(continued on page 4)

Seated in the lounge of The Charlotte R. Bloomberg Children’s Center’s pediatric procedure area, Marla Dubyak clutches a baby doll and responds to questions from Lauren Grabau: “When did she last eat? Has she had anything to drink? Any fever or cold symptoms?”

Playing a nervous mother and a triage nurse, the PACU co-workers carry on a scripted con-versation while 20 colleagues observe and take notes. Grabau’s questions may appear routine in this simulated workflow exercise, but her role is not. When the new pediatric preop and recovery unit opens in April, patient volume will soar, swelling workloads for nurses and support staff. Enter the triage nurse, a new role for the unit designed to foster timely patient throughput.

“The triage person can screen out sick patients ahead of time before they’re handed off to the preop nurse,” says Lisa Shoemaker, a nurse leader on the pediatric PACU. “We’d want to create the position for the preop process to see whether it will streamline things.”

The scenario unfolding in the PACU is one of hundreds taking place across The Johns Hopkins Hospital in preparation for life in the Bloomberg Children’s Center and the Sheikh Zayed Tower. At every level of care, clinicians and support staff are taking the stage in unit-based “day in the life” patient-care simulations, interdepartmental “dress rehearsals” and mock patient moves. All are designed to mimic the actual process of care in a multitude of settings, giving participants hands-on introductions to new workflow patterns, process

DomeINSIDE

A publication for the Johns Hopkins Medicine family. Volume 63 • Number 3 • March 2012

2. LEADERSHIP SPEAKS: It’S ALL About RELAtIoNSHIPS Edward D. Miller talks about his surprising interest—and quick grasp—in raising funds to support the institution’s most pressing needs.

2 FILLINg A PREScRIPtIoN FoR PRIMARy cARE Johns Hopkins Community Physicians expands its delivery of award-winning care in the suburbs of Washington D.C.

7 IN KuwAIt, MENtoRINg HEALtH cARE Hopkins takes a new approach to working with overseas hospitals for improving the standard of medical treatment.

6 A cLINIc FoR tHoSE MoSt IN NEED March marks the two-year anniversary of a student-run health resource center that’s helping inner-city residents

Published by Johns Hopkins Medicine Marketing and communications

before the curtain risesThroughout The Johns Hopkins Hospital, units are scripting scenes on how they’ll deliver care in the new clinical buildings.

A health care facility that’s the scope of the Sheikh Zayed Tower and The

Charlotte R. Bloomberg Children’s Center doesn’t open with a mere flip of a switch. It takes countless

hours of preparation by dedicated staff who will deliver top-notch

patient- and family-centered care in the new clinical buildings. This article

is the first of three in a series that will capture a momentous chapter

in the history of The Johns Hopkins Hospital, from final preparations for opening day to a look back at

how the hospital fared as staff and patients moved into the state-of-

the-art patient care towers. pa rt o n e

Filling a prescription for primary careJohns Hopkins Community Physicians expands its delivery of award-winning care in the suburbs of Washington, D.C.

the one aspect of my job as dean/cEo that I never thought would be interesting—or, for that matter, that I would be any good at—was fundraising. you think of fundraising as going up to people, sticking out your hand and asking for a $100 million. It’s not that way at all. Fortunately for me, early on in this job, Morris offit (former chair of the Johns Hopkins university board of trustees) gave me one the best pieces of advice I’ve ever received: Fundraising is all about building relationships.

More often than not, setting the stage for these relationships begins with the faculty. they are the ones who’ve either treated patients with the means to give, or they’re involved in promising research that donors are interested in supporting. People ask me how many fundraisers I have, and I always answer, 2,400. they’re called faculty.

An important element to fundraising to keep in mind is that people who give do so because they want to make a difference in other people’s lives. they do it so that fundamental discoveries can be made. they know that investing in Hopkins will make that happen. this is especially true with this generation of donors who want to support people and their projects, who want to be involved in their gift and who want to be kept informed about the progress made from their contribution—they are willing to give more when they see progress.

there are many examples I can cite to illustrate how all of this ties together. I’ll use the one that re-sulted in support for the Johns Hopkins brain Science Institute.

I guess it was about six years ago that I was invited to a picnic in washington, D.c., one Sunday in october to meet a person who was interested in making a gift. the contact was arranged by a faculty member. I sat down with the person, who came straight to the point: what were my needs? So I said that I had this new hospital that I’m building and I’m looking for money to help build it. without hesitation, he said he wasn’t interested in bricks and mortars.

He asked me to tell him my next priority. I said that if I was looking at an area that needed funding, the brain sciences would be it.

the following wednesday, this person—who wants anonymity—called me and said he had been thinking about my ideas and asked if $10 million could get me started in supporting brain sciences. I said, yes.

I got a group of people together that included Jan-ice clements, Jack griffin, Rick Huganir and told them that we had $10 million and to start thinking how that money might be used to advance brain science. this gave rise to the bSI.

they recruited faculty, found space and started pulling in grants. About 13 months after that meet-ing, they had spent close to $8 million and they put together a progress report, which I sent to the donor. He said he was blown away by how much we had accomplished in such a relatively short period of time. He then asked me if I would like another $10 million.

So the bSI kept working. Later, Janice, Jack, Rick, Jeff Rothstein and I visited the donor and his wife for lunch. He wanted to know about the progress and where we thought we were headed. we presented him with a report and a proposal that showed what we could do if we had another $80 million. He funded it. So what started being a $10 million gift ended up being $100 million to support brain science research. It also gave rise to a very close and warm relationship with the donor, who is still actively involved in what we’re doing.

I’ve never asked anyone for a penny. I simply tell donors what my needs are for the institution, what opportunities exist for them to make a difference. In 15 years, Johns Hopkins Medicine has raised $3.5 billion. that’s a lot of money and, on a personal level, a lot of wonderful relationships with donors.

It’s all about relationships Dean/cEo Edward D. Miller, M.D.

lEADERSHIp SpEAKS pATIENT CARE

a t a community forum several years ago, Suburban Hospital President Brian Gragnolati mea-sured one of health care’s most important “vital signs” when he

posed the following question to the audience of mostly retired people: “How many of you have had difficulty, or have a friend or family member who’s had difficulty, finding a primary care phy-sician who accepts your insurance?”

More than three-quarters of the listeners raised their hands. “I was stunned,” recalls Gragnolati, now senior vice president for the Johns Hopkins Health System. “In those days I couldn’t go to a community event where people wouldn’t ask, Why can’t I find a primary care physician in the Bethesda-Chevy Chase area who accepts my insurance?”

The market wasn’t adapting to their needs, he told them, because practices couldn’t afford to bring new people in and were uncertain about the future of health care delivery. National sur-veys continue to confirm the trend. According to a 2011 study in Archives of Internal Medicine, only 88 percent of U.S. physicians took on pri-vate insurance patients in 2008, a decline of 5.5 percent from 2005. At the same time, only 93 percent of doctors still accepted new Medicare patients.

Now, thanks to their ongoing integration with Johns Hopkins Medicine, both Suburban and nearby Sibley Memorial Hospital can claim a growing number of primary care physicians and specialists who accept private and federal health insurance. When the D.C.-area hospitals joined the JHM family, they not only gained access to Hopkins’ academic research and clinical opera-tions but also to its network of primary care physicians.

a primary care leader

Johns Hopkins Community Physicians (JHCP), the state’s largest primary care physician pro-gram, employs more than 370 health care pro-viders who handle about 800,000 patient visits each year at more than 35 locations. Its recent

growth in the D.C. suburbs, however, has been particularly significant, says JHCP President Steven Kravet. In 2009, the system maintained two primary care locations with less than 10 physicians in the National Capital Region, the area served by Suburban and Sibley. There are now 26 primary care physicians practicing at six primary care locations. One opened last July in downtown Bethesda and another is operating in the medical office building at Sibley.

In addition to primary care, JHCP has helped Suburban expand its base of specialists, such as vascular surgeons and cardiologists, who accept insurance. Specialists are being recruited simi-larly for Sibley.

“If you include our hospital-based providers—intensivists and hospitalists—we now have 60 providers in 13 different specialties in the Na-tional Capital Region,” Kravet says. This year, Community Physicians will open primary care practices in Bowie, Germantown and central D.C.—the latter an important market extension for Sibley.

“JHCP is helping to meet the community’s need for access, an employment need for phy-sicians who don’t want to establish a private practice on their own, and the hospital’s need to have young primary care physicians who will practice for a long time and accept insurance,” says Robert Sloan, president and CEO of Sibley Memorial Hospital.

extending help, filling gaps

In theory, each primary care physician can take care of about 2,500 patients. That means the 14 new JHCP doctors practicing in the National Capital Region can provide for roughly 45,000 patients, points out Gragnolati, who heads the Health System’s community division. He em-phasizes that all new JHCP physicians, including specialists, are enhancing, not competing with, those community physicians in private practice who still work with Suburban and Sibley. How-ever they also provide a reliable bridge to future health care delivery.

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the expanding Johns Hopkins Community physicians is tying together a network of patient care in the national Capital region.

2 • D O M E • M A R c H 2 0 1 2

“ Many insurance payers have made it very unattractive for small groups or individual practices to participate in insurance plans. A lot of people, particularly the elderly, can’t afford to pay for their health care up front and be reimbursed by their insurance.”

—bRIAN gRAgNoLAtI

“Without having the private practices replenish them-selves the way they did in the past, a community hospital can find itself one retirement away from the disaster of scrambling to find a specialist,” Gragnolati says. “JHCP physicians complement the existing base of community physicians who want to finish out their careers in private practice but who aren’t willing to take on the risk of re-cruiting new people.”

In addition to providing access to primary and specialty care doctors who accept insurance, the new relationship should help Suburban and Sibley reduce preventable pa-tient readmissions—a key goal of health care reform—by strengthening their connections to outpatient care, says Robert Rothstein, vice-president of medical affairs at Sub-urban.

“Running practices is not a core competency that hos-pitals have,” Gragnolati says. “It’s fabulous that our health system has an organization like JHCP that has such a long history of doing a great job running physician groups.”

As it expands, Community Physicians also is improving the way it delivers medical care—and getting national ac-claim for it. Last year, five of its primary care sites, includ-ing one in Montgomery County, received the highest level of recognition from the National Committee for Quality Assurance for proficiency at using a patient-centered med-ical home model of care. (See sidebar).

Administrators at Suburban report a “pretty impressive” increase in patients who are seeing Hopkins physicians, particularly primary care providers. “Although some pa-tients may have lost the doctors they were seeing for the past 20 years, we’ve gotten really good response and feed-back from those referred to JHCP providers,” Rothstein says.

—Linell Smith

Kudos for improving care delivery Five primary care sites of Johns Hopkins community Physicians have received recognition from the National committee for Quality Assurance for successfully coordinating and managing patient care through an approach known as the “patient- centered medical home.”

JHcP physician Scott Feeser, director of the medical home initia-tive, estimates that roughly 60,000 patients are benefitting from the program to improve care delivery. the Hopkins practices were awarded “Level 3,” the NcQA’s highest level of distinction.

the patient-centered medical home model focuses on prevent-ing disease, reducing preventable hospitalizations and involving patients in their own care through a team-based approach. It works this way: Each patient sees a primary care doctor who heads a team that may include a nurse, pharmacist, social worker and nu-tritionist. Providers work together to offer patients easy, 24-hour access to care, either electronically or by phone. they also contact patients regularly between visits to see how they are faring and to reinforce any treatment orders. Success depends upon electronic medical records keeping team members up to date with each patient’s condition and progress.

Feeser helped launch the pilot project in 2009 at the water’s Edge site in belcamp, where he is medical director. It has since been implemented successfully at JHcP sites in Hagerstown, Rockville (Montgomery) and baltimore (canton crossing and wyman Park), all of which earned the NcQA’s Level 3 rating.

the model also encourages patients to participate more actively in their own care—whether it be to stop smoking or lose weight.

Caregivers such as Francie Black are part of a new program aimed at improving care for geriatric patients.

as the num-ber of geriat-ric patients steadily rises across

the country—account-ing for about one-third of all hospital admissions nationwide—hospitals and physicians have grown increasingly aware of the complications and risks that these patients face from long-term stays.

As a result, Howard County General Hospital recently adopted the Acute Care for Elders (ACE) pro-gram model, a nationwide effort at improving geriatric hospital care and outcomes for elderly patients.

“Our main goal is to make sure that when el-derly patients come through the hospital, they’re able to maintain function,” says hospitalist Anirudh Sridharan, medical direc-tor for the hospital’s ACE program. “A win for us is getting these patients back home with the same level of function that they came to us with.”

The program launched as a pilot last November. Located on 4 South, it can accommodate 10 patients. To be eligible for the ACE program, a patient must be at least 70 years old, admitted through the Emergency Department from home, and at risk for functional decline.

For hospitalized patients, the culprit behind functional decline is often immobility. Elderly patients may be admitted to the hospital and find themselves spending the majority of their stay in bed with little exercise or socialization, or perhaps adhering to an abnormal routine that includes middle-of-the-night blood pres-sure and heart rate checks or catheter changes.

“When any person lies in bed for longer than two days, they start to decondition,” says Fran-cie Black, a nurse practitioner with the pro-gram. “Elderly patients lose muscle mass much more quickly than a 40-year-old and don’t have the capacity to bounce back as easily.”

The ACE model is designed to help patients avoid inactivity and prevent other common risk factors associated with functional losses. Through physical therapy, pharmacy consulta-tions, education, nutrition and high-quality nursing care, the hospital’s ACE team works with admitted patients to make sure that they remain active, well nourished and have plenty of opportunities to exercise their bodies and minds.

Meanwhile, a special medical ordering system takes into account patients’ ages, so that physi-

cians and other providers can remain cognizant of how certain treatments and therapies might negatively affect a person’s cognition or physi-cal function. “As doctors, we need to make sure we’re not tying them down by not giving un-necessary oxygen, by removing catheters as soon as possible, and by making it easier for them to get around,” Sridharan explains.

Medicinal techniques aside, patients are also encouraged to socialize and exercise their minds. That includes eating meals out of bed and in a common area where they can mingle with other patients, play board games, com-plete crossword puzzles and so on. “With aging brains, if they’re not exercised, they lose the capacity for simple math or keeping track of the day,” Black says. “We want our patients to function here much as they do at home.”

Since the program’s launch, patients have been receptive, Sridharan says, even those who might otherwise be inclined to sit still and recover in bed. “In the past, there was this mentality that if you’re sick, you need bed rest. But now we’re teaching people that’s not in their best interest,” he says. “If you explain to patients that the longer they stay in bed, the weaker they become, they get it immediately.”

—Lauren Manfuso

Care that covers all the basesHoward County General Hospital embarks on a new way to target treatment for elderly patients.

D O M E • M A R c H 2 0 1 2 • 3

redesigns and equipment. Practicing procedures and techniques

on mannequins in a simulation lab has be-come standard for students and clinicians at Hopkins Hospital and other institu-tions. Still, simulation has seldom been used to prepare for a large-scale transition to a new medical facility.

“We’ve never done anything like this on this magnitude,” says Robin Hunt, new clini-cal buildings planning and activation man-ager. Hunt along with Nancy Cushman and Katie Outten, both from operations integra-tion, are orchestrating two hospital-wide dress rehearsals to test and fine-tune codes, patient handoffs and other processes before the new clinical buildings open on May 1. “We’re relying on the expertise of frontline caregivers to identify what it is that needs to be tested and who needs to be involved, down to the detail of how many staff members, the type of equipment and supplies that are needed and how to schedule it all.”

Keeping it real

Most of the simulations under way in the new patient towers are based on the model of “experiential learning,” a

method that pairs scripted “real-life” scenarios followed by discussions led by trained person-nel. A proven bridge between classroom learn-ing and reality, experiential learning also is a way of testing ideas “that we think are going to work on paper,” says Julianne Perretta, an educator in the Johns Hopkins Medicine Simulation Center who is helping to develop and set goals for a variety of practice runs in the new buildings.

Unlike the use of simulation for educating nursing and medical students, the scenarios

taking place across the historic and new build-ings have a different purpose, Perretta says. “The actual process of patient care, whether placing an IV or giving medications, is chang-ing very little.” Not so for “all of the things leading up to the interaction with the pa-tient,” Perretta says. From mundane concerns such as where to park the car or store lunch, to safety priorities such as lifting patients and medication sign-off, these are the details ad-dressed by the day-in-the-life simulations.

If the scenarios uncover workflow and pro-cess flaws and result in more prep work for administrators and managers, then Perretta considers them a success. “We can’t afford to get this wrong once the new buildings open,” she says. “We want to solve most if not all of the problems before we move, and they’re often the things that we can’t predict.”

As opening day draws near, simulations will become more lifelike and intense, Per-retta says. To ready for the two March dress rehearsals, she is working with several depart-ments on “high-fidelity” scenarios in which every second matters with regard to a patient’s welfare. If a team is simulating a code, “They must behave as if the patient is really dying,” she says. “That helps us assess the environ-ment and processes more realistically.”

Dress rehearsal participants won’t have a script, Hunt says. “We don’t want to give them the details of every single scenario.” For example, if rehearsal team members know ahead of time that their scenario re-volves around a patient who codes, their response might be too polished to reveal possible design flaws to observers. “We will debrief to understand what went well and what needs to be revised prior to operating in the building,” she says.

Hunt is also managing two mock patient

NEw ClINICAl BuIlDINgS

Before the curtain rises(continued from page 1)

on the cover: paCU nurse leader Lisa Shoemaker plays an anesthesiologist who is reassuring an uneasy mother (performed by nurse Marla Dubyak) prior to her baby’s hernia surgery.

Start

after a pre-skit briefing by nurse managers, it’s show time for the pediatric paCU team. Nurse Marla Dubyak has volunteered to play a nervous mom whose toddler (a baby doll) is scheduled

for a hernia repair. From the moment a patient service coordinator greets the two at the orleans Garage bridge and escorts them to the Charlotte R. Bloomberg Children’s

Center, Dubyak and her 14-month-old “daughter” receive coordinated care and comforting words from a succession of support staff and clinicians.

4 • D O M E • M A R c H 2 0 1 2

moves—one that happened in February and another scheduled for March. Each was planned to run on a schedule identical to the two-day timeframe for the actual patient move, which will take place April 29 and 30.

practice, practice, practice

because the dress rehearsals center on process design, relatively few caregivers and staff will have a chance to partici-

pate, leading several departments to seek more opportunities to work through new protocols and workflows. “I’ve gotten re-quests to run some additional simulations” to prepare for any number of typical, clini-cal scenarios, Perretta says. “For instance, if the Lifeline team is transporting a patient from the new ICU, and the patient has sudden medical problems, they might not know where they can find a clinical location where they can stabilize the patient or call and ask for more help.” Practicing transport throughout the sprawling new buildings with mannequins in stretchers will make for better patient safety on opening day, Per-retta says.

In January, well before the simulations reach a life-or-death level of intensity, the pediatric PACU nurses took advantage of training time in their new workplace to rehearse for their day-in-the-life scenario. “Practice makes permanent,” says nurse ed-ucator Rebecca Putman, echoing the motto

of simulation experts such as Perretta. Putman and other nurse leaders wrote

the seven-scene skit to depict the process of caring for an infant scheduled for a left inguinal hernia repair. As mother and child made their way from the parking garage to the pediatric procedure area to recovery, each encounter with the triage nurse, preop nurse, child life specialist, surgeon, anesthe-siologist, clinical customer care coordina-tor and others demonstrated the complex choreography of normal clinical operations. Afterward, PACU staff members shared observations and pointed to potential work-flow glitches that needed further attention.

No amount of preparation for such a monumental transition is too much—even if it means preparing for a day-in-the-life simulation, Putman says. “As the unit edu-cator, I feel very responsible. I don’t want my nurses to be asked to do something when they aren’t familiar with the loca-tion of equipment or supplies and then get frustrated. All of the change and movement have already built up a level of anxiety. We wanted the skit to be a way to introduce things in a peaceful, entertaining and fun way and to carry that attitude to the day-in-the-life simulations.”

—Stephanie Shapiro

COMING IN APRIL Mock patient moves

FINISH

once the baby is registered as a patient, she gets an identification wristband from a triage nurse, who also takes her temperature and makes sure she has not had anything to eat since midnight. as pre-

op preparations proceed, Dubyak slips into scrubs and consults with the surgeon and anesthesiologist. In recovery, the baby awakens and receives an oral dose of tylenol and oxycodone from the paCU nurse who

will also review discharge instructions with Dubyak. after the skit, paCU team members pose questions and make suggestions for improving workflow on the pediatric preop and recovery unit.

D O M E • M A R c H 2 0 1 2 • 5

CommuNITy ouTREACH

In her first week as a medical student at Johns Hopkins, Claire Sampankanpanich boarded a bus with other bright-eyed future physi-

cians to tour some of Balti-more’s grittiest neighborhoods. The blocks of vacant, decaying homes bore little resemblance to the sheltered suburbs of San Diego where Sampankanpanich was raised.

Witnessing poverty and home-lessness firsthand deepened her desire to work in a disadvantaged community, which Sampank-anpanich says drew her to Hop-kins’ program over others across the country. Inspired, she sought out volunteer opportunities, discovering a passionate group of similarly concerned students who had opened a free health resource center blocks from cam-pus just months earlier. Today, she’s one of many students lead-ing the now two-year-old Charm City Clinic in its mission to reduce health disparities among low-income Baltimore residents.

Whether offering health screenings, helping clients apply for insurance coverage, or con-necting them with programs that offer free or reduced-cost prescriptions and doctor’s visits, the student-run operation in Baltimore’s Middle East com-munity helps locals facing socio-economic challenges overcome barriers to health care access.

“It’s really easy to assume that access to health care is the same thing as the availability of resources,” says Mike Rogers, a founding member and com-munity outreach director. While Baltimore has an abundance of health resources, they can be fragmented and difficult to ac-cess for some, says Rogers, who spent more time in the Middle East neighborhood than the classroom as an undergraduate at Johns Hopkins.

Lengthy and confusing paper-work needed to apply for state and federal programs that sub-sidize or fully cover the cost of

health insurance, prescriptions and medical care is a huge bar-rier for clients, many of whom lack adequate literacy skills. The benefits of tapping into such programs are untold. “Ninety percent of the medications that people really need to change the likelihood that they’ll die of a heart attack or stroke are avail-able for about $10 for a three-month supply,” says Ramy El-Diwany, a third-year Hopkins M.D./Ph.D. student who’s been a part of Charm City Clinic since its inception.

Founding members say their model differs from other student-run, free health centers across the country. Instead of providing short-term primary care services performed by medi-cal students seeking an opportu-nity to hone their clinical skills, Charm City Clinic volunteers act as a conduit to community resources and strive for long-term relationships with clients. Visits, whether by appointment or during walk-in hours, typi-cally take at least 30 to 45 min-utes, and nearly half are made by established clients. Lengthy visits help to build trust and allow students to practice interviewing and history-taking skills with guidance from Hopkins physi-cians who oversee their work.

From its formative stages, Charm City Clinic was created with direct input from neigh-borhood residents and leaders, among others, who said the com-munity was in need of a health resource center. One of these partners was the nonprofit Men & Families Center. The organiza-tion shared invaluable informa-tion from its past experience in providing community health services to help get the clinic started, and it has been critical to the students’ understanding of their neighbors’ needs.

Volunteers go to great lengths to ensure their clients’ health needs are being met, calling between visits, scheduling follow-up appointments in the

evening or even at the client’s home, if needed. Favorite stories of “extreme follow-up” include standing in line with a client at 5:30 a.m. at Healthcare for the Homeless and, on another occasion, sitting in the wait-ing room at the Department of Social Services office for half a day. “There has to be a balance between doing it with someone versus doing it for them,” El-Diwany says.

Word of mouth, and grass-roots efforts such as going door to door, training community members as outreach workers and using brightly colored hand-painted sidewalk signs to adver-tise their services have helped the clinic’s volume to double over the past year. In all, volunteers have served more than 500 cli-ents since their doors opened in March 2010.

Now Charm City Clinic lead-

ers are working to build capacity to address health needs for the increasing number of communi-ty residents turning to them. To do so, they’re seeking additional help from students and physi-cians interested in volunteering during the clinic’s weekly walk-in hours on Saturdays. To learn more about volunteer opportu-nities, call 443-478-3015 or visit charmcityclinic.org.

—Shannon Swiger

Visiting diversity professor Keith norris

Visiting diversity professor: Lessons from the community

When it came to addressing health care disparities among the more disadvantaged communities in Los

Angeles, Keith Norris took an unusual approach. The executive vice president for research and

health affairs at the Charles Drew University of Medicine and Science hired—as faculty—com-munity members with expertise in such areas as HIV/AIDS, and drug and alcohol addiction. He charged them with educating medical train-ees and clinicians about these health care issues.

Norris spoke about this novel community partnership to department leaders and under-rep-resented minority faculty and researchers at the Johns Hopkins Department of Medicine’s ninth annual Visiting Diversity Professor Lecture.

“We have a society where chronic diseases are predominant and the social determinants of health are the main drivers of poor outcomes,” Norris said. “But we do not have a medical edu-cation approach to teaching about those issues in a very tangible way.”

Norris, who is internationally recognized for his research on health disparities and chronic kidney disease, has recruited 11 individuals over the past year, many of whom also work for local nonprofits and governmental agen-cies. Now community faculty members are leading classes for medical and graduate stu-dents and teaming up with their clinical coun-terparts to research health disparities. Each is subject to the same appointments, promotions

and evaluations as their peers.The recent lecture and dinner was sponsored

by the School of Medicine’s Office of Diversity and Cultural Competence. The Visiting Profes-sorship is just one of many initiatives organized by the Department of Medicine’s Diversity Council, a group that tirelessly has led the en-terprise in recruitment of women and minority professors over the past decade.

Attendee Christian Bime, a third-year pul-monary and critical care clinical fellow, says events like the diversity lecture and dinner make him feel like a part of the Hopkins family. “As a minority, it’s inspiring to see successful role models like Dr. Norris,” Bime added.

—Shannon Swiger

A clinic for those most in need March marks the two-year anniversary of a student-run health resource center that’s helping inner-city residents.

Community outreach worker Anthony Carrington (center) helps medical students Claire Sampankanpanich and neil neumann

get the word out to residents about the clinic’s health resources.

6 • D O M E • M A R c H 2 0 1 2

In 2009, after the Kuwait Ministry of Health decided to overhaul the nation’s public health care system, it sought input from a

number of renowned academic medical centers. Johns Hopkins Medicine International (JHI) quickly responded with a pro-posal to the ministry. And then Hopkins waited—and endured.

Extensive discussions with the ministry led JHI to develop a new concept, one that fo-cused on how outside academic medical centers could work with Kuwaiti hospitals. JHI manag-ing director Zubin Kapadia and Mohan Chellappa, president of global ventures, stayed in touch with the ministry, even as the country’s parliament replaced their cabinet twice in 2011—a set of circumstances that re-quired building new relation-ships after each change. Months passed, and Kapadia and Chel-lappa consistently answered questions and offered reassur-ance that Hopkins’ commitment remained firm.

Finally, on Christmas Day of 2011, the patience—and mutual trust—paid off. Realizing that Hopkins’ expertise and resources aligned with their needs, the Ministry of Health signed a five-year collaboration agreement to improve the quality and delivery of health care at four of Kuwait’s five public general hospitals.

The agreement also called for expanding the nation’s pool of administrative and clinical tal-ent, and to assess and address national public health issues.

If the objectives of both par-ties are met, Kuwaiti citizens will have more consistent and even safer health care experiences, as well as reduced need to leave the country for medical care. Hospi-

tals will operate more efficiently and more effectively, with less risk and reduced costs. The Min-istry of Health will have a firmer grasp on public health issues and an expanded toolbox for address-ing them. In short, mentorship from Johns Hopkins Medicine will have forever changed the en-tire national health care system.

This contract ensures a lasting impact on a region in which International already has an ex-tensive portfolio. For example, JHI affiliates in Lebanon and the United Arab Emirates con-tinue to learn from the physi-cians, nurses and staff of the schools of medicine, nursing and public health.

“Our work at the community hospital level will set the founda-tion for much more advanced care in Kuwait for years to come,” Kapadia points out. He expects that this foundation will make Kuwait more attractive to specialists, which means more in-country health care options down the line.

The relationship between Ku-wait and Hopkins will be like a mentorship, which Kapadia calls a more sustainable col-laboration. “Instead of simply implementing changes, we’ll raise their level of capacity by instructing and guiding them over five years,” he says.

In Kuwaiti culture, successful mentorship requires carefully nurtured peer relationships, so that recommendations and advice are trusted and valued. Kapadia believes that this model will distinguish Hopkins in the marketplace, where most Western academic medical cen-ters serve as leaders or manag-ers, rather than as mentors or guides.

Mentors will sit in teams at

the four hospitals and be divided between administrators, who will guide leadership in establishing hospital-wide policies and sys-tems, and medical experts. These clinicians will certainly share best practices for procedures and treatments, and also for running a department.

A regional office will handle project-management details, recommending to the Ministry of Health strategic approaches to health administration and public health issues. The contract re-quires Hopkins to fill two public health official positions. From this office, they will be acces-sible to anyone within the public health system.

International currently is recruiting people, both from within Hopkins and outside of the institution, for both the

regional office and the team for one of the hospitals. Teams for the other three hospitals will be recruited and deployed later this year.

From Baltimore, Rebecca Alt-man, director of the project, will make sure that the people on the ground in Kuwait have the resources to carry out their roles. She’ll also make frequent visits to the regional office. “We’ll empower a body of passionate, well-educated health care provid-ers,” she says, “and enable them to make changes that will have broad impact on care delivery. What’s even better is that we’ll help them establish the pathways to continue improvements even after we’re gone.”

—Cymantha Governs

In Kuwait, mentoring health care Hopkins takes a new approach to working with overseas hospitals for improving the standard of medical treatment.

patient falls are a common occurrence in hospi-tals, according to numerous national studies. Falls rate can range from more than 2 to

more than 9 falls per 1000 patient days, with 30 percent of them resulting in serious injury to patients. They’re also costly—prolonging hospital stays, depleting resources and lead-ing to malpractice suits.

And, they’re widely considered by pa-tient safety experts to be preventable.

To both decrease the number of incidents and to better understand why patients fall, Suburban Hospital’s nursing staff has employed a new multidis-ciplinary fall-prevention initiative called the Morse Team. The name comes from the Morse Fall Scale, a method of assess-

ing a patient’s likelihood of falling. Available at all times, the Morse team comprises a registered nurse, a patient

care tech, a pharmacist and a nurs-ing supervisor, who immediately

gather at the site of the fall. As soon as the patient is stabilized

and returned to a safe place, the group investigates the

cause of the incident. They evaluate the physical en-

vironment, the medica-tions that the patient

has taken and the patient’s ability

to understand instructions. The team generates a report, which

is reviewed by the hospital’s nursing quality safety ser-vice council.

“This is a nurse-driven initiative that provides us with real-time understanding and education,” says nurse Carolee Beckford, the council’s chair. “We reviewed the falls data and identified the need for a change. Nursing council members researched best practices, created and approved the practice change, and educated the entire organization.”

Since the Morse Team was created in November 2011, the incidence of falls at Suburban Hospital has remained under the Joint Commission’s bench-mark of 3.73 falls per 1000 patient days. Patients, family members and visitors have taken notice of the process and have voiced their satisfaction. They like knowing that Suburban is focused on prevent-ing falls. “It’s a hospital-wide initiative owned by everyone,” Beckford notes.

—Debra Scheinberg

A team approach to preventing fallsSuburban Hospital nurses take the lead in protecting patients from avoidable injury.

CommuNITy ouTREACH

“ our work at the community hospital level will set the foundation for much more advanced care in Kuwait for years to come.”

—ZubIN KAPADIA

International’s Zubin Kapadia, rebecca altman, Mohan Chellappa and Nicole rosson are ready to assist Kuwait public health officials in improving health care standards.

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Hospital of Choice

the Johns Hopkins Hospital is the only medical center in Maryland to receive a Hospital of Choice Award from the American Alliance of Healthcare Providers (AAHCP). The AAHCP evalu-ates approximately 400 hospitals nationwide for the honor. Hop-kins was one of 50 hospitals in 29 states and the District of Colum-bia to receive the award for the winter quarter.

Military and Veterans Health Institute

the Johns Hopkins University School of Medicine has joined the Association of American Medical Colleges and the Ameri-can Association of Osteopathic Medicine to establish the Military and Veterans Health Institute. As part of First Lady Michelle Obama’s “Joining Forces” initia-tive, the institute has the mission of advancing care for veterans and their families in the areas of psychological health, regenerative medicine and rehabilitation.

EASt BALtIMORE

Judith Carrithers, J.D., M.P.A., has been appointed assistant dean for human research protec-tion and director of the Human Research Protection Program in the Office of Human Subjects Research. She succeeds Barbara Starklauf, who retired in December.

Chad Gordon, D.O., assistant pro-fessor of plastic and reconstructive sur-gery and clinical di-rector of Hopkins’ craniomaxillofacial

transplantation program, has re-

ceived a 2012 American Associa-tion of Plastic Surgeons/Furnas Academic Scholarship Award of $90,000 over the next three years to fund his research in the emerg-ing field of face transplantation.

Ian Hsu, a third-year medical stu-dent, is one of just 40 American recipients of a Gates Cambridge Scholarship, which will enable him to study for a master’s degree in social anthropology at the University of Cambridge in Great Britain. The scholarship program, begun in 2001, is funded by a $120 million gift from the Bill & Melinda Gates Foundation. Hsu is the fifth student from Johns Hopkins to be awarded a Gates Cambridge Scholarship since the program’s inception.

Benjamin Carson Sr., M.D., professor and director of pedi-atric neurosurgery, and Cornelia Liu trimble, M.D., asso-ciate professor of gy-

necology and obstetrics, oncology and pathology, have each been named a 2012 Influential Mary-lander award recipient by The Daily Record, Baltimore’s legal and business newspaper.

todd Dorman, M.D., senior associ-ate dean for educa-tion coordination, as-sociate dean for con-tinuing medical edu-cation and professor

and vice chair for critical care in the Department of Anesthesiology and Critical Care Medicine, has been appointed to a three-year term on the board of directors of the Accreditation Council for Continuing Medical Education.

David Nichols, M.D., M.B.A., vice dean for education and professor of pe-diatrics and anesthe-siology and critical care medicine, has

received the Saul Horowitz, Jr. Memorial Award from the alumni association of the Mount Sinai Medical School of Medicine in New York City, from which he graduated with honors in 1977. Nichols’ award recognizes an alumnus who has made signifi-cant contributions as a medical teacher, researcher and/or practitioner.

Joanna Pearson, M.D., a 2010 graduate of the School of Medi-cine and a second-year resident in the Department of Psychiatry and Behavioral Sciences, has received the 2012 Donald Justice Poetry Prize from West Chester Uni-versity for her first collection of poetry, Oldest Mortal Myth. It will be published in June.

thomas Quinn, M.D., professor of medicine and director of the Center for Global Health, was chosen to deliver the

Benjamin Keane Lecture at the Weill Cornell Medical Center in New York last October, and will be given the University of Notre Dame’s Distinguished Alumnus Award this May.

notable nurses

Jeanne Keruly, M.S., C.R.N.P., assistant professor of medicine and director of the Ryan White HIV/AIDS Clinical Services program, has been named vice chair of the Greater Baltimore

HIV Health Services Planning Council.

JOHNS HOPKINS BAy VIEw MEDICAL Center

Phillip Dennis, M.D., Ph.D., has been named director of the Sidney Kim-mel Comprehensive Cancer Center at Johns Hopkins Bay-

view and the director of Depart-ment of Oncology.

anita Langford, R.N., M.S., vice president of care management servic-es, has received this year’s William J. Mc-Carthy Award from

the Johns Hopkins Bayview Board of Trustees. The award rec-ognizes Langford’s ability to go beyond expected standards of ser-vice, skillfully handling the opera-tional oversight of the Johns Hop-kins Bayview Care Center.

Kenneth M. Stuzin, M.B.A., C.F.A., has been appointed to Johns Hopkins Bay-view’s Board of Trustees. Stuzin is a partner at Brown Ad-

visory, where he is responsible for managing the firm’s large-cap growth portfolios.

SuBuRBAN HOSPItAL

June Marlin Falb has been appointed vice president of de-velopment. As vice president of the Sub-urban Hospital Foundation, she will

spearhead fundraising initiatives for the campus enhancement proj-ect and clinical programs, as well as support ongoing efforts to es-tablish a stronger culture for phi-lanthropy from grateful patients.

SIBLEy MEMORIAL HOSPItAL

Edward “ted” Mill-er Jr., chairman of the board of trustees and president of RCS Construction Servic-es LLC, has been chosen from among

hundreds of nominees to receive the 2012 Outstanding Director Award in the nonprofit category from the Washington Business Jour-nal. Miller has served on the board of trustees since 1988 and became chairman in 2005.

HOwARD COuNty GENER AL HOSPItAL

Digna Marie Wheatley, r.n., M.H.S.A., clinical nurse case manager, a native of the U.S. Virgin Islands, has had a school gym-

nasium named for her in St. Thomas in recognition of her leadership two decades ago in or-ganizing a three-day, 1,200-stu-dent march to demand equal support for their educational fa-cilities. As a result of the unprec-edented march on the Islands’ legislature and government house, more than $600,000 was appropriated for the building of classrooms, the hiring of teach-ers, purchase of textbooks, and building of the athletic facility that was named the Digna M. Wheatley Gymnasium over the President’s Day weekend.

Dome

wHo / wHAT

Published monthly for members of the Johns Hopkins Medicine family by Marketing and Communications.

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EditorPatrick Gilbert

Contributing WritersStephanie Shapiro, Linell Smith, Cymantha Governs, Shannon Swiger, Lauren Manfuso Debra Scheinberg, Neil A. Grauer

Copy EditorsMary Ann Ayd, Justin Kovalsky, Judith Minkove

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Photographer Keith Weller

Dalal Haldeman, Ph.D., M.B.A.Vice President,Johns Hopkins MedicineMarketing and Communications

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president and Ceo of All Children’s Hospital retiresGary a. Carnes, president and CEO of All Children’s Hospital since 1997, has retired, effective February 29. Carnes’ 15 years at the helm of All Children’s was a momentous period in the 86-year history of the St. petersburg, Fla., hospital. not only did he preside over the building of more than 1 million square feet of new space devoted to children’s care, but under his leadership more than 1,000 employees were added to the staff. Four outreach locations were also added to increase to 11 the number of All Children’s centers in eight West Central Florida counties. now all Children’s “is poised to

realize its long-held vision of becoming a national and international leader in pediatric treatment, education and research,” says Jack Kirkland, the chairman of its board. thanks to Carnes’ inspired integration of All Children’s into Johns Hopkins Medicine, it became the first hospital outside of the Baltimore/washington, D.C., region to be a full member of the Johns Hopkins Health System. Jonathan ellen, currently Hopkins’ vice dean for All Children’s and the hospital’s physician in chief, will serve as its interim president until a permanent successor to Carnes is named.

pICTuRE THIS

Welcome to the nCB: employee celebration March 7, 3 to 7 p.m.W H e r e : Garden Bistro/lobby area on the new

buildings’ main level

Hopkins Medicine leaders will take this opportunity to thank all faculty and staff members for their work on the new buildings and for their efforts to make this a healing home for our patients.

S p e a K e r S

• Edward D. Miller, dean/CEO of Johns Hopkins Medicine

• Ronald R. Peterson, president of The Johns Hopkins Hospital and Health System and EVP of Johns Hopkins Medicine

• George Dover, director of the Johns Hopkins Children’s Center

• Pamela Paulk, vice president of human resources for The Johns Hopkins Hospital and Health System

• Judy Reitz, executive vice president and chief operating officer of The Johns Hopkins Hospital

Watch for further details at http://intranet.insidehopkinsmedicine.org/ncb/

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