Irish healthcare managers were so fortunate to be in the healthcare profession and should be so proud of their jobs, Mr. Michael Dowling, CEO Emeritus, Northwell Health, said when he addressed the Conference.
“Our work is so important. It is so much more than the things like metrics, performance management and KPIs which are part of it. Each day because of our work, disease is prevented, babies are brought into the world, new treatments, new methodologies, new cures, are introduced, we are there at the end of life. Our work confers on us extraordinary privilege and extraordinary obligations.
“Working in healthcare it not a job, it has special obligations and responsibilities. You don’t check in and check out, you don’t care if you have to come in everyday, your don’t care if your days are sometimes 24 hours long. We, as healthcare managers are fortunate to benefit from the major discoveries and scientific advances of the last 50 years, these extraordinary discoveries by nurses, doctors and researchers. We are extremely fortunate to live today and be where we are vis a vis how our parents lived 50 – 60 years ago. We should never forget the benefits we have now.
“There is a wonderful positive narrative to what we do as healthcare managers and we should be telling our stories. In the United States, we do documentaries on what goes on in our workplaces each and every day It is extraordinary and I feel extraordinarily proud of what we do every day and how we do it – with compassion and caring.”
Mr. Dowling also suggested that to develop innovation in healthcare in Ireland we should take one region and innovate there.
He said that leadership was all about guiding and inspiring people, building trust, unifying and creating a feeling of belonging. “We perform this every single day. Another aspect of leadership is being able to manage chaos. Managing chaos is one of our difficult leadership challenges. Where necessary, we must be able to challenge the status quo, break some of the bureaucracy, challenge regulations, not be satisfied with something that needs changing, do something new. If you want to energise, at times you have to say that this does not make sense and we need to do it differently.
“In the US we have more freedom to innovate. You can’t build teams in isolation, it is not a sole effort. We have to look at how caring and compassionate staff are, how are we working on this , how is care organised. I am a big believer in integrated systems of care . By this I mean having all care under the one leadership and under a single auspice.
“In Northwell we have ever aspect of care – we have education, home care, medical and nursing schools. Care is a continuum, not an individual transaction. We have all systems of care under one delivery system. Hospital care is just one cog in our delivery system. We have 28 hospital but care is not primarily delivered in hospitals. Just 47% of our care is delivered in hospitals. I believe there is far too much care delivered in hospitals which should be delivered elsewhere. If you don’t do that you will have unbelievably long waiting times. In our place orthopaedic care and cardiac care, including stents, have no place in hospital. Most cancer care and imaging are mainly delivered on an outpatient basis. We have 90 urgent care centres where urgent care is delivered near where people live . What we did in hospitals years ago we can now do at home.
“Patients are consumers and if I don’t treat patients well, they will go to my competitors They will walk. Competition improves performance by everybody. We spend too much time thinking what’s good for staff rather than what’s good for patients and patients’ families. Every Sunday afternoon I call the families of patients who have written in to us. Technology is powerful in hospitals but it is not the whole story. We must look at the power of relationships, the power of a handshake, a smile. As we maximise the power of technology, we are doing a terrible disservice to patients if we neglect that aspect of care.. If a doctor sits by your bed and holds your hand does that make a difference?
“The other thing which is very important for staff is creating a culture of continuous learning, expose them to new ideas The most important leaders in your organisation are supervisors. Most people who are dissatisfied with their jobs are generally dissatisfied with their supervisors. Every Monday I get all new employees together because who you hire matters, who you bring into your organisation matters. I spend three and a half hours with them every Monday morning telling them about our vision , what is expected of them and what is acceptable. I tell them if they don’t follow the values in which we believe they don’t work for us. They are entitled to get a job, but not entitled to keep it unless they behave in a certain way. I meet with physicians and nurses at 6.30 a.m once a week. I take people out to dinner and lunch to share information, get their input and expound our mission to them. I believe this engagement is very important.”
Mr. Dowling said that you had to allow people to make a mistake. If it was not malicious and they wanted to do something differently, it should be encouraged. They told employees to send in ideas they had for better care. They then narrowed these down to ten and those ten were asked to make presentations .
“We also encourage feed back. We have a broad definition of care, which is way beyond the delivery of medical care. We are involved in food – you can’t say you are concerned about health if you provide crappy food in hospitals. We provide organic food. We oppose gun violence, we are concerned about climate and the ill effects of social media. We are facing a disaster among young people as a result of social media. We have anxiety, depression and suicide among young people as a result of their addiction to social media. We also provide education on nursing, mental health and physical management in High Schools. This shows the students they can have careers in health care. Mental health is another area on which we are working. We have a lot of employees who voluntarily search around new York and outside in the woods and provide services to homeless people. Employees are more motivated by this than by KPIs, although KIPs are important.
“It is important to get out and talk about these issues . If you don’t stay with our values, you won’t be with us long and we can do that in New York. I couldn’t care less what your educational background or your seniority are. What I want to see if you are caring and do the job to the best of your ability.
“I had a guy who was complaining abut HR and I said you don’t like it, right now you are in it, fix it.”
Mr. Dowling said that in New York today national leadership was taking a giant leap backwards. International relationships and relationships with the WHO were being dismantled. “It doesn’t make sense to curtail money going to deal with starvation in Sudan. It is time we were not afraid to fight, these are health issues. The values of hate, racism and contempt for those who disagree are not values we should be espousing. We should be championing decency, respect, integrity and trust. These are values that promote health We should be optimistic and give people reasons to believe that life will develop and we should give oxygen to those who are willing to speak out.”
Michael Dowling
Northwell is the largest not-for-profit health system in the U.S. Northeast, serving residents of New York and Connecticut, with 28 hospitals, more than 1,000 outpatient facilities, 22,000 nurses and over 20,000 physicians. It is New York’s largest healthcare provider and private employer, with 14,500 providers, 28 hospitals and over 1,000 care locations.
Northwell cares for more than three million people annually in the New York metro area, including Long Island, the Hudson Valley, western Connecticut and beyond.
After leading the organisation for over 23 years, Michael Dowling stepped down as CEO on October 1, 2025, transitioning to the role of CEO emeritus. He is credited with transforming Northwell Health into a large, nationally recognized system.
A native of Knockaderry, Limerick, he is a graduate of University College Cork and has a Masters from Fordham University.
