January 26, 2011

Update: Positioning JHM for the Future

Dear Colleagues,

Some people say these are times of great uncertainty. We say these are times of great opportunity.

While it's certainly true that we face a new health care landscape brought about by our country's health care reform, our state's legislative proposals and powerful market forces, it is equally true that we enter into this new landscape with many advantages and many strengths.

Our research, education and clinical initiatives continue to set the standard for the rest of the world. Over the past decade we've witnessed unprecedented growth and expansion throughout our organization, in our size and partnerships, both here and abroad. Most importantly, the talents of our most precious resource, our employees, remain unsurpassed. We face the future with optimism.

Still, we can never rest on our laurels. We must adapt to changing circumstances and explore our options and opportunities.

What we have learned

Based on the valuable input we've received from many of the leaders across Johns Hopkins Medicine, we have concluded we must transform JHM for a new era through several means. We must effect this transformation by:

• Creating a fully integrated delivery care model across all components of JHM
• Reengineering systems and processes to enhance efficiencies and promote accountability
• Focusing on our most valuable asset—human capital—and fostering a collaborative environment with clarity of purpose and clarity of roles
• Implementing better quality and safety measures and monitoring our progress in meaningful ways
• Developing more cost-effective ways to deliver quality care and operate all components of our system

To accomplish these goals

We will need more robust and focused strategic planning and implementation processes. As we improve JHM, our vast research and teaching enterprise, whose discoveries have transformed so much of modern medicine, must and will remain vital and central to JHM's core.

Last year, we made great progress in jumpstarting this transformation when we established a special committee on health care reform and also engaged 30 representative leaders from across JHM to chart our future direction. We sought their wisdom, and we listened carefully to what they had to say during many conversations and discussions. As we examined our current infrastructure, systems and decision-making processes, it became apparent that we need to implement a program of restructuring to get us where we need to be.

Initially, this restructuring is focusing on four broad areas:

• Expansion of our international enterprise and revenues
• Increased focus and organization around health care reform transformation, cost-effectiveness and long-range strategic planning
• Greater system-wide clinical integration, specifically with our community-based hospitals and our community physician enterprise, that capitalizes on the expertise and skills of all of our health care providers, including nurses, nurse practitioners, physician assistants and specialized clinicians. Within Johns Hopkins, we also have great collaborative opportunities with our world-renowned schools of nursing and public health.
• Enhanced patient safety, quality outcomes and performance measures

Through these changes, one thing does remain the same—our commitment to our core values, our mission, our vision, our culture of excellence and our people. By nurturing and growing these unique Hopkins qualities throughout our institution, we will emerge a stronger, more vibrant, nimble, responsive and resilient JHM. Throughout this process, our top priority will remain our people. We want to encourage improved and more frequent communication, clearer roles and better decision-making processes.

Areas of change and opportunity

We want to briefly tell you about some of the steps we have already taken or are planning to take in these four areas noted above.

International Growth

Our international arm, Johns Hopkins Medicine International (JHI), continues to thrive with major new initiatives in Malaysia, Saudi Arabia, the UAE and several other countries. Not only are these initiatives important sources of revenue, they afford us the opportunity to extend our mission to the world. In recognition of the current and future importance of JHI, we recently named Steven J. Thompson chief executive officer. Under Steve's leadership, we expect to grow our overseas portfolio into a $1 billion business within seven to 10 years.

Health Care Reform, Market Forces and Planning

Even though there is uncertainty about the final outcome of health care reform legislation, we must anticipate that significant changes will occur and we must prepare for these changes. We believe that we must innovate to deliver services more cost effectively and to achieve the highest value for our patients. We want to create an organizational structure that promotes strategic, clinical, operational and financial alignment within the JHM system to further our mission and the promise of medicine.

To further aid us in preparing for the changes that market forces and health care reform will bring, we have decided to create a new executive-level position—to be filled shortly—whose role it will be to focus our efforts on capitalizing on health care reform initiatives while improving our strategic planning.

System-wide Integration and the Concept of a Community Division

Even in the absence of health care reform, transforming JHM into a more comprehensive and integrated delivery system is an imperative. Market forces demand it, business realities demand it, and our patients demand it. Integrating with Suburban Hospital and Sibley Memorial Hospital, expanding Johns Hopkins Community Physicians, and creating the Johns Hopkins Clinical Research Network under Daniel E. Ford have moved us much closer to our ultimate vision of becoming a fully integrated academic health system within the Baltimore-Washington region. But, we still have more work to do to seize this historic opportunity to develop a seamless, standardized delivery system. Enhancements and updates are needed to provide our patients with the right care, at the right time, at the right place, and yes, at the right price.

It will take a few years for us to ensure that all our JHM components are fully integrated, operationally coordinated and collaborative, but we are already on our way. For example, Julie Freischlag recently established a new position, vice chair of surgery, that will have oversight of surgery services delivered at our three community hospitals—Howard County General Hospital, Suburban Hospital and Sibley Memorial Hospital—and ambulatory locations in order to develop a truly regional health care delivery system ensuring safety, quality and service standards in surgical care. Michael E. Zenilman has accepted the new role. We are also developing a new process for facilitating integration, coordination and collaboration within our three community hospitals to better serve our patients throughout the region and to ensure appropriate coordination of services across these hospitals. Details about the structure we envision for our community division will be announced shortly.

Patient Safety, Quality Outcomes and Performance Measures

Few imperatives are more important than ensuring the safety and well-being of those who trust us with their care: our patients. This has been and will remain a top priority. Over time, we will develop additional safety and quality protocols, benchmarks and measures to be implemented throughout our system. And we will rigorously track and monitor these measures to foster continuous quality improvement. To spearhead this effort, we are considering establishing a new leadership role in the Dean's Office.

What you can expect

In the weeks and months to come, we will continue to communicate with you frequently about our restructuring and our progress. These are exciting times, and we are excited to share the progress with you. We appreciate what each of you has done and will continue to do in helping us position Johns Hopkins Medicine for the future. We invite your input and we thank all of you for the sense of purpose each of you brings to this process. We are counting on you to share this information with all your team members. Working together with the same spirit and commitment that have characterized Johns Hopkins for more than a century, we will transform our enterprise and continue to pioneer the next era of medicine. This is our promise to you.

Edward D. Miller, M.D.
Dean of the Medical Faculty
CEO, Johns Hopkins Medicine

Ronald R. Peterson
President
The Johns Hopkins Hospital and Health System
EVP, Johns Hopkins Medicine