help determine who might be most at risk, and I don’t think we’ll see practical results for quite a while.

The good news is it’s being made a major priority of the organization. We have the buy-in of the various disciplines that need to be involved, and we’re looking at the outreach that needs to be done and the technology that needs to be developed. But I know it will take a while for us to see the results. In many cases, it will take years. But that’s why you need to have persistence, so you don’t quit when things don’t happen immediately.

We’re often very project-oriented; we start something, want an immediate result and when it doesn’t happen, move on. We can’t be doing that with things as complicated as Black maternal mortality.

FH: Abortion access and legality is hand in hand with the issue of Black maternal mortality. Could you share your thoughts on the recent Supreme Court decision overturning constitutional protections for abortion?

MD: It is a very troublesome decision. It’s problematic when you eliminate people’s choice. The issue is very complicated; there’s a lot of morality and religion involved with a lot of this. I understand all that, but I think the role of government is to not preclude people, their healthcare providers and their other advisers from making a choice.

In this particular case, you should be promoting choice as much as you possibly can. … Also, there’s a huge equity issue here because relatively well-to-do people will always be able to travel elsewhere to get an abortion if they have a desire, but if you’re low-income and poor you may not have that option. Therefore, you’re going to go back to what was available, back-alley abortions and on-the-ground deliveries.

We’re going to have years and years of litigation here. This issue, some people think the Supreme Court’s action ‘solves’ the abortion issue. I think it will just accelerate the debate on both sides. There will be litigation each and every way, there will be discussions, there will be some very bad results. It’s unfortunate.

FH: Northwell has been working to expand its outpatient presence over the last several years and now has around 870 such locations across the region. Could you discuss this effort and other changes in care delivery?

MD: We started our initiative 15 years ago and then accelerated 10 years ago when we made a decision that a lot of things that were always done within four walls of the hospital don’t need to be done there anymore. We have a position as follows: Being in a hospital is a great place to be when you need to be there. It’s not one of the best places to be when you shouldn’t be there.

So the idea here is to make as many avenues and have a large distribution site for delivery of care as close to people as they live. You make it convenient, because service and convenience are a big part of the quality agenda.

Now, that does not mean—some people jump to this conclusion—that hospitals are irrelevant. Hospitals are very important. For very critical issues, hospitals will be for the most part where people get care. They will be the places where we take care of chronic care, intensive care, critical care. Those services will increase in the hospitals going forward.

We’ve been at the cutting edge of this, and now the use of technology—how we monitor wearable devices, how we monitor care from a distance, how we monitor home care—will create wonderful freedom for a lot of things we couldn’t do prior to the use of this technology. This became very useful during COVID—telemedicine accelerated during COVID, big time.

We have to continue that acceleration going forward so we can become a lot more consumer-oriented, consumer-friendly using technology … but I also warn that it’s not only about the technology. We cannot let technology substitute for the human element of care delivery. Technology is a tool, a very important tool, and if it is used to improve outcomes, performance, quality, we should be using it to the maximum. If it doesn’t improve, we should be very cautious about using it.

FH: Anything else?

MD: There’s a great definition of leadership: It’s about managing the present, selectively forgetting the past and paving the future.

Look out five years, look at where the environment is going, look where the science is going. Since we’re in the consumer business, we should be asking. 'Where should we be five years from now? Ten years from now?'

In other words, you start with the needs of the consumer and work backward. What does the consumer want, what will they want, especially in the new world of work and expectations. What do we believe they will demand and require and then work backward.

That’s how we look at things here. I know politics has been very toxic, and there’s a lot of stuff going on that makes us uncomfortable, but I believe there’s lots of positive opportunity in healthcare to do better than we’ve been doing and to look forward very optimistically.