A World Class Transformation World Class offers an inside view into the remarkable turnaround of an underperforming medical center in New York City into a world class institution. Ten years ago, NYU Langone Health was losing tens of millions of dollars and ranked in the bottom third of academic medical center hospitals for quality and safety. Today, the medical center delivers world class patient care and generates a substantial surplus.
In World Class, scientist, businessman, and expert in biotechnology and healthcare system development Dr. William A. Haseltine showcases NYU Langone Health as an inspiring model for all business leaders to emulate. Using real world conditions to highlight the information science and requisite interpersonal relationships needed for business transformation, World Class provides universal lessons for policy makers and leaders in all fields.
The academic medical center NYU Langone truly did transform itself in a decade under Bob Grossman & Ken Langone's leadership. That cannot be denied when one examines the various metrics by which one can evaluate a health system. Safety & quality increased at Langone. Rankings increased. Net income went from negative to positive. Square feet of buildings increased. . . on and on. A number of methods that Grossman & Langone employed are fairly common in the healthcare arena. They enforced clarity at NYU Langone. They created goals & had vision statements. They received feedback from others in their organization. Good acquisitions & mergers were done while bad acquisitions were either reversed or avoided. Care was shifted toward the outpatient areas in an effort to minimize the emphasis upon more costly, dangerous interventions in the inpatient areas. What most interested me, as someone who works in healthcare in an unnamed academic medical center, are the things that I have not seen enacted yet. I will list those. 1. Bob Grossman ripped out a set of information systems that were not integrated (including the Electronic Health Record) & replaced those with Epic. Lots of money and time was spent on this effort and the rewards that were reaped were tremendous. Having everyone on one platform enabled data to be gathered & standards to be enforced across the entire health system, from registration to scheduling to clinical actions to bill payment. 2. Creation of many, many "dashboards" with data being fed from Epic as well as other sources. All of these various dashboards contain metrics important to the organization: numbers of visits, post-surgery recovery durations, safety incidents, mortality, et cetera. 3. Publishing these dashboards to *everyone* in combination with the understanding that everyone will be judged by their performance compared to everyone else. If you are a surgeon whose patients are the slowest to recover post-surgery then everyone in your department will know that. If your area has a dip in outpatient visits then all outpatient areas will see that. If you as a researcher do not pull in as many grants as your fellow researchers then they will all see that. That which is measured gets managed, plus competitiveness is an important tool. 4. Destruction of silos. Grossman wiped out directors & managers who survived via protection of silos and replaced those people with individuals who could work collaboratively upon issues of common interest for the entire health system. 5. Expert usage of crisis. When a hurricane struck New York City Grossman and others worked very hard to keep the hospital open while also using that crisis to move the entire health system forward. Langone agreed with Grossman's desire to pay everyone on the payroll even when many facilities couldn't be opened for months. They rebuilt many departments in their central hospital with an eye to the future & fixing current issues rather than copying what was destroyed. They truly did not let a good crisis go to waste, as Rahm Emmanuel was quoted. 6. Improved patient experience. Grossman and others focused on patient-centered care rather than the care that individual departments or physicians might want to implement. 7. Brought in immense sums of money from donors. Wow. Simply eye-popping amounts. 8. Coordinated the university's efforts with the health system's efforts. Quite often Grossman would appoint the same person to be in charge of a medical department as well as the corresponding academic department, it seems.
Once Grossman had was able to get the finances of NYU Langone into positive territory he had the freedom to spend resources wisely. It would be hard to envision any other medical school deciding to make medical school tuition free for its students without having the money to pay for that.
It is clear with this story, however, that Grossman angered a number of people. He fired lots of directors & managers. He, in effect, limited tenure for researchers who did not produce research grants for the medical school & health system. Of course, looking back, these seem like the right moves to have made, but I imagine he made his share of enemies.
I did appreciate the notion, mentioned a number of times, that Grossman took responsibility for his mistakes. This book does make clear that Grossman is not perfect. That helped to make the entire narrative ring true for me.
I received an advance reading copy of this book and I'm grateful for that. I'd recommend reading this book if you work in a health system, especially an academic medical center.
I received a free ebook ARC of this from NetGalley for a review.
World Class is the interesting story of NYU Langone's transformation from a terrible medical school/hospital to an amazing one. This book was a mix of history, management, and medicine. While I sometimes got bogged down by all the names that were coming at me, this was a worthwhile read. The pacing was pretty good; Haseltine didn't spend too long on any one particular topic. The discussion of the IT changes and the physical changes they made were fascinating.
I enjoyed, in particular, the chapters talking about their additional hospitals that they've acquired (or however they described it). The discussion of how the insurance-mix of patient populations affects the hospitals and how that can strengthen and weaken "safety net" hospitals was interesting.
Overall, I recommend reading this if you're interested in a management profile, hospitals or healthcare of the future, or a feel-good business story.
This is a fascinating book about organizational change within a healthcare space. I came across the NYU Langone in the normal course of my day job 2 years ago and I am honored to witness what a great organization this is.
The book spells out the amazing journey NYU Langone took to rise from a mediocre institution to world class. Organizations in healthcare industry can take a good look in this book and emulate what this institution is doing to get to the next level.
The story of NYU Langone Health's transformation from underperformer to world-class leader is inspiring. It's amazing how the organization completely turned itself around. However, the book got a little repetitive at times and lost my interest. I would recommend it for someone working in the healthcare field, but probably not for the casual reader.
I received this book as a Goodreads giveaway. Yay!
On August 16, 2018 NYU Langone Health captured the attention of the world announcement that all medical school students will receive full tuition scholarships. This is the story of how NYU Langone Health moved from the bottom third in national quality and safety rankings to number one or two in the country, and now ranked as the number three medical school in the United States, just behind Harvard and Johns Hopkins, up from a ranking of thirty-fourth. It went to number seven among the top fifteen major teaching hospitals (the only New York hospital in the list of top one hundred). This transformation happened between 2007 to 2017 Robert I. Grossman, the CEO and dean who led the transformation. The author discusses the “levers of change” used to pry the organization from its past behaviors and put it on the path to a productive future. Changing the culture required several elements comprising this culture: • Agility • Accountability • Horizontal data transparency • Crystal-clear communication • Breaking silos • Focus
The author was diagnosed with head and neck cancer and was treated at the Perlmutter Cancer Center, part of NYU Langone, so writes from the perspective of a patient. Ken Langone, the former chair of Home Depot, agreed to join the board of both the university and the Medical Center in response to an invitation from his friend and lawyer, Martin Lipton.
The book discusses how “metrics provide objective measurement of all activities. Subjective measures would not color evaluations of performance.” But this is an illusion, since how and what is measured is, itself, subjective. There’s some discussion on what some of the metrics are. Grossman insisted that he and others should not be driven by opinions but by data. The tired old axiom of modern management that what gets measured gets managed, and what gets managed gets measured, is mentioned. He quotes one colleague: [The]way Bob uses the dashboard has caused me to revise what was a fundamental tenet of my own belief in management. I used to agree with other management experts who argued once a leader gets past managing five or six or ten indices, he is not managing anything. The idea is that there are too many variables to keep in mind. The leader should remain focused on those most important for success.” But, she added, “Bob has shown me that it is possible to manage many, many indicators simultaneously and effectively. Bob sees what is happening from the top, middle, and bottom of the organization.”
The hospital adopted the “relative value unit model,” which for radiologists depends on the type and volume of images they are reading. For surgeons it depends upon the number of cases plus time spent on office work. For hospitalists, the relative value unit is determined by the number of patients on the floor you supervise. I’m highly skeptical this is a world-class model to follow. This is fee-for-service run amok. The Concierge and Direct Primary Care models are far superior. The medial school went from four years to three years, which seems logical (law schools pay attention). The book was simple, a bit repetitive in places, and didn’t really study any other models, such as the Mayo Clinic. Some of the advice was banal, and in no way is NYU the only model to reform our broken healthcare system.
Notable quotes: Mike Tyson famously said, everybody has a plan until they get punched in the mouth. Winston Churchill said it best: “The price of greatness is responsibility!”
As a health researcher working in an academic environment for the past decade, I found this book fascinating for a number of reasons. Although prior to reading this book I had not given the tranformation of the NYU Medical School a lot of thought, in the world of academic health research, you would have to be living under a rock not to notice the slow and steady rise of the institution over the past decade. This book not only gave me some context around how/why that transformation took place, but Haseltine explains all of the key ingredients that really made Langone Health's transformation successful. The academic health research environment is increasingly precarious, especially with funding becoming more and more limited, new biomedical technologies are costing more to produce, and vying for human resource talent against well-funded private biotech companies is often brutal. I think we can learn a lot from Langone health's story and that's Haseltine's primary objective in writing and putting this book out there for others to learn from.
Beyond academic medical institutions, many organizations can learn from the ideas presented in this book - in particular, institutions of higher education both large and small have something to learn from considering how to turn around what might be a sinking ship! For this reason, I think leaders of many organizations can benefit from reading this book.
I docked a star on this book for a couple of reasons: 1. At times it feels like this is an advertisement for Langone and not just a book of best practices/lessons learned for others to follow; 2. There is a lot of overview and not a lot of depth. I was surprised at how little is written on many important topics, for example there is essentially one or two interspersed paragraphs on NIH and other funding mechanisms, which any academic researcher will tell you is the cornerstone of distinguishing excellent centers for healthcare research; 3. Haseltine integrates himself into the story but it feels awkward and doesn't really add anything to the entire book. I think he could have explained in the introduction what his connection is to the institution and left it at that. Instead, there are odd moments in the book where he brings himself back in, usually to explain a point from his first-person perspective, but it feels forced.
Otherwise, it's a good reference book and could be a great gift to an organizational board, leaders of large institutions, etc.
I actually won a KINDLE copy of this book through a giveaway on GoodReads, and the following is my honest opinion.
Having worked for the NYC Health & Hospital Corporation for over 33 years, like many co-workers working in various hospitals and capacities in the areas of Patient Accounting, Finance & Statistic Departments, and as well Data Processing [IT], you couldn’t help keep track of the stories coming out of the private sector regarding hospitals like the one this meticulously written book deals with.
Detailed oriented, fraught with first hand in-depth interviews with those involved with the story here is not a book which can’t be read quickly as something could be missed. The author of this book, Dr. William A. Haseltine has done a spectacular job of intertwining all of the various smaller stories involved within the timeline of this hospital transformation into a single cohesive story; and in doing so, has given his readers a graphic accounting of all of the various players [entities] and what they had to face along the way in the creation of the first-class, world-renown medical facility and medical school we have today.
Everyone knows about the high-cost of an excellent, first-rate college education, and when the field of study is Medicine the cost can be exceptionally high; yet on August 18, 2018, with its stunning transformation well-established, NYU Langone made the unprecedented announcement that all current and new medical school students would receive full tuition scholarships. This crowning glory is merely another achievement of its now being a ground-breaking, top-rated medical organization consisting of a hospital, medical school, and research facility, with each having the same caliber of performance.
For having given his readers a roadmap which they can use to achieve a similar revolution for their organization, or for having told the general public of what went on behind the scenes that made NYU Langone the medical facility it is today, I’ve given Mr. Haseltine 5 STARS.
World Class: A Story of Adversity, Transformation, and Success at NYU Langone Health by William A. Haseltine tells the story how how one of the worst healthcare systems became one of the best in about ten years. before it had been widely talked about NYU Langone Health concentrated on patient care, cost cutting and making sure that all of it's systems could work together. William A. Haseltine uses interviews to help tell the story. If you work in the health care field , this will help you see the changes and what worked at NYU Langone. If you are not iviled in working in thehealth filed some things may require you to look up some words but it is important because everyone is at least a patient or a friend or family member of a patient. Healthcare and its institutions need to streamline to change. this is a success story that needs to be read.
I won a free copy of this book from Goodreads First Reads program.
William Haseltine tells the story of NYU's rebirth from a lagging hospital and med school resting on its past glories to a powerhouse in academic medical centers. Much of this story is focused on two men who were driving forces behind this change, but there are general lessons to see. Grossman had a champion in Langone and a plan to be world class and patient centered. Good level of detail for both experts and casual readers, but some of the innovations aren't quite so unique as the author thinks they are. This is fine in a kind of biography of an institution but some needs taking with a grain of salt. It is a great look at what data driven health care can do for patients and systems and it is also a fair look at changes in the health care setting from hospital to outpatient. Solid book for general interest.
This was a really comprehensive look at how NYU Langone Health turned their fortunes around. As a higher-education administrator, I was interested in reading this to find some ideas and techniques that could be applied at my own institution, which didn't quite work out only because this book was really specifically focused on the healthcare aspects of the turnaround. There were some good things in here to take away, but a lot of it was too specific to do me a lot of good. Still, a good account and worthwhile reading, especially for those in healthcare.
How a longstanding institution went from mediocre to positively exceptional while changing from conventional to innovative. Lots of hard teamwork went into the changes and the willingness to see an outcome beyond expectations. This model for change is adaptable to other businesses as well. I won an ebook copy in a Goodreads Giveaway.
This book was a Best of the Best for the month of May, 2019, as selected by Stevo's Book Reviews on the Internet. You can find me at http://forums.delphiforums.com/stevo1, on my Stevo's Novel Ideas Amazon Influencer page (https://www.amazon.com/shop/stevo4747) or search for me on Google for many more reviews and recommendations.
Received this (e)book through a Goodreads giveaway. This was a great homage to NYU Langone Health and Bob Grossman. There's definitely a lot of great information here to digest. The missing star is because there isn't a lot about the struggles that I'm sure a transformation of this magnitude had along the way. Seems like everything just worked which is of course never the case.
"World Class" is an interesting look into the changes made at NYU Langone and the healthcare system in general. It's a certainly well done story and fascinating look. I really like books like this.
Great storytelling by Dr. Haseltine. I have also watched his YouTube videos explaining the journey of Dr. Grossman while reading this book. A great read.
I read this book not to learn about healthcare systems, but as a case study in organizational turnaround and performance improvement.
Say what you will about our (mostly broken) healthcare system, this is one of the BEST books I've read on the topic.
The importance of metrics, systems development (!!!!), accountability and responsibilty (and flatness and performance delegation) are universal lessons. Yes, nothing revolutionary (surprise!). It's like being healthy - everyone knows it's about eating properly and exercise, but we constantly join the latest fad.
This one has been added to my bookshelf for future rereading and refernece.
This book is a lot more academic then I expected. This was not created for the casual reader, but I have found some points to be interesting. I tried to finish reading this book, but I had to stop, since I wasn't interested and it felt more like a chore to finish.
If you are interested in a success story of a Medical Hospital/ University, then this book is for you.