In a new article in strategy+business, Center Executive Fellow Doug Wilson, Center board member Nathaniel Foote of TruePoint, and Eric J. McNulty of the Program for Healthcare Negotiation and Conflict Resolution at the Harvard T.H. Chan School of Public Health chronicle the dramatic transformation of NYU Langone Medical Center, A Center for Higher Ambition Leadership member company. Under the guidance of Dean and CEO Robert Grossman, MD, NYU Langone dramatically improved its financial and clinical performance while also innovating in medical education. It in now ranked as one of the top 10 hospitals in America by U.S. News and World Report and the ranking of its medical school has improved dramatically as well.
Wilson noted, “Leaders can create a vision with lofty, aspiring goals. The hardest step is to walk the talk. We interviewed many people in the NYU Langone Medical system. It was clear, Dr. Robert Grossman walked the talk. His team walked the talk. If you did not, you were moved out of the organization. If you did, you had a great opportunity for growth and doing the best work of your life.”
Grossman, an “insider-outsider” who was promoted to the job from his position as professor of radiology and chairman of the Department of Radiology, knew that the path to greatness would require significant change and deep engagement with the full range of stakeholders. He understood that a world-class academic medical center had to be a great place to seek care, teach, research, practice, and donate. “What stands out for me in the NYU Langone case is the way Bob Grossman created a shared commitment to excel,” Foote said. “His bold vision and early successes built renewed belief that collective excellence was possible. Critically, however, he also asked leaders in each part of the institution to define what ‘excellence’ meant in their own area, and then to track the data about how they were measuring up. The result was new levels of leadership initiative in all corners of the institution.”
In the end, the transformation would have to include everyone from the board room to the front lines:
Grossman said, “Building belief in the vision was critical.” “I also wanted to show the institution that it was much better than what they perceived yet at the same time embrace the brutal facts.” He decided to engage the leadership team and the broader organization in a structured dialogue around the vision. The senior team jointly crafted a concise “Statement of Strategic and Organizational Direction” and shared it with the entire organization with a call for input. In addition, a task-force of 12 next-level leaders conducted confidential interviews with more than 100 people, representing a cross-section of the extended leadership of the organization.
The key findings from the data were shared with the senior team with bracing honesty. There was good news – the vast majority of respondents agreed with the need to transform the organization and viewed the vision as personally meaningful. However, they also viewed NYU Langone as ill-equipped to achieve any of its strategic priorities, and were hungry for greater clarity about how the vision could be achieved. They also saw the organization’s deep silos and the senior team’s own lack of effectiveness as critical obstacles that needed to be addressed.
In light of the feedback, the senior team focused and reoriented its agenda. To create greater clarity about the path to achieve the vision, Grossman drafted a one-page, “50,000 foot” strategic roadmap, providing an overview of the sequencing and interrelationships among the key initiatives, such as the implementation of an integrated IT platform, the complete renovation of the emergency department and the introduction of an entirely new medical school curriculum. The senior team then undertook a 60-day drill down to develop “10,000 foot” plans for each of the three core missions – research, education, and patient care — including a view of the support and coordination requirements from key functions.
At times, Grossman moved quickly to remove obstacles and demonstrate commitment to the vision. At others, still guided by the vision, he demonstrated exceptional patience. Along the way, he used data transparency to set standards, empower people, mark progress, and guide adjustments to both strategy and tactics. He knew that financial sustainability was not simply a matter of squeezing costs out of the system. With board support, he invested in people and physical infrastructure. And, while Grossman’s role is central to the story, he is quick to insist that the transformation was a team effort. McNulty noted, “I regularly teach people aspiring to lead in health care. The lesson from NYU Langone that I’ll be sharing is that, with the right mindset, you can face hard truths, make tough choices, and build a hopeful, positive culture simultaneously. Honesty about the present and aspiration for the future go hand-in-hand.”
The take-away for other organizations is a “three-part prescription for organizational transformation”: commit to a compelling stretch vision, use data to both empower and increase accountability, and give people the resources and support they need to succeed. The journey has not been easy. It has, however, demonstrated how what we call a Higher Ambition approach yields dramatic dividends in stakeholder commitment, operational excellence, and financial performance.