'The idea of the stand-alone hospital is gone'.

Northwell Health, formerly known as North Shore-Long Island Jewish Health System, continues to pursue aggressive expansion moves throughout the New York City metropolitan area. CEO Michael Dowling is also stepping up the New Hyde Park, N.Y.-based system's investment in startup firms and innovative technologies that are launched in-house. Dave Barkholz, Modern Healthcare's Southern Bureau chief, caught up with Dowling at last month's J.P. Morgan Healthcare Conference in San Francisco. The following is an edited transcript.

Hospital mega-mergers hit fast and furious in 1Q.

The need for scale and space is accelerating tie-ups between hospital giants.

Trends in hospital network participation and system affiliation, 2007-2012.

Key Findings. (1) Hospital network participation from 2007 to 2012 increased in larger hospitals (more than 150 beds), non-government not-for-profit hospitals, and metropolitan hospitals. Network participation changed inconsistently in other types of hospitals. (2) Hospital system affiliation has generally increased in hospitals of all sizes, non-government not-for-profit hospitals, hospitals in all census regions, CAHs, and both metropolitan and nonmetropolitan hospitals. There are notably higher percentages of system affiliation among midsized and large hospitals, investor-owned hospitals, and metropolitan hospitals compared to their counterparts.

Success factors for strategic change initiatives: a qualitative study of healthcare administrators' perspectives.

Success factors related to the implementation of change initiatives are well documented and discussed in the management literature, but they are seldom studied in healthcare organizations engaged in multiple strategic change initiatives. The purpose of this study was to identify key success factors related to implementation of change initiatives based on rich qualitative data gathered from health leader interviews at two large health systems implementing multiple change initiatives. In-depth personal interviews with 61 healthcare leaders in the two large systems were conducted and inductive qualitative analysis was employed to identify success factors associated with 13 change initiatives. Results from this analysis were compared to success factors identified in the literature, and generalizations were drawn that add significantly to the management literature, especially to that in the healthcare sector. Ten specific success factors were identified for the implementation of change initiatives. The top three success factors were (1) culture and values, (2) business processes, and (3) people and engagement. Two of the identified success factors are unique to the healthcare sector and not found in the literature on change models: service quality and client satisfaction (ranked fourth of 10) and access to information (ranked ninth). Results demonstrate the importance of human resource functions, alignment of culture and values with change, and business processes that facilitate effective communication and access to information to achieve many change initiatives. The responses also suggest opportunities for leaders of healthcare organizations to more formally recognize the degree to which various change initiatives are dependent on one another.

Engineering a fail-safe health system. Memorial Hermann wants to eliminate health care errors (really).

Memorial Hermann Healthcare System is on an all-out mission to eliminate health care-acquired infections. Despite a bit of physician resistance, the results so far are astonishing.

Use of electronic health records in residential care communities.

KEY FINDINGS: In 2010, only 17% of residential care communities in the United States used electronic health records. Residential care communities that used electronic health records were more likely to be larger, not-for-profit, chain-affiliated, colocated with another care setting, and in a nonmetropolitan statistical area. The types of information most commonly tracked electronically by residential care communities that used electronic health records were medical provider information, resident demographics, individual service plans, and lists of residents' medications and active medication allergies. Four in 10 residential care communities that used electronic health records also had support for electronic exchange of health information with service providers; nearly 25% could exchange with pharmacies, and 17% could exchange with physicians.

Competing for consumers. Coming coordinated-care squeeze prompts providers to push into insurance market.

Squeezed by coordinated-care initiatives, a number of hospital systems are looking to help fill beds and reap more revenue by offering insurance plans on the state exchanges set to launch this fall. Some will use narrow networks, a strategy that allows systems to create a captive customer base. "I think it's going to be a huge growth area in the exchanges," says Jonathan Gruber, left, a professor of economics at MIT.