Nicholas Sgaglione, MD, has spent his career watching orthopedics evolve through one upheaval after another — from the rise of bundled payments to the shift to outpatient surgery.
But if there’s one thing he’s learned, it’s that progress only sticks when people believe in it.
“You can’t get through challenges by complaining,” said Dr. Sgaglione, chair of orthopaedic surgery at New Hyde Park, N.Y.-based Northwell Health. “You have to stay optimistic and look for opportunity in the face of challenge.”
That philosophy guides New York state’s largest nonprofit health system as it balances scale with humanity. Northwell employs more than 100,000 team members. Growth, Dr. Sgaglione said, means little without connection.
“We’re growth-oriented, but equally people-oriented,” he said. “Our job as leaders is to create an environment where people feel supported, valued and heard.”
That mindset has shaped how Northwell responds to rising patient demand and workforce strain. Orthopedic visits and procedures continue to climb as patients live longer and stay more active, so the system has expanded its use of nurse practitioners, physician assistants, athletic trainers and scribes — what Dr. Sgaglione calls “healthcare extenders.”
“The team-based model lets physicians focus on what they do best,” he said. “And it gives patients a better experience — they’re engaged from the moment they walk in, not left sitting and waiting.”
Financial pressures have pushed hospitals to rethink how they deliver care. For Northwell, that shift began nearly a decade ago with a commitment to bundled payments.
“When we started with bundles, it was a complete paradigm shift,” he said. “We learned how to operationalize value — not just talk about it.”
The change forced a new approach: fewer rehab stays, more home recovery and closer monitoring of costs and outcomes. The process, he said, taught the system what value-based care really means.
Today, Northwell relies heavily on data to maintain quality and efficiency across its orthopedic network. Metrics on readmissions, implant costs and patient outcomes are reviewed continuously.
“Surgeons need to understand what care actually costs,” Dr. Sgaglione said. “If they’re not aware, they can’t be part of the solution.”
Technology is also playing a growing role. Northwell is testing AI tools that can predict complications, streamline pre-authorizations and identify risk factors before surgery.
“AI isn’t going to replace us,” he said. “It’s a tool that helps us be safer, smarter and more proactive — especially as so much of orthopedics moves to the outpatient setting.”
That shift, he added, creates new responsibilities.
“In the hospital, you can catch problems quickly. When patients go home the same day, we have to build systems to monitor them just as closely.”
As technology is advancing, Dr. Sgaglione is equally focused on maintaining trust — both inside and outside the health system. Social media, misinformation and political polarization, he said, have complicated how patients perceive healthcare.
“Our obligation is to stay evidence-based and science-driven,” he said. “We can’t lose sight of that, no matter what’s happening around us.”
He sees similar caution ahead for regenerative medicine and biologics — fields full of promise but still in need of rigorous study.
“There’s a lot of innovation going on, and it’s exciting,” he said. “But we have an obligation to pursue it scientifically — to make sure the evidence supports it.”
After nearly two decades leading one of the country’s largest orthopedic programs, Dr. Sgaglione said he’s still optimistic about what’s ahead — and what leadership really means.
“When challenges arise, we can either dwell on them or learn from them,” he said. “The opportunity is always there — we just have to look for it.”
