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Volume 60
Number 8
October 2009



Depth of Field
A new way of looking at academic medicine is changing the culture at Johns Hopkins Bayview.

blank Depth of Field
David Hellman literally demonstrates his pyramid theory.

Talk about bringing a new dimension to one’s work. David Hellmann is attempting to turn Hopkins’ symbolic academic triangle into a 3-D pyramid, all in the name of better patient care.

The notion of the clinician-educator-researcher rightfully built Hopkins’ reputation in the 20th century, says Hellmann, the vice dean of Johns Hopkins Bayview Medical Center and chair of its Department of Medicine. But 21st-century medicine requires greater depth and commitment to patients.

"The triangle was created at a time when the country was focused on acute care and infectious disease, when people lived an average of 35 years," says Hellmann. Things have changed radically since then. "We have a rapidly aging population, a silver tsunami of people with chronic disease. So I wondered, could we make the triangle stronger?’’

In Hellmann’s new world geometry, the pyramid is a more substantial metaphor. "In a pyramid no wall stands on its own; it’s fortified and buttressed by the other sides. It means we have to make a science of collaboration, to promote where the fields interface, whether it’s doctor-nurse, clinician-scientist, neurologist-rheumatologist."

The apex of Hellmann’s pyramid, the point to which all disciplines ascend, is the patient and his family, friends and community. The base is the recognition that everyone at Hopkins plays a role in fostering health. "The pyramid’s foundation is really a change of culture," says Hellmann.

The centerpiece of Hellmann’s pyramid-centric creation is the Center for Innovative Medicine, several initiatives that have galvanized staff to better address patient needs. A grant funded by philanthropist Aliki Perroti allows medical students to spend more time with patients in the clinic, their homes and communities, giving aspiring clinicians the opportunity to get a feel for the patient’s perspective.

In another example, the ED was completely revamped by Eric Howell, deputy director of inpatient services, to greatly increase patient flow. Red alert hours—the number of hours the hospital tells ambulance services the ED is full and they must divert drivers to other hospitals—dropped from 40 per week to just one and reduced ED wait times for patients by an hour and a half.

Hellmann notes that these efforts have two commonalities. They improve patient care and drive the long-term financial and public support necessary to move the pyramid from an experimental, philanthropy-dependent concept to a financially sustainable and replicable model ready to go big time.

"Look at Flexner," says Hellmann of the 1910 Carnegie Foundation-funded report that made Hopkins’ triangle the model for academic medical centers. "If research shows the pyramid makes a difference in patient care and actually reduces readmission rates, it’s possible you could ask Medicare and other funders of graduate medical education to fund this."

– Mat Edelson



Johns Hopkins Medicine

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