Reflections at 3 months:

It is a great pleasure to report some of my reflections and activities from my first 3 months.  Much of my time has been spent in meetings, and as much as some may not appreciate it, this time has let me meet our faculty and has improved my grasp of the dimensions, challenges and opportunities for our great department.  I continue to be struck by the depth of talent and the genuine commitment to our research, clinical and educational missions.

Our hospital is busy and full

Our hospital seems to be perpetually full.  We are usually over 85% of our capacity – a situation where the margins for error are low and the opportunities for system breakdown are more frequent and perilous.  I have begun to meet with leaders across JHM to consider how we can care for the patients best served in our hospital while improving the throughput of these patients from admission to discharge.  As a first step, Dr. David Hellmann and I are beginning to examine ways to use capacity at Bayview Medical Center to offload some of the medicine-directed emergency department volume at Johns Hopkins Hospital (JHH).  Because of the decentralized nature of our health system we have the potential to distribute and grow clinical programs in a non-redundant and highly efficient manner.  I am in the process of touring all our hospital and ambulatory sites, so far having visited Bayview, Sibley and Suburban Hospitals, to consider how we may improve system-wide coordinated care.

The Ebola outbreak is an emergent challenge for our health system, hospital, and department.  I am pleased that Dr. Lisa Maragakis is leading our effort to care for potential Ebola patients seeking care at JHH. Although the list is too long to include here, there are many other clinical activities worth extolling. It is clear that our faculty, learners, and staff are working incredibly hard to provide the highest quality of care to the sickest, neediest and often most complicated patients.  I deeply appreciate these efforts.

Our trainees and faculty are highly engaged in clinical education

Since the time of Dr. Victor McKusick, the Osler residency has been built around a firm system, which has implications for geography of care, continuity of care, and the teams where learners and faculty aggregate.  The firm system remains as vital and relevant today as at its inception, but it has been challenged by loss of geographical coherence that followed the expansion of our hospital.  This week marks the reopening of the Nelson Harvey Building, an event that will help reestablish a sense of place for our firms.

Drs. Lee Daugherty Biddison and Sanjay Desai recently led a focused operations and educational retreat.  This retreat led to a number of new ideas and helped me to better understand some of the challenges and opportunities for how we may begin to further improve our education and clinical care missions and integrate all the missions in a way that will best prepare our trainees for the healthcare environment in which they will practice and lead.   I was intrigued by a discussion of how we could build more flexible pathways for firm faculty with diverse interests. Some advantages of expanding firm faculty roles could be increasing exposure of our learners to physician scientists and allowing clinically focused faculty to spend more concentrated and better recognized time with the firms.  Having the best medical residency in the country, it is indeed a great responsibility to protect our traditions while exploring ways to further improve our system and lead the world in internal medicine education.

Leadership transitions

There are a number of divisions and centers engaged in leadership transitions.  Recently, Dr. Paul Ladenson announced his intention to step down from directing the Division of Endocrinology, Diabetes and Metabolism once a successor is named.  We are in the early stages of assembling a search committee to begin a national search for the next division director.  Additionally, I am meeting with faculty in Endocrinology, Diabetes and Metabolism, Clinical Pharmacology, Allergy and Clinical Immunology, Pulmonary and Critical Care Medicine and the Immunogenetics Laboratory to learn their aspirations for their divisions or programs and to plan for leadership transitions.

We recently embarked on a process to transparently select our departmental vice chairs and associate vice chairs.  Many of you have likely seen the RFA for the new Executive Vice Chair position.  During the course of the next year more of these positions will follow, including Vice Chairs in Research, Faculty Advancement and Promotions, and Technology, as well as Associate Vice Chairs for Quality and Safety, Ambulatory Medicine and JHCP. I very much appreciate the faculty who have served in these positions and the thought and effort for those of you who have submitted applications or are contemplating submitting applications. This process is the best way for me to begin to ascertain the members of our department who aspire to various leadership roles and to devise these and other opportunities for professional advancement.

Promotions and compensation

We have an industrious and diverse faculty. Our faculty are engaged in complex, exciting work in sometimes inefficient systems within our School and Health System. The combined challenges of complexity and inefficiency create obstacles worthy of new solutions.  I’ve been involved with School of Medicine leadership to begin discussions toward broadening pathways for recognition of our faculty. Our aims is to develop more flexible tools to recognize the outstanding accomplishments of our faculty who in some cases don’t fit easily into our traditional structures for recognition, advancement and promotion.

 

One of my goals is to improve the financial transparency and the pay of our faculty.  A first step towards this goal will be to analyze our workforce through a type of clinical FTE census.  This process will allow us to have more quantitative and meaningful conversations with our health system regarding workforce and gap analysis.  Understanding definitions of clinical FTEs in the various divisions and service lines will be necessary to build a transparent compensation model for our department.  Our administrators, led by Matt Lautzenheiser, are working hard to construct a framework for defining clinical FTEs.

Advancing discovery and technology transfer

I am meeting with various scientific leaders to review resources that can allow all our investigators to collaborate and compete for funding more effectively.  I recently met with Drs. Shukti Chakravarti and Steve Sozio to begin planning our spring Departmental Research Retreat.  The potential to create goods and services out of scientific discoveries represents a major and still largely untapped opportunity for researchers of all types in our department.  Finally, I’m beginning to meet with leaders in our department, in our school, across our university, and in the private sector to consider how our department, which has the largest research enterprise in our school, can best advance these goals and present new opportunities for our researchers.

In summary, I couldn’t have hoped for a more exciting three months.  I am invigorated and excited as I look over the next year.  I want to especially thank all of you for your making me and my family feel that we belong here.  The world knows that we are amongst the very best places for research, clinical care and education but it is a too closely held secret that the people at Johns Hopkins Medicine and in our department are very warm, welcoming and collegial. It is energizing and humbling to serve our department.

Sincerely,

Mark

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