The future of Johns Hopkins Medicine

Date: September 16, 2011

A time for restructuring

Dean/CEO Edward D. Miller, M.D.

Most of you have received communications throughout the past several months about the restructuring of Johns Hopkins Medicine. I’m sure many of you may be wondering: Why now? What’s different? How will this affect me? All legitimate questions. Let me give you some context to this critically important, strategic new structure that will offer clarity about the direction we need to go to stay competitive.

Why now? If you go back to what were the early years of Johns Hopkins Medicine, we had the school of medicine, Hopkins Hospital, Hopkins Bayview Medical Center, small home care and managed care operations, and one suburban outpatient center. We were a compact institution with a pretty straightforward structure, and it was easier to ensure that the appropriate people were at the table to make decisions. It was successful for almost 14 years.

Now, fast-forward to the past three years. In pretty rapid succession, our school of medicine has grown in its research and educational impact, and our system has added three more hospitals: Suburban and Sibley Memorial in the D.C. area and All Children’s Hospital in St. Petersburg, Fla. Johns Hopkins HealthCare has become a billion-dollar managed care business. Home Care has expanded and now also plays an important role in extending patient care and managing patient populations. We have the largest primary care practice in Maryland with Johns Hopkins Community Physicians, and we’ve tripled our ambulatory care locations. Johns Hopkins Medicine International has expanded its reach globally. In short, we’ve outgrown ourselves.

On top of this, we face a great deal of uncertainty due to federal health care reform, with Medicare, Medicaid and NIH funding at risk of being cut in the ongoing budget battles, the trickle-down effect that could have on the Maryland budget, and the changes in the hospital reimbursement rates from the state Health Services Cost Review Commission. 

So, it was clear to us that we needed to change our structure. A big part of what’s driving this new structure is to make it clear to every employee—whether their job is in environmental services, patient care, admissions or security—where we’re headed, how decisions are being made, why we’re making them and who is making them. You can’t ask employees to support the decisions we make together if we aren’t clear about where we’re headed.

When decisions are being made, there are representatives from patient care, research and education at the table, so that one part of our mission isn’t being neglected or doesn’t benefit. We want to make sure that we all understand the outside forces and opportunities that we face and their potential effects on our future and on our lives at Hopkins.

I can give you an example that sums up all of these reasons for the change: Epic, our upcoming, enterprise-wide electronic patient record system. The initial decision was not to implement Epic because it was too costly. But that didn’t align with what was best for patients and providers.

As you know, we now have made a decision to implement Epic. We came to the right decision, but it took too long. The health care landscape is changing too fast, and we need to respond more quickly and efficiently to these kinds of issues and opportunities in the future.

To make us more efficient and responsive, we’ve established an Operating Committee and all strategic issues will go up through the new structure and to this committee where the decisions will be made. On that committee, we have all the people who should be at the table: the vice deans, the clinical chiefs and those who will head our enterprise-wide divisions, including international, patient safety and quality care, the community hospital division, the office for faculty and community physicians, the offices of research and education, and the office of managed care and population health, all supported by our strategic planning efforts.

With all of this in mind, we have to remember that Johns Hopkins Medicine remains the most well-known health care institution, and we must protect and enhance the value of our brand.

You could say that the new structure looks pretty corporate, and quite honestly, it is. But my response is, we can’t afford not to be corporate when we’re a $6 billion business. It’s not done on the back of a matchbook any longer. There’s a lot at stake, a lot of lives at stake, and not just our patients, but our employees. So as leaders and decision-makers, we have to do it right. We can do it well only if we do it together.