What a Difference a Decade Makes

Take a stroll anywhere on the East Baltimore campus and the last thought likely to cross your mind is fear of being mugged. Day or night, physicians and staff keep their appointed rounds without once looking over their shoulders. It wasn’t always so.

Like many of the nation’s top medical centers (think Yale and Penn), Johns Hopkins is located in the inner city. With that location comes an excitingly diverse patient population and also a few challenges that invariably weave themselves into the fabric of urban life.
In 1994, when Joe Coppola signed on as chief security guru for Johns Hopkins Medicine, he inherited a set-up he calls a mish-mash, technology that amounted to little more than “two cans and a string,” and a record of on-campus crime that included more than 700 thefts and 20 robberies the previous year alone. About the only thing that didn’t surprise the 24-year Secret Service veteran was that prospective employees and medical residents were thinking twice before agreeing to spend most of their waking hours here.

But from his rented desk and chair, Coppola hired four directors (one each for University and Hospital buildings, one for external security and one for support services) and recruited protective service officers willing to undergo his spit-and-polish training program that combines psychological testing, customer service and defense tactics.

Today, on an annual budget that’s hardly had to budge from the $10 million he started with, Coppola oversees a 24/7 operation that employs 534 full-time officers who protect the entire Health System. Directors enjoy a hawk’s view of the campus courtesy of 144 computer-linked cameras. And since 9/11, four officers trained as a special response unit are the designated first responders in the event of a biological or chemical incident.

Coppola’s measures—now emulated by other urban academic medical centers— have paid off. Violent crime incidents now total zero, and campus thefts have plummeted. Furthermore, during interviews held in preparation for the site visit of the Accreditation Council on Graduate Medical Education, staff all described security as spectacular.

But Coppola is also adamant about investing in the community: Woven into his grand security tapestry are a crime-stoppers tip hotline for neighborhood residents, funding for a clergy-run crime prevention group, and daily communication with city, state and federal law enforcement agencies. “If there’s one message Johns Hopkins must send,” he says, “it’s that we’re not here to build a moat.”

Lindsay Roylance


Something the Lord Made airs nationally May 30 at 8 p.m. on HBO.

All in the Family

> Charles Flexner with a recent book about his often-cited relative.

Maybe there's a gene for shaking up medical education that's only expressed every hundred years or so. In 1910, it was educator Abraham Flexner who turned American medical training on its ear with his famous report decrying most schools of that era as deplorable while at the same time extolling Hopkins—with its tough entrance requirements, rigorous curriculum, and emphasis on both lab research and clinical education—as the ideal. Now, the torch has passed to Charles Flexner, Abraham's great-great nephew, who's heading a task force charged with rethinking what Hopkins' 800 residents and 1,200 fellows should get out of the years they spend here.

“This is an opportunity to again lead the way in producing innovative approaches to education and training that will set examples for other institutions around the country and around the world,” says Flexner, 47, an associate professor of medicine and pharmacology and molecular sciences. “It's an attitude that I think defines Hopkins, defines who we are.”

But why mess with success?

According to Flexner—the 2000 winner of the Professors' Award for Excellence in Teaching, which annually honors faculty members judged to have a profound effect on School of Medicine students—the reasons lie in how medical practice itself has changed. Imaging technology, for example, may have made it possible to bring any part of the body into extraordinary focus, but interpreting all that information is daunting. Stringent regulations mean physicians today spend hours documenting every detail of treatment and complying with new privacy rules. Even more important, last year's strict new limits on residents' workweeks are pushing once-effective teaching methods into obsolescence.

To get its hands around these and other challenges, Flexner's 18-member Task Force on Competencies and Curricula started work in September focused on the “core competencies” set by the Accreditation Council on Graduate Medical Education—medical knowledge, patient care, communication skills, professionalism, practice-based learning, and the health care system in general. The group will assess clinical training at Hopkins and recommend ways to improve, bearing in mind, says Flexner, two questions: “What should the physician of the 21st century and beyond look like? And what's the best way to produce the model physician?”

But, noting that his great-great uncle raised more than $500 million to carry out the reforms he advocated (and that was a century ago), Flexner is convinced that inventing better mousetraps will be the easy part. “Abraham's real contribution to medical education—and he stated this repeatedly—wasn't so much writing the report,” his descendant makes clear, “but going out and identifying the sources of funding to implement it.”

A Glorious Decade Of Growing Green Spring

> The dome away from home.

Ever since it opened 10 years ago, Johns Hopkins at Green Spring Station has been on a roll. What started as a relatively small enterprise, with several dozen physicians based in one pavilion, rapidly attracted more practices and support services. Today, an entire second pavilion later, the organization’s first outpatient center in Baltimore County’s upscale suburbs has more than 235 part-time and full-time faculty physicians who treat some 300,000 patients each year. That translates into no less than $100 million worth of business for Johns Hopkins Medicine.

The next move, not surprisingly, is to expand. But for five years, Hopkins, the community and at least three developers have been locked in a legal battle, vying for the rights to further develop Green Spring. “We were already concerned about this complex 40 years ago, when Green Spring was still a place for pony rides and ice cream,” says Jack Dillon, executive director of the Valleys Planning Council, an influential land preservation group in the area. “Green Spring is at the edge of an urban/rural area. Traffic is heavy, and overdeveloping could bring in additional congestion.” Still, he adds, “if they come up with a plan that is architecturally pleasing, the community would rather have Hopkins there than anyone else.”

What Hopkins wants is to build a three-story, 50,000-square-foot edifice surrounded by surface parking where a racquet club now stands. It would house a multispecialty surgery center, a state-of-the-art imaging suite and physician offices. A fitness center and several shops would serve not only patients but also the community at large.

What’s certain is that no one will have to bend over backwards to attract doctors to Green Spring. “This is a wonderful setting for practicing medicine,” says Paul Auwaerter, an internist on the full-time faculty who leads a practice of six physicians. “We have more control in our little office than we would downtown, and we’ve had no employee turnover.”

Anne Bennett Swingle

Info for Life

At any one time, some 250 clinical trials are operating within the Sidney Kimmel Comprehensive Cancer Center. But until this year, if you’d asked anyone how to find all the Hopkins studies on, say, pancreatic cancer, you’d probably get little more than a blank stare because no one had ever pulled the information together.

Now, thanks to an easy-to-navigate online database, anyone can home in on specific cancer trials being conducted throughout Hopkins, searching by cancer type, keyword or protocol number and turning up an overview of each study’s eligibility criteria and other details. Furthermore, a cancer information specialist is available to answer patients’ questions and help them find the right study. To check out the database, go to www.hopkinskimmelcancercenter and click on “Clinical Trials.”

Patrick Gilbert

Oh Happy Day

For the 14th straight year, The Johns Hopkins Hospital not only leads U.S. News & World Report’s annual honor roll of American hospitals, it’s in the top 10 in 16 of the 17 specialty categories listed, ranking #1 in gynecology, otolaryngology and urology; #2 in geriatrics, kidney disease, neurology/neurosurgery, ophthalmology and rheumatology; #3 in cancer, digestive disorders, hormonal disorders, pediatrics, psychiatry and respiratory disorders; #4 in heart/heart surgery and orthopedics; and #13 in rehabilitation.

Hopkins’ research prowess also took center stage when it again headed the list of 121 medical schools in National Institutes of Health funding. The School of Medicine received 967 awards totaling more than $414 million. Washington University in St. Louis was second with 775 awards worth more than $368 million.

Mary Ann Ayd

Against the Wall

Over the past 10 years, half of the M.D.’s and Ph.D.’s Hopkins has handed out have gone to women. Women also make up 40 percent of assistant professors. Inevitably, however, the number advancing further in rank drops off dramatically. Why are these young faculty leaving?

“Our institution is known for getting the brightest young faculty,” says Dean/CEO Ed Miller, “but we haven’t always done a great job finding out why they often don’t make it past the assistant professor level.”

An employee satisfaction survey, rolled out by the institution three years ago, never jelled with the faculty, who felt the questions lacked relevance to their problems or contentment. So this year, the Committee on Faculty Development and Gender conducted a faculty survey to find the underlying causes that impede the progress of women and minorities. It grew out of a request to re-examine the status of women faculty that periodically goes out from the University provost’s office to each of the schools. But Miller’s administration decided to take a broader view by placing women’s issues in an all-embracing category of faculty development. “We’re going to compare responses by gender,” says biophysicist Cynthia Wolberger, committee co-chair along with Neurology Director Jack Griffin, “and then get an overall snapshot of faculty development issues relevant to both men and women. We know there’s a leaky pipeline, and now we have to find out how to repair it.”

In preparing the survey, the committee focused on such factors as career satisfaction, advancement opportunities, mentoring, empowerment, resources, quality of life and retention. Results, due this fall, are being reported in the aggregate to protect individual respondents’ identities.

Patrick Gilbert

On Films and Food

> Resident Michael Awad, no longer hunting images

One of the trickle-down effects of the 80-hour workweek for residents is that their concerns have grabbed the attention of Hopkins administrators like never before. No longer is compressed time for education taken up with, say, tracking down X-rays. Even complaints about the scarcity of after-hours meals are being taken seriously.

“It’s not as though nothing ever had been done before,” says Julia McMillan, associate dean for graduate medical education and a professor of pediatrics. “There was certainly a mechanism for individual program directors to hear their own residents’ concerns, but it was catch as catch can. Now, we not only have a better system for detecting problems, but a receptive ear on the part of Hospital administration.”

According to Michael Awad, House Staff Council president, the Hospital’s radiology system topped the residents’ complaint list. “It’s not unheard of for several hours a day to be spent [by residents] tracking down films,” says the surgery resident. “It’s the bane of the existence of many house staff and it’s a big time drain.” Trying to locate a film—in radiology, a private office, the clinic, the OR—is just one issue. “Another problem,” says Awad, “is that if a single person has a film, no one else can look at it.”

The Hospital has adopted numerous fixes, but the revolutionary change arrived with a system called PACs, in which film images are digitized and can be retrieved on a computer anywhere in the Hospital. It’s now running in such areas as ultrasound, MRI, CT, the emergency departments and intensive care units, and will be available next year in the ORs and interventional radiology.

Even the residents’ concerns about food service are getting attention: EspressOasis, near the cafeteria, now is open 24/7, and if that doesn’t suit, the Hospital has three alternative plans waiting in the wings.

“The house staff not knowing who to go to or how to have their concerns addressed was part of the problem,” says McMillan. “One of the very good things that’s happened because of all this is better dialogue.”

Mary Ellen Miller

In Search of . . .

When Frank Frassica agreed to head the search for a new director of physical medicine and rehabilitation, he went about the usual business of picking committee members and looking for a consultant to advise them. Then he got a call from Vice Dean for Faculty Janice Clements.

“She pointed out that my committee lacked diversity,” recalls the director of orthopedic surgery. “I’d chosen all white males. I didn’t do that intentionally, it was just that I’d looked to people who were in my comfort zone. Then it hit me: Hopkins Medicine has made diversity a priority, but if we start with a committee and consultant who aren’t diverse, how do we expect the outcome to match that expectation?”

Department directors traditionally have been selected based on their research, but that thinking has shifted, fueled in part by such issues as promotion criteria, improving mentorship, and challenges faced by women and minority faculty. So late last year, Dean/CEO Ed Miller asked his deans to come up with ways to improve the search process. Among the recommended changes:

• Include more women, minorities and junior faculty on the search committees, which have been composed of only department chairs and senior professors.
• Use the executive search firm Witt-Kieffer, which has built a reputation in academia for identifying and placing female and minority candidates. Search committees will still use consultants to evaluate the future of the field and analyze a department’s needs, but, says Clements, “to get real change, we need an open search.”

Frassica says adding diversity to all elements of the search process doesn’t mean a white male will never be chosen, and Miller cautions that changing the makeup of department directors won’t happen overnight. “But these changes,” he says, “are a great first step.”

Patrick Gilbert

Power Of One

undergoing cystoscopic examinations were identified instead as allergic reactions to the disinfectant used to clean the scopes. Diane Iverson began worrying when several of her patients experienced such symptoms as shortness of breath, hives and plummeting blood pressure. With the help of another nurse, she systematically narrowed the culprit to the cleaning solution, and in April after reviewing similar complaints from elsewhere, Johnson & Johnson issued a warning for its disinfectant. “Diane took this problem personally,” says Walsh, “and she was not going to let it go away.”

Lindsay Roylance

Face Time with Robert Arceci, director of pediatric oncology

Q. You can’t pick up a newspaper without reading about medical mistakes, and Johns Hopkins hasn’t been immune.
A. Believe me, I wake up at night thinking of ways to make things safer.

Q. What are you doing to ramp up safety in pediatric oncology?
A. One of our best moves is a computerized chemotherapy system to use in giving these drugs to children with cancer that anticipates errors and rechecks every calculation—there’s only one other like it in the country. Chemotherapy orders can only be written through this system. And the system, not people, computes the drug doses and then double-checks them against the patient’s height and weight. Also, two pharmacists, two nurses and two physicians must agree, independently, on every order.

Q. Since a computer is only as good as the data in it, how do you know the system is working with accurate information?
A. We’ve been building our medical records team, including hiring new staff, to make sure that every bit of data gets into the records. If we have a patient in a clinical trial, for example, and there’s a new finding, it goes right into the system. That way, clinicians have all the information they need to make treatment decisions.

Q. What if someone still thinks something isn’t right?
A. Anyone anywhere along the way can stop the train. If a patient, parent, secretary, physician has a question or concern, everything stops until it’s reconciled. If a secretary is entering a doctor’s note and it doesn’t make sense or records are missing, that person can stop the process until the issue is resolved. The climate of not questioning the doctor is gone.