Karen Blum

Date: 01/09/2018

Leo Rotello, director of the medical/surgical intensive care unit at Suburban Hospital and director of critical care for Johns Hopkins Community Physicians, made an observation about Johns Hopkins’ leadership courses. While the courses were very good, a significant portion were geared toward academic advancement, “which is really not practical for those who are running clinical programs who need to develop a leadership base,” he says.

As Rotello set out to plan a course specifically for inpatient clinical leaders, he was introduced to John Flynn, vice president of the Office of Johns Hopkins Physicians, who had success directing a leadership training program for outpatient practice management teams called the Ambulatory Management Program (AMP) and a similar course for ambulatory surgical teams. Together, the two expanded AMP to create the Clinical Hospital Advanced Management Program (CHAMP).

CHAMP is a 10-month course that opens with a two-day boot camp in the Lean quality improvement methodology. “Lean gives all participants a common vocabulary with which to identify less than optimal processes and specific tools to improve them,” says Flynn. “It’s been a core part of AMP, and it worked well with the first cohort of CHAMP participants.”

The Lean boot camp is followed by monthly sessions covering topics such as leadership and collaboration, internal audit, service excellence, team effectiveness, and finance and negotiations. Participants also have the opportunity to analyze a clinical issue in their home units. About 28 employees from throughout Johns Hopkins’ Maryland/D.C. hospitals participated in the first course, which finished in October 2017, and 32 are enrolled for the next one, which starts Jan. 31, 2018.

“We want to provide an environment to develop up-and-coming clinical leaders among hospital-based practitioners,” Rotello says. “We talk about how to build a budget for a program, what does ROI mean, and compliance issues related to the HSCRC” — the Health Services Cost Review Commission — “very practical skills that you need when you’re looking to build a clinical program.”

Many participants enroll as teams with physician, nurse and/or administrative leaders, adds Flynn. The biggest reward for him has been advancing integration systemwide, with people who perform similar roles in the various Johns Hopkins hospitals having the chance to interact and discuss common challenges and opportunities. When the course comes to an end, Flynn says, “our intent is that the fellowship and collaboration has only just begun. This course serves as a tremendous accelerator toward integration across the enterprise.”

Intensive care physician Mauro Sarmiento, medical director of the respiratory department at Suburban Hospital, and Art Pease, nursing director for Suburban’s clinical decision unit — an observation unit providing aggressive, short-term care for patients with chest pain, dehydration or other health issues that may not require admission — participated in the first class.

Sarmiento, Pease and colleagues had come up with a plan to improve the triage process and care for patients with small intracranial bleeds, but the CHAMP program gave them the tools and the platform to advance the idea. About 80 percent of traumatic brain injuries (TBI) are mild or minor, Pease says, and because Suburban is a level II trauma center, a significant number of its emergency department (ED) patients are TBIs. In addition, they are frequently referred TBI patients from Howard County General Hospital and Sibley Memorial Hospital. Currently, these patients are admitted to the intensive care unit for appropriate neurological monitoring. But because they are low risk and are often transferred or discharged after a short stay in the ICU, it didn’t make sense to tie up an ICU bed from a resource utilization and patient care perspective, says Pease. Further, Medicare and most insurance companies don’t cover inpatient stays that are not at least three nights. Sarmiento, Pease and their team worked with ED physicians, hospitalists, trauma surgeons, neurologists and intensivists to design a new plan.

Starting in early 2018, patients who present to the Suburban ED with mild intracranial hemorrhages will be admitted directly to the clinical decision unit under the hospitalist team. “It allows us to provide excellent patient care and optimize resources,” Pease says.

“Sometimes, being in a silo, it’s hard to be an agent of change,” adds Sarmiento, but the CHAMP program allowed him to view the problem more objectively. Networking with colleagues at other hospitals also gave him ideas on better management of diabetic and intubated patients. “One of the perks of having CHAMP is we are intermingled with all campuses.”