World Class: A book review by Bob Morris

World Class: A Story of Adversity, Transformation, and Success at NYU Langone Health
William A. Haseltine
First Company Press (February 2017)

“We believe that quality is cost effective.” Robert Grossman (Dean and CEO of NYU Langone Health)

In less than ten years, NYU Langone Health was transformed from one of the worst to one of the best healthcare centers in the world in terms of patient care, research, and teaching. William Hazeltine tells that story for the first time. He had no prior relationship with NYU or NYU Langone Health other than becoming a patient (treated for head and neck cancer) while researching the book.

He interviewed almost everyone centrally involved in the transformation from 2007 until 2017. There are four persons of special significance: Kenneth Langone (Vice Chair, NYU Board and Chair, NYU Langone Health; Martin Lipman (Chair Emeritus, NYU, and Trustee, NYU Langone Health); John Sexton (President Emeritus, NYU, 2002-2015); Robert Berne (NYU Professor of Public Policy, XVP for Health); and Robert Grossman (MD, Saul J. Farber Dean and CEO of NYU Langone Health, 2007-present).

Hazeltine shares what he considers the most valuable to be learned from NYU Langone Health’s transformation. Each is thoroughly discussed within the narrative, in context. These were of greatest interest to me:

o “In organizational change the three most important variables are leadership, leadership, leadership. NYU Langone was transformed because it had strong and wise leadership [in its key positions] that established, pursued, and achieved impressive goals by executing well-crafted plans with great efficacy…within an aspirational culture.”

o “The crucial role of the dashboards may be a running joke among among NYU Langone insiders [‘Bob and his dashboards!’], but it reflects an important development in organizational transformation: Large complex organizations require more than clear thinking about strategy and tactics. They require vast amounts of information. It’s the only way to know what’s being done, what needs to be done, and how well things are being done.”

o “Management by walking around is being supplemented by management looking at a dashboards. There are always things going on in an organization that management cannot see by walking around but can monitor by having the equivalent of thermostats, and sensors, dipsticks and yardsticks.”

o “Grossman’s approach was to formulate goals and ask those charged with achieving those goals what resources they needed to get there. Then, he would let them run their own show. He was an enthusiastic cheerleader and optimistic observer, but he was not second-guessing his line managers. Instead, he would objectively measure their results and hold them to account if the goals they had agreed to were not met.”

o According to NYU Langone Health’s former CFO, Michael Burke, “Doctors in academic centers tend to be hypercompetitive. Give them a dashboard and a scorecard, and they will strive to be at the top, whether they are in the hospital or the medical school. The dashboard allows very detailed comparisons.” And yes, contrasts.

As I worked my way through this narrative, I was again reminded of the fact that Toyota’s assembly line innovations helped other automobile manufacturers to improve the quality of their vehicles, to be sure, but have also helped countless other companies in other industries to achieve comparable improvements. I share William Hazeltine’s hope that the lessons learned from the adversity, transformation, and success at NYU Langone Health will help other healthcare centers to improve the quality of their own patient care, research, and teaching. And as has Toyota, it will help countless companies in other industries to demonstrate that higher quality really can be cost effective.

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