Hospital for Special Surgery CEO Louis Shapiro On Making Healthcare More Accessible

Growing up, Louis Shapiro had to deal with both of his parents trading off illnesses. The hardship meant Shapiro had to work long days at his dad’s floor covering store, where he grew an appreciation for running a business. His parents’ sickness spurred him to go into pre-med in college, but he quickly realized after one course of organic chemistry that practicing medicine wasn’t for him.

Instead, he got into the management side of healthcare and was able to combine his interests in business and medicine. The Pittsburgh native received his BS and MHA degrees from the University of Pittsburgh and then worked at Allegheny General Hospital in several roles. From there, he went east to Danville, Pennsylvania, where he took on a senior leadership position at Geisinger Health System.

As Geisinger became known nationally for its integrated model of care, Shapiro’s own star rose and he was asked if he would be interested in serving as the CEO of The Hospital for Special Surgery (HSS). At the time, he didn’t know much about the New York-based hospital for orthopedics and rheumatology. “Back then, the only thing I knew about HSS was it was the hospital you drove under when you’re on the FDR highway on the East Side of New York City,” he recalls.

He accepted the offer and 13 years later, Shapiro has helped developed the Hospital for Special Surgery into a national powerhouse of its own. It’s been ranked as the top orthopedics hospital in the country for 10 consecutive years by US News. Moreover, its expanded nationally and has committed to new construction on the East Side of NYC.

Chief Executive visited Shapiro’s high-rise NYC office, right next to that famous wing over the FDR, to talk about the organization’s employee engagement initiative, on making healthcare more accessible and more. Below are excerpts from part one of this interview.

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One of your big focuses at the Hospital for Special Surgery employee engagement. Most healthcare providers are focused on patient engagement—why is employee engagement an important initiative for you?

Employee engagement is one way to describe it. We do talk about that a lot, but it’s more [in reference to] what’s the importance of culture in an organization? And how does that drive performance? So having employees engaged in what you’re trying to do is synonymous with creating a culture that is a foundation strategy for HSS.

I have had experiences in organizations that had a good culture and for a variety of reasons, lost it. And I’ve been in organizations that the only thing it had were its people and they knew how to invest in them. So, experiencing those two ends of the spectrum, I made a decision in my own mind that I had a singular responsibility for this organization as CEO and was going to make this an important platform. I believe that culture is a strategy that if deployed correctly, it allows organizations to achieve a level of results that are otherwise unattainable.

It’s not just for an altruistic reason of doing the right thing. I mean, obviously that’s great but the notion of a culture here…the general notion of it is leadership by all. We have 6,000 people here. Leadership by all means every one of those 6,000 people may have a different job to do…but everyone’s a leader. You’re a leader of yourself. And what part of you do you bring to work every day? You’re a leader of our commitment to excellence and nothing less than that. You’re a leader of helping the organization get from where it is to where it needs to go on its roadmap. And we’re all the same in that regard. The challenge is how do you create an environment where that’s not just lip service.

What would you say are the biggest challenges you face—whether it’s related to healthcare or a cultural issue? What are the things that keep you up at night?

There are three things most important to me. Job one is don’t mess things up. Job two, make things better. It doesn’t matter what we’ve accomplished yesterday, make things better today. We have the lowest infection rate. Irrelevant. We have infections. How do we make it better? We have the highest patient satisfaction. Irrelevant. How do we make it better? We have a lowest complication rate. Irrelevant. How do we make things better? Our value to employers is better than any other place. Irrelevant. How do we make it better?

Better, better, better. It’s not bigger, it’s better. So that’s two. Three, how do we make HSS accessible to the world?  We’re sitting here, the largest musculoskeletal institute in the world, we have figured out how to be the leader, not only the largest, but also the leader. And then we have all this knowledge about how to take care of one of the biggest health issues out there. If you go to a large employer, musculoskeletal is probably their first or second largest spend. It’s probably the fastest growing spend in their healthcare portfolio. And among others disease categories, there’s probably more variability and opportunities for improvement. It is not fair for people not to be able to come here. Now the problem is we can’t be everywhere and let everyone get on a plane and come here. We grow as much as we can in a way that doesn’t dilute the brand. We’re growing throughout the Tri-State area; we’re growing where we sit right now. We’re going to have a new building for people to drive under soon.

So, more people want to come here, right. For care. It’s hard to grow in New York. So yeah. And so that’s one thing. And then we probably have seven or eight locations that are under construction right now throughout the Tri-State area and beyond. Midtown, West Side, Hudson Yards, Brooklyn, Long island, Queens, Connecticut, Florida. We want to deliver care close to where people live. We have a relationship [with a provider] in Aspen, Colorado. We have things that we are doing in other parts of the world as well.

Talk to me about HSS’ partnership with employers?

About six years ago, we had a board retreat. Usually our roadmap gets validated at the board retreat we have every couple of years. What came out of that board retreat is we need to do a better job of articulating our value proposition to consumers, insurers and employers. And what was born out of that was to focus on employers. So today we have relationships with probably 30 large employers that may have a New York base, but also are national or international.

Some of those relationships are super strong and some of those are developing and we have others in the pipeline. And those relationships include a variety of different services, including facilitated access. How do we make sure that our workforce has access to [HSS] in an efficient manner? In some cases that includes education on how to maintain and protect their musculoskeletal health. In some cases that includes providing services on site at those employers, particularly physician services and Rehab. And we do that for many employers in many locations throughout the Tri-State area. And then in some cases, it includes health care services. We may have a bundle with them, which is sort of a traditional reimbursement relationship.

Healthcare these days is focused on lowering the cost of care for patients. As the CEO of the Hospital for Special Surgery, you are at the center of this. How do you deal with these realities?

I would say that’s why the third thing is make HSS more accessible. If we could wave a magic wand and replicate this across the country, we would save the country. It would save billions of dollars. I don’t work in government. I don’t work in Washington. It’s not my job, but my job is to take HSS and don’t mess it up, make it better, make it work, more accessible. By making it more accessible, we’re filling an obligation to make our contribution to fixing our portion of healthcare.

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