How Northwell’s CEO spots a future leader

When Michael Dowling’s retirement party ended around 9:30 p.m. on Sept. 30, John D’Angelo, MD, found a place to take a nap.

In the early hours of Oct. 1, Dr. D’Angelo officially began a new chapter after 25 years with New Hyde Park, N.Y.-based Northwell Health: that of president and CEO. At midnight, he walked through the doors of a freestanding emergency department he helped build in 2014 — and started listening. Over the next 23 hours, he visited 16 Northwell Health sites, hitting every market, deliberately including the night shift.

The leadership transition between longtime CEO Mr. Dowling and Mr. D’Angelo was a warm handoff that occurred over six months, but the leadership development spans much further. Northwell is a case study in succession planning in health systems, in building and nurturing talent from the inside, and in the value of lengthy tenures within an organization and the institutional knowledge and shared values it can equip up-and-coming leaders with.

Dr. D’Angelo oversees 28 hospitals and more than 100,000 employees at the roughly $24 billion system, which is New York’s largest private employer and healthcare provider. Before taking the helm in October, he most recently served as Northwell’s executive vice president and president of the central market, which is its largest. The CEO role was his second job interview in 25 years, the other being for a job as an emergency medicine physician.

In the hundreds of conversations since he was selected as Mr. Dowling’s successor, Dr. D’Angelo said he was particularly struck by how much complexity remained invisible until he reached the CEO level.

“There’s still a lot of work to be done as we’ve grown so fast in how we leverage our size and scale,” he said April 14 at Becker’s Annual Meeting.

Leaders must ‘act like owners’

Dr. D’Angelo took the helm during a transformative period. He was selected April 15, 2025. Northwell finalized its largest merger yet on May 1, adding seven hospitals. The system is simultaneously executing what he called the largest Epic implementation in the software company’s history — 35,000 employees transitioning in November, 46,000 more going live May 30.

And then the retirements came. Within months of the CEO transition, Northwell’s COO, chief nursing officer, chief strategy officer, chief development officer and three other senior executives also retired. Dr. D’Angelo treated the moment as an opportunity to be deliberate — not just filling seats, but rethinking what roles and competencies Northwell actually needs going forward.

“Especially my top 75 executives — so all my clinical chairs, system executives, market presidents — they understand that the expectation of them is that they are what I would call ‘T-shaped leaders,’” Dr. D’Angelo said. “They’re responsible for their lane, but they’re equally responsible for, if not more responsible for, the global health system’s best interest.”

For a system operating on thin margins with finite resources, that collective discipline is not optional. Northwell posted a 1.1% operating margin for the first nine months of 2025. He tells his executives to push hard for their own area — they’re the experts, and he gives them room to set strategy in their lane — but to remember that on the provider side of healthcare, every decision is a trade-off.

“We don’t have unlimited resources,” Dr. D’Angelo said. “And I’m not just talking time, I mean dollars. It’s time and money, because it’s leadership and frontline attention that you dedicate toward things. You’ve got to be really intentional about what’s going to drive the greatest value to the top priorities of the organization.”

Alongside T-shaped thinking, Dr. D’Angelo looks for leaders who act like owners. He is not one for micromanagement, he confessed, and pushes responsibility and accountability out to the team around him in equal measure — trusting those leaders to do the same with their own teams.

“We have to be very comfortable with managing to milestones, being transparent and measuring our performance against our goals, short- and long-term,” he said. “That’s the level of sophistication I’m looking for in the leader and in the leadership team.”

Dr. D’Angelo shares with his predecessor a strong distaste for leaders who kick their heels up, relaxed with the status quo. Comfort navigating uncertainty is a non-negotiable for health system leaders today. “You can’t be a leader that tries to protect the status quo,” Dr. D’Angelo said. “You’ve got to be comfortable with evolution.”

He also looks for leaders who chase impact rather than titles — a mindset he says has shaped his own career. The best leaders, he said, lean in where they can contribute most, leverage what they’re genuinely good at and trust that recognition will follow. The orientation matters even more in healthcare, where Dr. D’Angelo believes the strongest leaders operate from a sense of purpose rather than compliance.

Balancing mission-driven services, financial sustainability

Northwell’s purpose-driven culture is a big reason Dr. D’Angelo has stayed for 25 years. It also shapes some of the system’s most significant financial decisions.

The system is the second-largest provider of behavioral health services in New York state, behind NYC Health + Hospitals. One of the system’s current capital projects is a new tower on Zucker Hillside, Northwell’s behavioral health campus.

“We know when that building goes up, we’re going to lose more money,” he said. “We really believe in a lot of things that are part of our mission — substance use disorder, mental health — but it’s part of who we are and it’s why many of us have been here so long because we truly believe in the purpose of the organization.”

The math is stark: the system brings in $24 billion and spends $24 billion, operating at a half a percent margin. A more comfortable margin is theoretically within reach, but not without trade-offs Dr. D’Angelo isn’t willing to make.

“We could have a 3% or 4% margin if we abandoned our mission,” he said. “But that’s not who we are, and our board knows that.”

Beyond behavioral health, Northwell leans into other mission-driven work that doesn’t generate revenue — including the gun violence CEO consortium Mr. Dowling founded, which now includes more than 70 health system leaders addressing gun violence as a public health issue.

Evolution, leveraging technology

The forces converging on health systems right now — an aging population driving up demand, workforce shortages, rising costs and pressure on affordability — amount to what Dr. D’Angelo called a “perfect storm.” His answer is not to wait for the environment to stabilize. It is to rethink how care is delivered in the first place.

“The way forward is a number of things, but one of them is really getting out of our own way and really thinking about how we deliver care, how we think about care models, future job roles that we may need that we don’t have today, and how we empower a workforce with technology.”

Technology, in his view, is not a solution unto itself — it is a tool, and one that has to be deployed strategically. He cautioned against chasing volume.

“You can’t run a big organization with 5, 6, 7, 8,000 different products and so much overlap,” he said. “You’ve got to be really conscious of making sure you’re building the right portfolio.”

The deeper shift, though, is cultural. Health systems have long measured themselves by clinical outcomes — and by that measure, Northwell performs well. But Dr. D’Angelo argued that standard only captures part of the patient experience, and increasingly, not the part patients are most frustrated by.

“For the most part, we do an exceptional job when they are a patient — when they’re in the stretcher or on the bed,” he said. “We have to be transparent: We do a terrible job when they’re a customer — when they need access, when they need to be navigated, when they leave a hospital and they’re told, ‘It’s really important to see a doctor in the next two weeks,’ then they’re trying to call and the next appointment is in six months.”

Northwell’s response has been to get “customer obsessed” — a phrase Dr. D’Angelo used deliberately. The system currently operates more than 60 call centers, a fragmentation he called unacceptable. To think through how to fix it, he has looked outside healthcare, including a conversation with the CEO of LVMH, which includes Louis Vuitton, about maintaining consistent customer experience across locations with high frontline turnover. The answer, he was told, comes down to the store manager — a lesson he is now applying to Northwell’s office managers and frontline leaders.

The goal is not just competitive positioning. It is trust — and the health partnership that becomes possible when patients trust their system across their entire care journey, not just during an acute episode.

“If we get that right and the experience is highly reliable, people will trust us. And if they trust us, we can be a better partner in their health journey.”

For Dr. D’Angelo, that aspiration connects directly to how he has approached every role he has held at Northwell — and how he thinks about leadership more broadly.

“It shouldn’t be about a title or a role,” he said. “It should be, ‘how do you make the most impact in your organization and to your patients?’ … If you lead others in healthcare through a lens of purpose and commitment, not compliance, you’ll go far.”

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