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Illustration by Jack Hornady.

Anatomy of a Complaint

Marva, can you come up here? Right now?” By the Thursday noon a couple of months ago when that plea came in to Marva Johnson’s Hospital office from a nurse on a patient unit in Nelson Tower, Johnson had been on the job long enough to know that she should expect just about anything when the phone rings in the Office of Patient Relations.

Working out of a room on the ground floor of the Hospital, Johnson is one of three representatives who act as problem-solvers when patients or their family members issue complaints. On any given day, she can find herself settling hassles over anything from scheduling annoyances to billing problems to peeves about food service. She even spent a couple of hours recently arranging for a portable oxygen tank to be waiting for a patient’s wife who had breathing problems. “We’ll do whatever it takes to make a visitor happy,” Johnson says.

That’s why minutes after taking this call, she was on the unit, listening to a woman rage about a battle she had just had with a bill collector for the television service in her husband’s room. Why, the woman wanted to know, hadn’t her husband been credited for “free days”—the vendor offers a day of TV with no charge for every five days a patient signs up for the service. And why had he been billed for days spent not in his room, but in postsurgical intermediate care?

Now, on the scale of things that go on in a hospital, a dust-up over a TV bill may sound like small potatoes, but for the Office of Patient Relations, it represented just one more case of someone whose feathers the Hospital had unwittingly ruffled. Since last year, when Patient Relations became the focus of a “service excellence” initiative aiming to improve how Hopkins handles complaints, it’s reduced the time it takes to close the file on such disputes from 70 days to 14. “What we’ve done,” says Martha Afetse, director, “is put in a more intelligent process.” In 1997, Patient Relations fielded more than 1,000 complaints and accepted some 300 compliments.

Johnson’s perseverance in settling the TV-bill fracas demonstrates Patient Relations’ dogged determination in soothing the ire of a guest. Here’s what the log shows:

· Thursday (1:30 p.m.). Accompanied by Afetse, Johnson returns to the patient’s room to get more details and promises to help. As a matter of policy, Patient Relations now acknowledges all patient complaints within one business day and follows up in writing at intervals of 14, 30 and 45 days for unresolved complaints.

· Tuesday. Johnson calls TV Services to hear its version of the incident. To avoid further encounters between the arguing parties, Johnson herself agrees to collect future TV bills, forward payments to TV Services and issue receipts to the patient and his wife.

· Wednesday. The patient is discharged, and a $20 balance remains outstanding. For the next few days, Johnson and the patient’s wife trade phone messages.

· Friday. Johnson finally reaches the patient’s wife, who remains convinced that free days haven’t been properly credited to her account.

· Ten days later. Johnson asks TV Services to review the patient’s billing records for his month-long stay. She is told that poring through receipt books will be too time-consuming, and the $20 will be waived. The patient is ecstatic; so is his wife. Case closed.

-- Jim Duffy

Boom Time at BME

Biomedical engineering at the University is on a roll. After two and a half years of meticulous planning, networking and winning over science-savvy donors, this fall the department firmed up plans to create a biomedical engineering institute, funded in large part by a $17 million grant from the Virginia-based Whitaker Foundation.

One of only a handful of such endeavors in the nation, the institute will bridge scientists from the School of Medicine and the Whiting School of Engineering and tackle topics the National Institutes of Health has identified as “high-priority areas for the 21st century,” says director Murray Sachs, Ph.D., who re-cently won the esteemed Von Bekesy Medal from the Acoustical Society of America. Projects will include building computer models of human organs, starting from genes; exploring interactions between cells and other matter to help in the creation of artificial organs; and improving imaging systems in order to gather information about internal organs without invasive procedures.

The institute’s landmark will be a new 60,000-square-foot building on the Homewood campus, funded by Whitaker and a $10 million donation from University trustee A. James Clark. Slated to open in the fall of 2000, the three-story facility will house 13 faculty laboratories, four undergraduate teaching labs and space for visiting scientists. But for the most part, the 18 (out of 35) biomedical engineering faculty with labs on the medical campus in East Baltimore will stay put, visiting the new facility only for meetings and such.

Besides strengthening the University, the institute promises to offer a boon for the state’s economy. Sachs says its research should lead to spinoff companies and collaborations with industry and draw more biotechnology to the area.

-- JD

Jet-Setting to Singapore

Steve Thompson

Two short years ago, Steve Thompson couldn’t find Singapore on a map. Today, the Johns Hopkins Medicine vice dean of administration is such an old hand at hopping across the Pacific to the island nation that he reserves a favorite seat, 15H (upper deck, on the aisle, at an emergency exit), for flights over. “You get a little extra room to spread out there,” explains Thompson, noting that such seemingly trivial bonuses can prove amazing luxuries on flights that cross 13 time zones and last 26 hours.

Since early last year, when “CEO of Johns Hopkins Singapore” became the second part of Thompson’s title, he’s put in a week a month in Southeast Asia overseeing the startup of a Hopkins research/clinical/educational facility in ultramodern Singapore and issuing a steady stream of updates that included:

· the appointments of Hopkins pharmacologist Paul Lietman, M.D., Ph.D., as director of research; Singaporean James P.F. Chou as chief operating officer for clinical care; and Hopkins oncologist Enser W. Cole III, M.D., as assistant clinical program director.

· the selection of the first batch of research projects (all headed by Hopkins faculty), which include studies of a novel nose-throat cancer treatment, new approaches to liver disorders, a new test for tumor-specific or associated antigens to help diagnose cancers common among Asian populations, and the feasibility of a “urology virtual reality workbench” that would enable surgeons to simulate operations prior to surgery.

· the news that renovation work is nearly complete on both a 15,000-square-foot research facility on the National University of Singapore’s campus and a 36-bed clinical care center in the National University Hospital.

Long-term Hopkins plans call for the construction of a stand-alone hospital and a research operation employing 75 top scientists. Of concern to Thompson is the center’s potential to become a completely separate outpost, because it’s on the other side of the world. “It’s an imposing undertaking,” he emphasizes, “that requires nimble maneuvering through two sizable bureaucracies—the Singapore government and Hopkins—to create a genuine team of physicians, researchers and administrators working together on different sides of the globe.”

As for life on the 21-square-mile Asian nation, the new CEO confesses he’s developing a taste for certain local specialties—shark-fin soup, for one, and Sri Lankan crabs (seasoned with spices that make Old Bay taste tame), for another. “I don’t think anyone in Singapore eats dinner at home—ever,” he marvels.

-- JD

Crisis in Our Own Backyard

Oast fall, when University President William R. Brody charged a 76-member task force to put together a model public-health program for inner-city communities, he had more than an academic exercise in mind. “You only need to take two steps outside the doors of The Johns Hopkins Hospital to understand that the surrounding community is suffering,” Brody said. “We have an obligation to try to help.”

The President’s Council on Urban Health, as the effort has been dubbed, now is examining ways that Hopkins can partner with civic, government and business groups to combat the health crisis engulfing East Baltimore. Statistics from this neighborhood are among the worst in the state, with high rates of cardiovascular disease, diabetes, cancer, HIV-related illnesses, violence and substance abuse. The community also has the highest rates of sexually transmitted diseases in the country and the highest rates of syphilis of any city in the developed world.

Hopkins Health workers in East Baltimore.

The council’s 76 members include University experts in an array of disciplines, as well as community and civic leaders. Its co-chairs are Colene Y. Daniel, the Health System’s vice president for corporate services and community health and services, and Martha Hill, professor of nursing and director of the Center for Nursing Research.

“It’s not a matter of going in and starting from scratch after a long drought,” says Hill. “There’s enormous strength in these communities that we think can be leveraged to confront some of the problems.”

Brody has asked the council to come up with a set of recommendations by the end of the academic year, at which point the University will help lead a long-term public-health campaign in the backyard of its own Hospital. “We’re in for a marathon, not a sprint,” Brody vows.

-- JD

Broadening Couple Recognition

After years of batting around the issue, a couple of months ago, the University announced it would extend benefits to same-sex domestic partners. The decision brings Johns Hopkins into line with peer institutions like Yale, Duke and Stanford, who years ago decided to extend their services and benefits to gay and lesbian couples. Adopting this policy, President William Brody pointed out, reinforces the University’s commitment to parity in the workplace and assures compatability between its personnel benefits policies and its equal opportunity policy.

The fact that same-sex domestic partners now will receive benefits available to heterosexual married couples, after years of failing to achieve equal status—and despite positive recommendations from University groups—is thanks to a combination of circumstances. Always before, the proposal had been denied with the explanation that the cost of extending coverage to this additional category would prove a financial hardship on the University. But careful study of the data gathered from other universities and the business sector demonstrated that the expected financial hits never materialize.

In fact, says Audrey Smith, University vice president for human resources, for several reasons the additional cost ends up at only around 1 percent. Gay and lesbian partners often hold individual benefits through another employer and choose not to change to couple benefits because they don’t want to disclose the personal information required for eligibility. Additionally, since same sex-domestic partners don’t receive the same federal income tax deductions available to heterosexual couples, it often doesn’t prove advantageous for them to change to couple status.


"We're in for a marathon, not a sprint," Brody vows of his campaign to boost East Baltimore.

But the real catalyst for Hopkins’ policy change came with Brody’s appointment as president a year and a half ago and his creation of the Diversity Council to bring more inclusion and tolerance to the University. “With any institution like Hopkins, it takes hard work from constituencies within, and also it takes strong leadership from the top to make something like this happen,” notes history professor Ronald Walters, who chairs the Diversity Council. “We hit the right combination.”

-- Patrick Gilbert

Physician, Administrate Thyself

Doctoring skills and business horse sense once sprang from different parts of a university. No more. Most aspirant physicians now appear to recognize that business savvy can prove a boon to their careers. Such was the case for 13 first-year medical students who signed on this fall for a pilot elective on the fine art of health care administration.

The course—the brainchild of Rebecca Ashkenazy, a second-year student, who proposed it to Toby Gordon, Sc.D., vice president for planning and marketing—included heavy reading, lectures and an ambitious schedule of meetings all over the campus, complete with sessions that paired students with personal mentors from the ranks of Hopkins executives (even Hospital President Ron Peterson took on a student sidekick). Gordon directed the undertaking; Ashkenazy served as the student organizer.

Mentor Scott Sherman and Student Karen Jacobson.

Mentor Scott Sherman shows student Karen Jacobson the way to navigate one of Hopkins' high-tech habitats.

Hopkins is famous, of course, for its long history of physician/administrators, from William Osler, the originator of the medical residency programs, right on down. Gordon stressed that point in the first session. She also gave an overview of the economic challenges facing this academic medical center in today’s market.

In the weeks that followed, students shadowed administrators in specialties ranging from emergency medicine to Hopkins publications, and attended a six-part lecture series featuring outside experts addressing relationships between medicine, law and economics. On their own, the future M.D.s organized such extra sessions as a group dinner with new University Chief Information Officer Stephanie Reel.

Each student also met regularly during the course with an individual mentor from the ranks of Hopkins executives. Student Kevin Nusz, who signed up for the course because he’d heard doctors delivering frank accounts of career frustrations and come to the conclusion that he needed to “at least understand how the system works,” found himself bandying about theories and career strategies over coffee or dinner with Steve Thompson, vice dean for administration and CEO of Johns Hopkins Singapore. “It’s been one of the best parts of the program,” Nusz said, “because Steve’s working right where it’s at when it comes to the administration of health care.”

Karen Jacobson shadowed Scott Sherman, assistant dean and director of the Office of Corporate Liaison, to learn how communications technology affects medical practice and sort through ethical issues confronting researchers working with private biotechnology firms. Sherman says the learning process went both ways. “It’s sometimes easy to forget, given my involvement in business development, that we are a medical school,” he said. “These first-year students are extraordinary, and while I hope they can learn something from me, I am certainly learning from them as well.”

As the elective drew to a close in late October, Gordon noted that it clearly was an idea whose time had come. “We had many more students who wanted to do this than we could let into the class,” she said.

-- JD

They Make House Calls

On a surprisingly warm morning a couple of months ago, Jean Wang hit the road with Bonnie Jacobowitz. First, they visited a small house in a blue-collar Baltimore neighborhood, where an elderly man tended a wife with colon cancer. Then they traveled to an East Baltimore rowhouse to call on a woman in her 50s suffering the debilitating side effects of diabetes. Wang is a first-year medical resident—one of 52 profiting from a two-week outpatient rotation by taking a firsthand look at Hopkins’ home care operation. Jacobowitz is a home care nurse and as such belongs to one of this nation’s most venerable services for tending to the sick—one that’s recently been reinvigorated.

The idea for the unusual training came from three young faculty physicians in the Department of Medicine—Jeffrey Magaziner, Gregory Prokopowicz and Joseph Lofrancesco—who were designing a curriculum to broaden the exposure of interns to outpatient medicine. “We were brainstorming one day,” recalls Magaziner, “about areas in which we received little or no training. One of those was home health care.”

Nurse Bonnie Jacobowitz (left) and resident Jean Wang out on rounds.

Takin' it to the streets: Nurse Bonnie Jacobowitz (left) and resident Jean Wang head out on home-care rounds.

Good home care, Magaziner is convinced, can hold down health costs by decreasing the need for repeat hospital or doctor visits. “Nurses, for example, can do a better job of assessing a patient’s compliance with a doctor’s care plan, checking for home safety issues and getting a feel for a patient’s overall status than a doctor can during an office visit.” But physicians unfamiliar with this line of treatment, Magaziner says, can easily underestimate what can be done at home.

Interns on the new rotation won’t have that problem. They receive an orientation in everything from Medicare eligibility rules for home care, to the technicalities of providing IV therapy in the home. They then spend two half-days making rounds with visiting nurses.

By the time Wang headed out with Jacobowitz, she’d already completed an inpatient rotation and referred some 25 patients leaving the Hospital to home health care. Seeing what happens at the other end, she says, added meaning to her referrals.

For the visiting nurses, the enlightenment worked both ways. They got a real kick out of making rounds with the newly minted M.D.s , according to Amy Rader, senior director of Home Health Services. In fact, the whole idea has been such an all-round success that Oncology and Pediatrics are looking into introducing similar roations for their house staff.

-- PG