New Marketplace
E Pluribus Unum for Health Care (09:14)

Emme Deland, Senior Vice President and Chief Strategy Officer at NewYork–Presbyterian Hospital, says the new era of health care delivery is all about relationships. She likened today’s health care delivery challenges to the productivity study of chickens conducted by William Muir. In the study, Muir found that the average flock of chickens flourished, while the “super flock” was aggressive, wasteful, and unproductive.

“NewYork–Presbyterian,” Deland says, “is probably a flock of super chickens. We have the privilege of being affiliated with two med schools, we just added four hospitals to our regional network, we’ve employed 800 primary and specialty physicians. We have the wealthiest of patients, and 30% of our patients are on Medicaid. There’s great diversity in what we’re trying to do. We provide care in 100 languages. It’s a complicated community.”

Health care in general, she adds, is very complicated. There’s a complicated web of stakeholders, payers, hospitals, physicians, regulators, patients, and consumers. Relationships, therefore, are key to building social capital, bonds, loyalty, and trust.

To find out one of their goals for addressing this, look no further than the coins in your wallet. E pluribus unum — printed on nearly all of our coins, means “out of many, one.” In other words, Deland says: How can we leverage the many to provide wonderful one standard of care?

NY–Presbyterian is taking many steps to answer that question, including:

  • Developing a framework around an initiative of respect. “We’re framing it around the principle of accountability, so we are implementing a credo that everyone will sign,” Deland says.
  • Looking at performance evaluations. “Respect is one of the ways we’ll reward people,” Deland adds.
  • Listening to what their employees have to say. Says Deland, “We are going around to listen to our employees and what they are telling us — what works, what doesn’t work, how can we support the way they do their work.”
  • Developing collaborative councils at various levels of the organization to create opportunities for the physicians, nurses, and various support services to work together — “which we have not been successful at doing in the past,” Deland adds.
  • Making sure the people providing the care have what they need. “We’re developing a service standard for all patients in the care model, in patient or outpatient, and making sure we have the right leadership, 7 days a week, 24 hours a day, so we can get the right services done that we need to for the patients.”
  • Developing a new communication strategy: coordinated huddles, enabling people all around the organization to hear up and down what is happening.

“Change isn’t easy for any academic medical center, but it’s absurd for us to have any judgments on the kind of changes, the expectations, based on the last 5 years. This is a journey. We need a little more time before we can be judgmental about what works and what doesn’t work,” says Deland.

“As all of us contemplate the future, I think e pluribus unum, which is probably more important today than any time in my lifetime, may bring us more sanity and success than just flocks of super chickens.”

From the NEJM Catalyst event New Risk, New Business Models held in Boston, October 6, 2016.

More From New Marketplace
New Risk, New Business Models

How NYP Used Its Innovation Stack to Launch a Telehealth Program

NewYork–Presbyterian uses a structured program for developing innovation. The first project was the development and launch of a comprehensive telehealth offering in less than a year.

New Risk, New Business Models

Good Riddance to Big Insurance Mergers

If there is any silver lining, it’s that other insurers might learn from blocked mergers and devote more energy to growing by offering superior value, rather than by swallowing rivals.

New Risk, New Business Models

Massachusetts Hospitals Seek to Get Larger to Shrink Costs

Beth Israel Deaconess Medical Center, Lahey Health, and New England Baptist Hospital propose to merge to gain market heft. What will be the impact on costs in one of the nation’s most expensive health care markets?

My Favorite Slide: Surprising Mortality for Some Americans

Call to action: Survival statistics for a slice of middle-aged white people in the U.S. are uniquely troubling.

New Risk, New Business Models

Focusing on High-Cost Patients — The Key to Addressing High Costs?

A focus on high-cost patients may not only fail to contain health care spending, but it may also help to entrench the status quo.

New Risk, New Business Models

Improving Hospital Incentives with Better Cost Data

Hospitals’ existing cost data could be used to substantially increase the accuracy of the Medicare payment rates for inpatient hospital care.

New Risk, New Business Models

Success and Failure in the Insurance Exchanges

Efforts to reform or replace the ACA should proceed with the knowledge that highly publicized market exits are a poor and probably inaccurate signal of a failing market.

New Risk, New Business Models

Changing How We Pay for Primary Care

Primary care accounts for more than half of the United States’ office visits, but direct spending on primary care is only a tiny portion of our nation’s total health cost.

New Risk, New Business Models

Getting Real about Health Care Costs — A Broader Approach to Cost Stewardship in Medical Education

In the next era of cost-stewardship education, future and current physicians will have to be taught to reduce spending across the care continuum.

New Risk, New Business Models

Discord Between Ballad Health and the FTC

How a proposed merger of two large rural health systems has created opposition from federal regulators and economists, but supporters among local business groups.


A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »


Value Based Care

107 Articles

Health Care — A Final Frontier…

Design must move beyond narrow projects and encompass complex systems.

Good Riddance to Big Insurance Mergers

If there is any silver lining, it’s that other insurers might learn from blocked mergers…

Why Real-World Results Are So Challenging…

User engagement outside of clinical trials is the critical factor.

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now