Operating a large healthcare system requires significant effort to align different employees, physicians and business entities around a set of core values. Mark Solazzo, chief operating officer of North Shore-LIJ Health System in New York, discusses five of his system's best practices for pursuing common goals and keeping 42,000 employees on the same page.
1. Survey employees about their alignment with the system. Operating a large healthcare system is a significant undertaking, and Mr. Solazzo credits his organization's success in part to employees' understanding the goals and values. North Shore-LIJ regularly surveys its employees and asks them to rank their personal agreement with the statement: "I understand how my work contributes to the goals of my hospital/facility." Mr. Solazzo says, "We consistently score in the range of anywhere from 92-100 percent of the entire workforce, and I think the healthcare benchmark for that question is about 86 percent." He says the high percentage of aligned employees depends on consistently communicating the organization's goals and projects to every level of the system.
He says the goals of the organization are also enforced at every level. "We have four overarching goals in our healthcare system: quality, service excellence, financial performance and efficiency," he says. "For each entity goal, we set a target and monitor it at the system level and at each hospital or business entity," he says. "For each hospital or business entity, the management team [cascades that goal] down to the department level."
2. Give managers a stake in the system's success. Mr. Solazzo says North Shore-LIJ Health System involves managers at different levels of the organization in the health system's success by tying compensation to success. This means rewarding managers for success at their individual positions as well as system-wide successes. Tying compensation to system-wide successes means leaders of different hospitals are incentivized to work together and share ideas. "If I'm the head of North Shore University Hospital, part of my compensation is tied to how I do at North Shore, but a larger percentage is tied to how the system does," Mr. Solazzo says. "Everyone has got a common goal to help the weakest link."
He says North Shore-LIJ facilitates communication among hospital leaders by posting departmental performance outcomes on the system's internal website on a monthly basis. "When we see somebody struggling, their peers usually have a conversation with them," he says. "We also have monthly meetings where we share information on what's working and what's not working, and that occurs at the executive level and the department level throughout the organization."
3. Pay special attention to newly acquired hospitals. If a large system acquires a hospital, system administration should not assume that the new hospital will automatically adapt to system culture. "When a hospital comes into our system, sometimes there's resistance to change and a lack of understanding of what we're trying to accomplish," Mr. Solazzo says. "We've been at this a long time, and we've added a lot of different businesses and different hospitals. Early on, we were learning how to do this, so our most recent mergers and acquisitions have been much easier because we're coming from an area of experience."
When dealing with the administration in a newly acquired hospital, Mr. Solazzo says the key and the challenge is to be as transparent as possible. If the new hospital administration thinks your system is planning on "slashing and burning and changing things," Mr. Solazzo says, you may have trouble convincing administration and medical staff to trust you. Instead, be very clear from the beginning about your system's values and goals, including any changes the new hospital will need to make to fit with your culture.
In some situations, acquiring a new hospital may mean replacing old administration. Mr. Solazzo says the transition varies significantly depending on the new hospital. "We've had situations where we've had to replace the entire leadership team, situations where one or two individuals have had to go and situations where the whole team has embraced the system," he says. "It goes back to their values … and there are very competent administrators who may not share our values."
4. Developing your workforce to achieve business outcomes. North Shore-LIJ operates 15 hospitals and has over 42,000 employees, meaning the organization has to make an effort to involve individual staff members in system-wide projects. Without a program in place to identify and reward good ideas, the system might overlook entry-level staff members and miss out on ideas that could benefit the organization. Mr. Solazzo says the system has implemented a process where, every year, each business entity looks at its different levels and identifies staff members who have shown exceptional performance over the last year. Around 200 individuals are selected at the beginning of the year as "high potentials," and over the course of the year, those individuals meet with senior leadership, undertake strict assignments and receive rigorous performance evaluations. "We also give them special training, and we have a very large center for learning and innovation," Mr. Solazzo says. "We try to invest in our employees and significantly invest in our high potentials. Some get promoted at the end of the year, some stay on the list and some come off the list. Over 90% of participants remain part of the high potential talent pool, and 70% of the high potentials have been promoted or moved within the organization."
In a very large organization, there will be great performers at every level. The trick, Mr. Solazzo says, is to identify those performers and move them into positions where they can have the most effect.
5. Understand the physician perspective. Integration with a large health system may be naturally opposed to the practice of a traditional physician. "Physicians are an independent group," Mr. Solazzo says. "The whole idea of the private practice of medicine is about independent practitioners and businessmen and women. You have to understand that landscape to start off with." To effectively reach a large number of your physicians, you need to start with patient care, a number one priority for all physicians regardless of practice model. He says North Shore-LIJ takes care to involve physicians in clinical decisions, as well as projects to reduce infections and target other performance issues. He says if your system starts with the premise of improving patient care — rather than leading with the need for physician integration and alignment — your physicians will involve themselves naturally.
Read more advice on operating a health system:
-Lessons From the Group Practice Demonstration for ACOs: Q&A With University of Michigan's Dr. Caroline Blaum
-10 Must-Reads for Hospital Leaders to Start the Year
-Shifting From a Hospital-Based to Community-Based Mindset: Q&A With Valinda Rutledge, CEO of Caromont Health
1. Survey employees about their alignment with the system. Operating a large healthcare system is a significant undertaking, and Mr. Solazzo credits his organization's success in part to employees' understanding the goals and values. North Shore-LIJ regularly surveys its employees and asks them to rank their personal agreement with the statement: "I understand how my work contributes to the goals of my hospital/facility." Mr. Solazzo says, "We consistently score in the range of anywhere from 92-100 percent of the entire workforce, and I think the healthcare benchmark for that question is about 86 percent." He says the high percentage of aligned employees depends on consistently communicating the organization's goals and projects to every level of the system.
He says the goals of the organization are also enforced at every level. "We have four overarching goals in our healthcare system: quality, service excellence, financial performance and efficiency," he says. "For each entity goal, we set a target and monitor it at the system level and at each hospital or business entity," he says. "For each hospital or business entity, the management team [cascades that goal] down to the department level."
2. Give managers a stake in the system's success. Mr. Solazzo says North Shore-LIJ Health System involves managers at different levels of the organization in the health system's success by tying compensation to success. This means rewarding managers for success at their individual positions as well as system-wide successes. Tying compensation to system-wide successes means leaders of different hospitals are incentivized to work together and share ideas. "If I'm the head of North Shore University Hospital, part of my compensation is tied to how I do at North Shore, but a larger percentage is tied to how the system does," Mr. Solazzo says. "Everyone has got a common goal to help the weakest link."
He says North Shore-LIJ facilitates communication among hospital leaders by posting departmental performance outcomes on the system's internal website on a monthly basis. "When we see somebody struggling, their peers usually have a conversation with them," he says. "We also have monthly meetings where we share information on what's working and what's not working, and that occurs at the executive level and the department level throughout the organization."
3. Pay special attention to newly acquired hospitals. If a large system acquires a hospital, system administration should not assume that the new hospital will automatically adapt to system culture. "When a hospital comes into our system, sometimes there's resistance to change and a lack of understanding of what we're trying to accomplish," Mr. Solazzo says. "We've been at this a long time, and we've added a lot of different businesses and different hospitals. Early on, we were learning how to do this, so our most recent mergers and acquisitions have been much easier because we're coming from an area of experience."
When dealing with the administration in a newly acquired hospital, Mr. Solazzo says the key and the challenge is to be as transparent as possible. If the new hospital administration thinks your system is planning on "slashing and burning and changing things," Mr. Solazzo says, you may have trouble convincing administration and medical staff to trust you. Instead, be very clear from the beginning about your system's values and goals, including any changes the new hospital will need to make to fit with your culture.
In some situations, acquiring a new hospital may mean replacing old administration. Mr. Solazzo says the transition varies significantly depending on the new hospital. "We've had situations where we've had to replace the entire leadership team, situations where one or two individuals have had to go and situations where the whole team has embraced the system," he says. "It goes back to their values … and there are very competent administrators who may not share our values."
4. Developing your workforce to achieve business outcomes. North Shore-LIJ operates 15 hospitals and has over 42,000 employees, meaning the organization has to make an effort to involve individual staff members in system-wide projects. Without a program in place to identify and reward good ideas, the system might overlook entry-level staff members and miss out on ideas that could benefit the organization. Mr. Solazzo says the system has implemented a process where, every year, each business entity looks at its different levels and identifies staff members who have shown exceptional performance over the last year. Around 200 individuals are selected at the beginning of the year as "high potentials," and over the course of the year, those individuals meet with senior leadership, undertake strict assignments and receive rigorous performance evaluations. "We also give them special training, and we have a very large center for learning and innovation," Mr. Solazzo says. "We try to invest in our employees and significantly invest in our high potentials. Some get promoted at the end of the year, some stay on the list and some come off the list. Over 90% of participants remain part of the high potential talent pool, and 70% of the high potentials have been promoted or moved within the organization."
In a very large organization, there will be great performers at every level. The trick, Mr. Solazzo says, is to identify those performers and move them into positions where they can have the most effect.
5. Understand the physician perspective. Integration with a large health system may be naturally opposed to the practice of a traditional physician. "Physicians are an independent group," Mr. Solazzo says. "The whole idea of the private practice of medicine is about independent practitioners and businessmen and women. You have to understand that landscape to start off with." To effectively reach a large number of your physicians, you need to start with patient care, a number one priority for all physicians regardless of practice model. He says North Shore-LIJ takes care to involve physicians in clinical decisions, as well as projects to reduce infections and target other performance issues. He says if your system starts with the premise of improving patient care — rather than leading with the need for physician integration and alignment — your physicians will involve themselves naturally.
Read more advice on operating a health system:
-Lessons From the Group Practice Demonstration for ACOs: Q&A With University of Michigan's Dr. Caroline Blaum
-10 Must-Reads for Hospital Leaders to Start the Year
-Shifting From a Hospital-Based to Community-Based Mindset: Q&A With Valinda Rutledge, CEO of Caromont Health