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Stepping Aside
By advocating civility and transparency, Beryl Rosenstein changed the Hopkins culture.

blank In the last couple months of his vice presidency, more than 300 nurses sent Rosenstein letters and e-mails of thanks for his efforts on the job.
In the last couple months of his vice presidency, more than 300 nurses sent Rosenstein letters and e-mails of thanks for his efforts on the job.

Looking back on his 15-year tenure as vice president of medical affairs, which ended on June 30, Beryl Rosenstein takes pride in many of his accomplishments—shaping the hospital’s patient safety program, working to improve medication safety, and helping Hopkins to be compliant with myriad regulations without sacrificing excellence.

But his most significant contributions may be defined in less concrete terms. Hospital leaders and colleagues say he has been a force for culture change by improving civility and communication among disciplines and encouraging a work environment that is more transparent about its shortcomings.

“He has a great sense of team,” says Karen Haller, the hospital’s vice president for nursing and patient care services. “He understands it’s not just the physicians who help the patient get better.”

When Rosenstein formed the hospital’s patient safety committee, for instance, he made sure that many disciplines, and even a patient representative, were included among the members.

Instead of having discipline-specific policies—as in the past—he worked with Haller and other leaders to have clinical policies housed in one manual. Committees that review policies bound for the Medical Board now include more than 100 nurses.

It’s perhaps because of his support for all disciplines that, in the last couple months of his vice presidency, more than 300 nurses sent him letters and e-mails of thanks for his efforts on the job.

Rosenstein has been an outspoken advocate of the need for caregivers to feel safe challenging each other in a nonthreatening environment. He was a driving force behind the hospital’s code of conduct, approved in late 2006, which set forth guidelines for resolving conflicts in a collegial and constructive manner. A related policy, approved in 2008, formalized the steps for taking unresolved concerns about patient care up the chain of command.

Rosenstein first arrived at Hopkins in 1961 as an intern in pediatrics, making 40 cents an hour. Except for two years in the mid-1960s, when he worked with the United States Public Health Service, he has been part of Hopkins ever since.

He remembers being in awe of the institution from the beginning. (Most of his medical school textbooks at Tufts University were written by Hopkins luminaries.)

But like the rest of the health care field, there was little talk about medical errors. That changed significantly after the 1999 report from the Institute of Medicine, “To Err is Human,” and a couple of high-profile patient deaths at Hopkins. Those events sparked the creation of the hospital’s patient safety program and Rosenstein’s appointment as the hospital’s patient safety officer.

“In the past, when there were medical errors, they may have been presented at a morbidity and mortality conference for the department, but they certainly weren’t discussed beyond the department or beyond the people involved in the event,” Rosenstein says. “But now it’s very different. There’s broad discussion of sentinel events. They’re discussed with the trustees, it’s written up in the On Guard newsletter.”

Colleagues praise his demeanor in handling adverse events without a “blame and shame” approach.

“He has improved patient safety by saying that we need to honestly look at what we can do better, without making people feel like they’re in trouble,” says Caryl Siems, who sits on the patient safety committee as a representative of patients and families.

The end of Rosenstein’s term in Medical Affairs doesn’t mean he’s retiring soon. He will spend more time in the cystic fibrosis clinic, where he long ago established himself as a leader in the fight against the disease. As the clinic’s director from 1971 to 2002, he began treating these patients when the average life expectancy was about eight years. Today it’s pushing 40.

He also will take on a slew of other duties, including co-chairing an institutional review board, serving on the Professional Assistance Committee and looking at insurance company denials and appeals.


–Jamie Manfuso



Johns Hopkins Medicine

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