Northwell CEO on the pandemic: 'It's going to take another 12 months'

Newsday sat down with Michael Dowling, president and CEO of Northwell Health, the largest employer in the state, to talk about the likely impact of the omicron variant, the future of remote work, the opportunities and perils posed by technology, equity in health care, the latest book he’s writing and more.

This interview has been edited and condensed.

With so many unanswered questions right now about the omicron variant, how can Long Islanders stay safe over the holidays?

In many ways, it's relatively simple. One is that whenever you are in a group setting, wear the mask. The masks work. When we put masks on employees, the infection rate went way down. The other thing is, you get vaccinated, you get the booster. You make sure that you don't get into large groups around the holiday season. There'll be new variations of the virus, probably over the course of the year. So it's not going to end quickly. It's going to take another 12 months for it to completely end, I believe.

Are there ways to reach people who are still hesitant or resistant to getting vaccines?

There are some that are probably wavering about whether to do it or not. We will just continue making the case that this is the proper thing to do. If you're fighting a war, which we are against the virus, then you should use the tools that are at your disposal. You will never get to everybody. But if you get 50% of the people that are not vaccinated to get vaccinated, you're in a much better situation.

How did workers refusing the vaccine mandate affect Northwell? [In October, Northwell said it had terminated 1,400 workers, or about 2% of its roughly 77,000 employees, for refusing to comply with a statewide and systemwide COVID-19 vaccine mandate.]

Quite a number decided not to comply with a requirement of employment. And they left. Their choice. It's unfortunate, we did not want to lose any of those. But they made that decision not to work. It hasn't had any negative effect on our operations. It has not affected our growth plans. I would say to all of the employees who decided to get vaccinated and comply and do the right thing, I congratulate them, I thank them. The other 1 1/2 percent got the attention. But I would like to bring back attention to the 98% plus that actually decided, ‘Yeah, we believe that if you're working in health care, you get vaccinated, it’s the right thing to do.’

What challenges are you facing in attracting and retaining staff?

With regard to recruitment, I don't think we have any major issue. Is it more difficult in some places, like operating room nurses and nurses in the emergency department, perioperative nurses? It does become a little bit more of an issue, but nothing that we cannot deal with.

We have been getting about a million job applications a year at Northwell. We hire 250 people a week, and we're continuing to grow.

Do you expect that some of your employees will work remotely forever?

The nature of work has changed. I still believe that to the extent possible, people should be coming to work. We're social beings, and the discussions that go on at the coffee pot are important.

But I think you'll have a hybrid situation. More and more, we'll be able to communicate with patients whether the employees are at home or whether they're actually in the hospitals or the ambulatory locations. I do think that people will be coming into the office maybe one day a week. We have reconfigured many of our offices here to allow for people to come in and out and not have their own offices anymore. People are also more productive from home in certain functions. First of all, they don't spend three hours a day traveling. They can work at five, six o'clock in the morning and take a break in the middle of the day and then work at night. And there are functions where that's very appropriate because it's easily monitored.

My advice to other employers is, have a positive attitude. This is not a challenge. This is a candy store of opportunities.

How will COVID change workplaces in the long term?

I don't think you can sit down and say, ‘This is exactly the way it's going to be.’ In many ways, the world will change, as it did after World War II. Our perspective in life has now changed. And that's good. I mean, every so often you need a kick in the butt. COVID gave us that kick in the butt. And it wakes you up. And it gets you to ask the question about what's important.

I walked every COVID unit in every hospital, so I saw what went on there, and you don't want to see that again. But we as an organization, it tested us. And I think we came out of it pretty well.

I think, overall, that we will be better off because we went through something like this, as bad as it was, I think we've come out a bit stronger, you know, and difficult times make you strong.

Along with the many advances and conveniences that are made possible by technology, there are also risks. How is Northwell coping with those risks? And, in particular, what was done after the Huntington Hospital data breach was discovered, to prevent that from happening again? [In November, the hospital informed 13,000 patients that their nonfinancial information had been illegally accessed by a worker who has since been fired. The worker has pleaded guilty to federal criminal charges and faces up to 10 years in prison.]

Every company that I'm aware of has at one time or another been, quote-unquote, hacked. Every company, even the federal government security apparatuses. So I'm not surprised that these things occur. We have ongoing reviews and audits all the time in every one of our facilities to try to determine unusual behavior.

This is the world we live in. Will it happen again? Probably. In every industry. You try to prevent it to the best of your ability. But I don't think there's any complete, 100% foolproof system. You put the precautions in place, you do the best you possibly can, you train people, you inform staff about the dangers of doing XYZ. And if you're lucky, you won't have many of these problems. We haven't had many of these. But it's an unfortunate circumstance, that is the nature of the world we live in. And this is why we all have to be very careful.

Does the health care industry need more U.S.-based businesses as suppliers, and are there opportunities there for Long Island based businesses?

We did not have an issue with PPE during COVID. I do believe that we have to be better prepared domestically for these circumstances and not have to be dependent upon outside countries. Is there an opportunity for Long Island businesses here? That would be great, we would be willing to partner with some of them.

We need to take the lessons of COVID to figure out what we need to do now to prepare for the inevitability of this happening again.

With the lifting of certain regulations during the pandemic, what became possible that would not have been possible before?

Most of the things that we did to respond to the crisis of COVID, we would never have been able to do if regulations had not been relaxed. Innovation blossomed as a result, we became unbelievably creative.

I remember the day we were sitting here, and we needed to create 200 beds, overnight. At North Shore University Hospital, we took the conference center and we converted that into beds. We took the lobby at LIJ and turned it into an emergency department. Under normal circumstance that would take me two years to get approval to do, and I'm not exaggerating.

What are you doing to make health care delivery more equitable?

COVID obviously demonstrated some of the inequities that exist. And we are now working very diligently in a lot of those communities to make sure we do an awful lot more in the future.

We spend hundreds and hundreds and hundreds of millions a year taking care of people who are underinsured, or not insured at all. I think it's our obligation to the community, we've got to be the holistic provider in the community for everybody, irrespective of your background, your color, your gender, your sexual orientation, it doesn't matter.

We provide a lot of mental health care. Is that something that I would do if I was only interested in making money? The answer would be no. But we do it. Why? Because it's important, because it's necessary, because it’s part of our mission. There are some parts of our business that lose money, other parts of our business that make money. So it's this cross-subsidization.

The other problem with many of the underserved areas where the equity issues are the worst is that most of the providers are paid by Medicaid. Medicaid does not pay you enough to cover your costs. But if you waited for the reimbursement, you'd never start. So you start to do it. And then you try to influence the reimbursement systems.

You're working on a book about aging. What intrigued you about that topic?

We are benefiting from the crisis of success. We've done so well with the science of medicine that we're able to keep people alive a lot longer than we could previously. The elderly population is expanding dramatically. And there are people who are living a long time and are very healthy and working. And then you have a category of people that, unfortunately, have chronic illness. They live a long time, but they're very sick and they need an awful lot of help. So how do we keep people at home? How do we take care of the caregivers? How do we use technology to help them more? The biggest cost of health care, by the way, is end of life. That's what basically the book is about.

Long Island in particular has a graying population. Are there words of advice that you would give to Long Islanders about how to put themselves in the best possible position as they get older?

Get vaccinated. The biggest determinants of health are lifestyle, behavior and your social circumstance, where you live. Medical care only contributes about 15% to your improved health.

Most doctors and nurses and hospitals are on the downstream side of it, we take care of you when you get sick. We’ve got to be on the upstream, so that we prevent you from getting sick. And part of that is providing information so you can follow the proper behaviors yourself.

I would hope that we spend an awful lot more time in the school systems on education about health. And what's the responsibility of the food industry, the beverage industry? What's the obligation of the housing industry that has lead paint in the old buildings that causes ill health among children?

This is why we take on gun violence as a public health issue. This is why we're focused more and more on the issue of sustainability. It's why we focus more and more on veterans, for example. The biggest advances in health care over history have been public health. In New York City, cleaning up the streets, putting in running water, closing the open sewers, those dramatically improved health. You can always make a difference, you can always be the catalyst that promotes a change in direction.

By Maura McDermott

maura.mcdermott@newsday.commauramcdermott

Maura McDermott covers education. Since joining Newsday in 2012, she also has worked on the investigations team and covered real estate and the business of health care.