NYU Langone Hospital-Brooklyn boasts one of the lowest mortality rates across both the borough and nationwide. But that wasn’t always the case.
When New York City-based NYU Langone Health acquired what was then known as Lutheran Medical Center in 2016, its leaders inherited a fragmented operation: outsourced physicians, a patchwork of incompatible health records systems and almost no reliable data from which to gauge quality metrics. Ten years later, the hospital has reduced mortality by 33%, grown surgical volume by more than 20%, and is the only hospital in Brooklyn to earn a five-star quality rating from CMS.
Becker’s recently spoke with Bret Rudy, MD, executive vice president and chief of hospital operations at the 450-bed hospital, to detail the tangible operational moves behind the transformation.
Bring physicians in-house and unify data
After the acquisition, one of NYU Langone’s first priorities was to bring physicians in-house. At the time, physicians in many departments — including the emergency department, ICU and radiology — were staffed through outsourcing arrangements with for-profit companies, creating misalignment with the organization’s quality and efficiency goals, Dr. Rudy said.
As such, leaders shifted to a fully employed model, which he said helped ensure those providing care to patients were genuinely invested in the outcomes.
Running parallel to that was an equally pressing problem: the hospital had almost no usable data. Within the hospital alone, three separate EHRs were in use. Meanwhile, programs the hospital ran in family health centers, school-based clinics and homeless shelters were on different systems or still on paper. This left leaders with no reliable way to track key metrics such as length of stay or mortality by department, which made it nearly impossible to identify where quality gaps existed, Dr. Rudy said.
Shortly after the merger, NYU Langone moved its entire network onto Epic.
“All of a sudden, we had data we could look at and actually then pinpoint where our problems were and start to address them directly,” Dr. Rudy said.
Aligning leadership from the top down
Driving quality improvement at scale required getting the right people in the right seats, starting at the top, Dr. Rudy said. One of the less popular moves leaders made after the acquisition was condensing the hospital’s executive leadership team. At the time, Dr. Rudy said the leadership structure included an overabundance of vice presidents, senior vice presidents and senior directors, making it difficult to pinpoint who was responsible for what. Today, the executive leadership team at the hospital is roughly 30% the size it was when NYU Langone arrived.
“It was important to streamline those functions, make sure people are working to their maximum ability and invest in your frontline staff,” Dr. Rudy said.
Doing so allowed the hospital to pour more resources into frontline staff and patient care, he said. For example, in the early days of the merger, nurses were routinely caring for as many as seven or eight patients at a time. That ratio was brought down to 1-to-5.
Physician leadership underwent its own reset. To build alignment and eliminate silos, NYU Langone merged departments across campuses, with each department led by a systemwide chair and a dedicated chief at the Brooklyn facility. Dr. Rudy said having experts from both the Brooklyn campus and NYU Langone’s flagship Manhattan campus at the table when new clinical protocols were being developed was critical for generating physician buy-in and a shared sense of ownership over outcomes.
Aligning physicians under a single model and giving leaders real-time visibility into performance laid the groundwork for measurable gains in quality, including the mortality reduction, according to Dr. Rudy.
Building a destination hospital, not a referral source
From the start, NYU Langone approached the Brooklyn hospital not as a community hospital, but as a full extension of its flagship academic medical center, with the expectation that what was offered in Manhattan, over time, would also be available in Brooklyn. That mindset drove a deliberate, yearslong effort to add complex service lines rather than pull them out of the community.
Most recently, NYU Langone Hospital-Brooklyn launched a cardiac surgery program.
“If you asked me three years ago, would we have cardiac surgery, I would have said no,” Dr. Rudy said. The decision to invest in all of the resources and infrastructure needed to perform cardiac surgeries was driven primarily by community need, he said. Many patients in the area requiring heart surgery were being transferred to Manhattan for care.
“Being able to offer these services in the community where patients live has been incredibly successful,” he said. “When you bring more complex patients in, that provides an important service, but it also provides a larger base for your revenue.”
Driving OR efficiency and volume growth
Growing surgical volume required more than simply adding cases. In the early days after the merger, the hospital’s operating rooms ran on eight-hour shifts, which allowed for staffing flexibility but created inconsistency as case complexity grew, Dr. Rudy said. In practice, eight-hour shifts meant a surgeon could find an entirely new team stepping in mid-procedure at a critical moment. Instead, the hospital shifted to 12-hour shifts, which enabled longer OR availability and allowed specialized, consistent care teams to form around specific surgical departments.
From there, leaders turned their attention to tightening turnover time and maximizing utilization. A key part of that effort was ensuring stakeholders across the organization were collaborating closely, including supply chain, building services and sterilization teams. Together, those changes helped bring turnover time down to roughly 30 minutes, with OR utilization now exceeding 90%.
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