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

What Is Risk Management in Healthcare?

Healthcare risk management comprises the systems and processes employed to uncover, mitigate, and prevent risks in healthcare institutions. Understand its purpose, elements, the risk manager’s role, and more.

ED Telehealth Express Care Service Patient Room

Revolutionizing the Delivery of Care for ED Patients

How the NYP OnDemand Emergency Department Telehealth Express Care Service reduced stay times and revisit rates in one year.

Targeting Unconscionable Prescription-Drug Prices — Maryland’s Anti–Price-Gouging Law

Why, in the early 21st century, are so many drugs that were cheaply available in the 20th century becoming prohibitively expensive?

The Economics of Indication-Based Drug Pricing

What would indication-based drug pricing accomplish?

Controlling the Cost of Medicaid

Both political parties should support policies that focus on incentives as a mechanism for improving and sustaining their value.

Resetting the Nation’s Health Care Quality Agenda

Poor measures of care quality have consequences. The National Quality Forum is essential to creating measures that are valid and reliable.

Untapped Business Opportunities for Entrepreneurs in Delivery System Reform

Opportunities for Private-Sector Entrepreneurship in Health Care Transformation

Two veterans of public service say that government can do only so much — which creates attractive business opportunities for entrepreneurs.

Moving Past the EHR Interoperability Blame Game

Why can't EHRs talk to one another? We never created the right incentives, but we pretend that we did.

Emerging from EHR Purgatory — Moving from Process to Outcomes

What's the effect of the mode of physician payment when it comes to EHRs?

Reframing Analytics: Transforming Insights into Action

Centralizing clinical data for an integrated delivery system revealed a surprising lesson: sometimes predictive analytics are not enough.


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

Learn More »


From the Commonwealth to Obamacare: Reflections…

The former Executive Director of the Commonwealth Health Insurance Connector — a model for the…

Value Based Care

220 Articles

Harnessing Emerging Information Technology for Bundled…

A four-part framework developed by physicians at Partners HealthCare provides a stepwise process for assessing…

From the Commonwealth to Obamacare: Reflections…

The former Executive Director of the Commonwealth Health Insurance Connector — a model for the…

Insights Council

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

Apply Now