True to the Mission

David B. Hellmann, M.D., M.A.C.P.

David B. Hellmann,
MD, MACP

As we celebrate the 20th anniversary of the Center for Innovative Medicine, I’m proud to bring you this special edition of CIM Breakthrough, which is chock-full of more stories than ever about the extraordinary people and programs that have coalesced under CIM’s umbrella to dramatically improve patient care at Johns Hopkins — and around the world.

So much has happened at CIM over these two decades, and it’s impossible to capture every seminal moment in these 48 pages. Instead, in keeping with the theme of 20 years, we’ve captured 20 key accomplishments that exemplify work unfolding within areas key to CIM’s mission: clinical excellence, humanizing medicine, healthier aging, pioneering research and making medicine a public trust.

The scope of this work is breathtaking, and I am humbled to bear witness to the way our initial founding objective — to bring the best minds together to make medicine better, day by day, year by year — has expanded in scope. From CIM’s origins as a think tank at Johns Hopkins Bayview Medical Center, we have grown into a universitywide enterprise that now serves as a model for cross-disciplinary academic collaboration.

How have we accomplished this? That’s a question I’ve given a lot of thought to of late. As a native of Kentucky, I grew up when Col. Sanders was hawking his Kentucky Fried Chicken all over the world by claiming that it had a unique taste thanks to his “secret recipe of 23 herbs and spices!” But unlike Col. Sanders, I am happy to spill the beans about the “secret sauce” that has made the Center for Innovative Medicine so impactful.

First, from the very beginning, with the encouragement of then Johns Hopkins University President Bill Brody, we aimed high. Borrowing from the mission of Johns Hopkins — which from its founding has sought to revolutionize teaching, research and clinical care — we’ve reached for the stars. Modeled as well on President John F. Kennedy’s bold proclamation in 1962 that the United States would send a man to the moon, not because it was easy, but because it was very difficult, CIM’s aspirational goal of making medicine a better public trust has galvanized our best people, stimulated their most inspiring ideas, and unleashed their undaunted efforts. So, for example, in establishing the Miller Coulson Academy of Clinical Excellence to nurture and reward superlative doctors, the Academy’s founders developed a research-based process for measuring excellence that has become the standard not just at Johns Hopkins, but also at several important academic medical centers around the country. And in launching the Aliki Initiative to improve the way young doctors can be trained to provide patients with more humanized care, we didn’t limit the reach to the Department of Internal Medicine at Johns Hopkins Bayview. Today, it’s estimated that residents trained through the Aliki initiative have touched the lives of nearly 1 million patients. What’s more, the Aliki Initiative has inspired creation of CIM’s far-reaching new Initiative for Humanizing Medicine.

“In creating opportunities for lawyers to sit alongside Nobel laureates, for nursing leaders to swap ideas with biomedical engineers, we have created a fertile, cross-disciplinary environment that might best be described as ‘Johns Hopkins without borders.’”

Second, with our clarion call for big ideas that will change medicine and improve the patient experience, we’ve extended a wide welcome to big thinkers of every stripe, not just doctors and researchers, and not just members of one department. Through our CIM Seminars, Miller Lectures, book clubs and annual retreats, we’ve brought together brilliant minds from business, nursing, public health, engineering and more to brainstorm creative solutions to some of the biggest challenges in health care today. In creating opportunities for lawyers to sit alongside Nobel laureates, for nursing leaders to swap ideas with biomedical engineers, we have created a fertile, cross-disciplinary environment that might best be described as “Johns Hopkins without borders.”

Thirdly, thanks to the incredible generosity of our donors and the visionary leadership and philanthropy of my partner Stephanie Cooper Greenberg, chair of our International Advisory Board, we have committed to inspiring and treasuring Johns Hopkins’ most promising clinicians and researchers. In today’s cash-strapped world of academic medicine, it’s never been more difficult for junior researchers to procure funding from agencies like the National Institutes of Health. Time and again, CIM donors have stepped up to change that grim equation — to support the people whose big ideas have gone on to change the standard of care for a wide range of debilitating diseases.

Of course, the final ingredient to the secret sauce, that one that binds the other three together, has been our shared commitment at CIM to listen to our patients. It is only by keeping patients at the center of everything we do that we can succeed in our mission to make medicine a public trust.  While I’m proud of all we’ve accomplished at CIM these past 20 years, I’m even more excited about what’s to come. By staying true to our recipe, I’m confident that CIM will continue its high-flying trajectory, reaching new heights we can’t even imagine today. Thank you so much for your support — and I hope you enjoy the ride!

David_Hellmann_sig

David B. Hellmann, M.D., M.A.C.P.
Aliki Perroti Professor of Medicine

October 30th, 2024

Posted In:

True to the Mission

David B. Hellmann, M.D., M.A.C.P.

David B. Hellmann,
MD, MACP

As we celebrate the 20th anniversary of the Center for Innovative Medicine, I’m proud to bring you this special edition of CIM Breakthrough, which is chock-full of more stories than ever about the extraordinary people and programs that have coalesced under CIM’s umbrella to dramatically improve patient care at Johns Hopkins — and around the world.

So much has happened at CIM over these two decades, and it’s impossible to capture every seminal moment in these 48 pages. Instead, in keeping with the theme of 20 years, we’ve captured 20 key accomplishments that exemplify work unfolding within areas key to CIM’s mission: clinical excellence, humanizing medicine, healthier aging, pioneering research and making medicine a public trust.

The scope of this work is breathtaking, and I am humbled to bear witness to the way our initial founding objective — to bring the best minds together to make medicine better, day by day, year by year — has expanded in scope. From CIM’s origins as a think tank at Johns Hopkins Bayview Medical Center, we have grown into a universitywide enterprise that now serves as a model for cross-disciplinary academic collaboration.

How have we accomplished this? That’s a question I’ve given a lot of thought to of late. As a native of Kentucky, I grew up when Col. Sanders was hawking his Kentucky Fried Chicken all over the world by claiming that it had a unique taste thanks to his “secret recipe of 23 herbs and spices!” But unlike Col. Sanders, I am happy to spill the beans about the “secret sauce” that has made the Center for Innovative Medicine so impactful.

First, from the very beginning, with the encouragement of then Johns Hopkins University President Bill Brody, we aimed high. Borrowing from the mission of Johns Hopkins — which from its founding has sought to revolutionize teaching, research and clinical care — we’ve reached for the stars. Modeled as well on President John F. Kennedy’s bold proclamation in 1962 that the United States would send a man to the moon, not because it was easy, but because it was very difficult, CIM’s aspirational goal of making medicine a better public trust has galvanized our best people, stimulated their most inspiring ideas, and unleashed their undaunted efforts. So, for example, in establishing the Miller Coulson Academy of Clinical Excellence to nurture and reward superlative doctors, the Academy’s founders developed a research-based process for measuring excellence that has become the standard not just at Johns Hopkins, but also at several important academic medical centers around the country. And in launching the Aliki Initiative to improve the way young doctors can be trained to provide patients with more humanized care, we didn’t limit the reach to the Department of Internal Medicine at Johns Hopkins Bayview. Today, it’s estimated that residents trained through the Aliki initiative have touched the lives of nearly 1 million patients. What’s more, the Aliki Initiative has inspired creation of CIM’s far-reaching new Initiative for Humanizing Medicine.

“In creating opportunities for lawyers to sit alongside Nobel laureates, for nursing leaders to swap ideas with biomedical engineers, we have created a fertile, cross-disciplinary environment that might best be described as ‘Johns Hopkins without borders.’”

Second, with our clarion call for big ideas that will change medicine and improve the patient experience, we’ve extended a wide welcome to big thinkers of every stripe, not just doctors and researchers, and not just members of one department. Through our CIM Seminars, Miller Lectures, book clubs and annual retreats, we’ve brought together brilliant minds from business, nursing, public health, engineering and more to brainstorm creative solutions to some of the biggest challenges in health care today. In creating opportunities for lawyers to sit alongside Nobel laureates, for nursing leaders to swap ideas with biomedical engineers, we have created a fertile, cross-disciplinary environment that might best be described as “Johns Hopkins without borders.”

Thirdly, thanks to the incredible generosity of our donors and the visionary leadership and philanthropy of my partner Stephanie Cooper Greenberg, chair of our International Advisory Board, we have committed to inspiring and treasuring Johns Hopkins’ most promising clinicians and researchers. In today’s cash-strapped world of academic medicine, it’s never been more difficult for junior researchers to procure funding from agencies like the National Institutes of Health. Time and again, CIM donors have stepped up to change that grim equation — to support the people whose big ideas have gone on to change the standard of care for a wide range of debilitating diseases.

Of course, the final ingredient to the secret sauce, that one that binds the other three together, has been our shared commitment at CIM to listen to our patients. It is only by keeping patients at the center of everything we do that we can succeed in our mission to make medicine a public trust.  While I’m proud of all we’ve accomplished at CIM these past 20 years, I’m even more excited about what’s to come. By staying true to our recipe, I’m confident that CIM will continue its high-flying trajectory, reaching new heights we can’t even imagine today. Thank you so much for your support — and I hope you enjoy the ride!

David_Hellmann_sig

David B. Hellmann, M.D., M.A.C.P.
Aliki Perroti Professor of Medicine

October 30th, 2024

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1. Recognizing and Rewarding Great Clinicians

Clinical Excellence When Rosalyn Stewart, director of the Johns Hopkins Hospital Substance Use Consultation Service, was promoted to full professor in November 2020, it marked a welcome new day for many faculty members across Johns Hopkins Medicine.

That’s because Stewart was the first to be promoted on Hopkins’ new Clinical Excellence track, which recognizes and rewards faculty members whose professional focus is on providing outstanding patient care.

In the four years since then, more than 100 superlative clinicians from departments throughout Johns Hopkins Medicine have been approved for promotion on the new track — and dozens more are now at various stages of the evaluation process.

“In terms of applications, the pace has really picked up. The Clinical Excellence track is absolutely thriving,” says Hopkins psychiatrist Meg Chisolm, who initially co-led the track’s promotions committee, which is now co-led by ophthalmologist Sharon Solomon and CIM Director David Hellmann.

This momentous step forward, Hopkins leaders agree, can be directly attributed to the foundation laid by CIM’s Miller Coulson Academy of Clinical Excellence, which launched in 2008 with Scott Wright as director.

“At Johns Hopkins, we pride ourselves on doing things rigorously and objectively, but up until the Miller Coulson Academy, there was general skepticism that clinical excellence could be measured in a clear and consistent way.” – Cynthia Rand

“At Johns Hopkins, we pride ourselves on doing things rigorously and objectively, but up until the Miller Coulson Academy, there was general skepticism that clinical excellence could be measured in a clear and consistent way,” notes Cynthia Rand, senior associate dean for faculty.

The design of the Miller Coulson Academy reflected nearly two years of research and interviews with experts throughout the country conducted by four Miller Coulson Scholars — Colleen Christmas, Chris Durso, Steve Kravet and Scott Wright — who were supported in their work by a gift to CIM from Johns Hopkins Medicine trustee Sarah Miller Coulson.

The scholars, who published their findings in Mayo Clinic Proceedings in 2008, were inspired by a provocative question asked in 2006 by Mrs. Anne Miller: “Why aren’t there more Dr. Philip Tumultys?” She was referring to a man who had been her doctor, a legendary Hopkins clinician known for his “back-to-basics, humanistic approach to the treatment of patients.” She was concerned that — despite their remarkable success in scientific discovery — academic medical centers were not producing skilled, thoughtful clinicians of the caliber of Dr. Tumulty.

Says Rand: “The Miller Coulson Academy really made a mark, both locally at Johns Hopkins and nationally, by developing a truly rigorous process — including extensive internal and external peer review and objective clinical metrics — for measuring excellence in clinical care.”

Shifting the Culture

While Johns Hopkins Medicine has long operated under a tripartite mission — of research, education and patient care — when it came time to evaluate faculty members for recognition and promotion, excellence in research dominated.

“That means that there were faculty members who were pulled away from their true passion — caring for patients — because they needed to put so much time into research, writing papers and traveling to conferences in order to get promoted,” says Chisolm.

That culture saw a dramatic shift with the establishment of CIM’s Miller Coulson Academy, which has cultivated a community of standout clinicians — now numbering more than 100, from across Johns Hopkins Medicine — since its start 16 years ago.

“Membership in the Miller Coulson Academy has become an aspirational goal for many for whom excellence in patient care is their raison d’être and their passion,” says Wright, holder of The Anne Gaines and G. Thomas Miller Professorship. “Joining the Academy gives one the opportunity to regularly meet with other Academy members — leading clinicians from all across the institution — who are focused on how to provide superb, patient-centered care.” Being elected to the academy is valued so highly that many academy members note their membership in the signature line of their emails.

Importantly, Academy members also serve as role models and teachers to the next generation of physicians by mentoring trainees, presenting at Ground Rounds and through continuing medical education courses.

Each year, only a small percentage of the most respected physicians who are invited to apply to the academy (after having been nominated by many peers) are ultimately offered membership. When building their portfolios, applicants must provide the names of 10 patients, 10 physician peers, 10 learners and 10 nonphysician clinical providers (e.g., nurses and medical assistants) who provide confidential assessments across eight domains of clinical excellence. One key element to the process is external evaluation: Master clinicians from top academic institutions around the country review and score the clinical portfolios that are submitted.

“As the Miller Coulson Academy advanced,” says Rand, “we were able to use its groundbreaking work as part of our rationale in our presentation to school of medicine leaders that yes, indeed, we do know how to measure clinical excellence fairly and to create a rigorous promotional pathway. Without the Miller Coulson Academy, we never would have been able to successfully make that argument.”

The Miller Coulson Academy has also made a significant impact across the broader landscape of academic medicine, with institutions including Ohio State College of Medicine, Columbia University’s Vagelos College of Physicians and Surgeons, and Harvard Medical School adopting aspects of the model for their physician training and faculty promotion.

A Clear Path Forward

When the first round of faculty candidates came up for promotion on the Clinical Excellence track in 2020, Chisolm says, “It brought tears to my eyes to discover top clinicians who had spent decades devoting themselves to the service of patients and their families, and yet they were languishing at the lower promotion ranks. What’s more,” she adds, “they had mentored younger trainees who had gone on to become physician scholars who were recognized and promoted. It was both ironic and startling.”

Now there is a clear path forward for promotion, which begins with a 360-degree review, through which nominees are evaluated by clinical peers, leaders, staff members and learners, as well as from patients and their family members (when applicable). To be promoted to associate professor, applicants must be rated in the top 25% of their field. To attain full professor, they must be rated in the top 10%. Many applicants far exceed those levels, Chisolm says.

Applicants are evaluated based on several domains of clinical excellence. “They must be clinical leaders,” says Chisolm. “Most have built clinical programs, instituting innovations and improvements in the way patient care is provided, and their work is being emulated across the country. Some have established programs in other countries.”

In addition, successful applicants must be actively engaged in teaching the next generation — teaching, mentoring and encouraging young health care professionals and family members. Finally, they must be actively engaged in the mission of discovery, pursuing quality improvement projects or participating as a clinical expert on a scientific project.

“The Miller Coulson Academy really gave us the ‘bones’ for building this new pathway, and we wanted to be very clear that ‘excellence’ is key to how clinicians will be evaluated,” Rand says.

“Not only did the Miller Coulson Academy create the bedrock for the Clinical Excellence track to launch — it has been key to the expansion of clinical excellence beyond the mothership of The Johns Hopkins Hospital.” – Cynthia Rand

Already the new promotion track is proving crucial to retaining top clinicians who might otherwise have been recruited away to other institutions — and to attracting clinician leaders who previously would not have considered joining Johns Hopkins. “Who wants to go from being a full professor at one institution to being an assistant professor with no real plan for promotion?” says Chisolm. “We saw firsthand how difficult it was for department chairs to recruit outstanding new faculty from outside.”

With the new Clinical Excellence track, the prospects for recruitment and retention have dramatically improved, she says. “There’s a validation that comes with this. You belong here. You are valued. That’s immeasurable.”

The timing of the new Clinical Excellence track “was just about perfect,” says Rand, “because Johns Hopkins Medicine leaders had been thinking about a broad clinical expansion, which means we need to bring in many more outstanding, clinically excellent physicians and offer them a way to build a career here.”

Rand continues, “Not only did the Miller Coulson Academy create the bedrock for the Clinical Excellence track to launch — it has been key to the expansion of clinical excellence beyond the mothership of The Johns Hopkins Hospital. We now have a basis for expanding and growing our clinical faculty and recognizing their clinical excellence.”

She pauses, then adds, “I feel like a proud godparent.”

“What started out 20 years ago as a humble directive — to make medicine a better public trust — has flourished into a full-fledged cultural crusade in medicine. Through its many transforming initiatives, CIM has provided gravity-defying lift to a medical world, where excellence and collaboration are the norm; where patients are seen and cared for as people; and where caring, creativity, ingenuity, humility and an unstoppable desire to do more are everyday beliefs. As a CIM board member and supporter, I’ve been honored to watch, experience and admire CIM’s towering achievements and impact. Simply put, CIM is a force for good in medicine and in our world.”
– Stephanie Cooper Greenberg, Chair of International Advisory Board

“From a 10,000-foot view CIM has been astonishingly effective. CIM started out with small, focused projects — all based on this idea of medicine as a public trust, together with the constant theme of keeping patient voices heard — and has amazingly grown into a powerful force for growing medicine in a way that always keeps patients at the center.”
– Cynthia Rand, Senior Associate Dean for Faculty

October 30th, 2024

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2. Driving High-Value Health Care

Graphic of dollar signThe figures are both sobering and staggering. Nearly 20% of American households reported medical debt in 2019, and it remains the leading cause of bankruptcy, while also contributing to food insecurity, utility debt, eviction and foreclosure. Meanwhile, experts estimate that $700 to $900 billion in annual health care expenditures is wasted — through unnecessary tests and treatments, and failures in delivering and coordinating care.

Into this breach stepped Johns Hopkins radiologist Pamela Johnson, Stanley Levenson CIM Scholar. “I knew a problem of this magnitude could not be solved by a single medical institution,” she says. “As a nation, we needed to move from ‘high volume’ to ‘high value.’”

So in 2017, she and her Hopkins colleagues convened 100 academic medical centers partners from across the country to form the High Value Practice Academic Alliance. The cornerstone of this national alliance is an annual conference, held each year in Baltimore, where clinicians disseminate their initiatives to improve health care quality while driving down unnecessary costs. The alliance also zeroed in on training tomorrow’s physicians in the principles of high-value health care. The impact has been far-reaching, with more than 1,000 abstracts presented to date.

“Over time, we realized we needed to shift from single-resource issues to more broadly improving the effectiveness of clinical care and coordination to protect patients from potentially avoidable emergency department visits and hospital stays.” – Pamela Johnson

In the first years of the alliance, says Johnson, physicians focused on reducing “low-value” tests as part of the national Choosing Wisely campaign, which has successfully eliminated unnecessary lab and radiology tests at Johns Hopkins and across the country.

“Over time, we realized we needed to shift from single-resource issues to more broadly improving the effectiveness of clinical care and coordination to protect patients from potentially avoidable emergency department visits and hospital stays,” says Johnson. Toward that end, alliance faculty are publishing a “roadmap” — a series of manuscripts — to guide hospitals across the country in delivery patient-centered, high-value care.

“Our mission is to dramatically improve the reach and quality of health care for patients throughout the United States,” Johnson says, “which will drive measurable reductions in health care spending.”

In addition to her national leadership, Johnson has been a key driver of change at Johns Hopkins. In 2020, she was appointed vice president of care transformation for the entire Johns Hopkins Health System (see p. 20). “The funding I received as CIM’s Stanley Levenson Scholar has been absolutely critical to this work,” Johnson says. “It has been used to support the national alliance, the creation of continuing medical education programs and the awarding of seed grants to Hopkins faculty.”

October 30th, 2024

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3. Bolstering Bedside Medicine

A renowned pulmonologist and critical care physician, Brian Garibaldi has directed the Johns Hopkins Biocontainment Unit and the Johns Hopkins Precision Medicine Center of Excellence for COVID-19. But some of his most powerful work has been as a physician educator and tireless advocate for the revival of a once sacrosanct ideal — that learning and developing excellent bedside skills is essential to great patient-centered care.

It is also essential to physician morale. “No one becomes a doctor because they want to spend their time being a computer sleuth,” he says, pointing to studies showing that physicians spend more than half of their time on the computer and only about 13% with patients.

In 2016, Garibaldi co-founded the Society of Bedside Medicine, a global initiative that, among other things, supports a bedside medicine fellowship at Hopkins and other institutions. And his appointment in 2018 as the Douglas Carroll, MD CIM Scholar — funded to honor the legendary Hopkins bedside clinician by his daughter, Susan Immelt, and her husband, Stephen — has helped fuel his mission of reinvigorating the Hopkins culture of bedside medicine.

“Because we don’t spend a lot of time in the presence of patients and their families, fundamental clinical skills — such as how to conduct a physical exam and how to talk to patients — are in decline.” – Brian Garibaldi

It helped support his expansion of the clinical skills curriculum he’d developed for the Osler Medical Residency Program to the Bayview Medical Residency Program as well as his creation of a novel bedside clinical skills assessment program. “Because we don’t spend a lot of time in the presence of patients and their families, fundamental clinical skills — such as how to conduct a physical exam and how to talk to patients — are in decline.”

Garibaldi believes that decline can be reversed — “by building back time at the bedside” using tools like AI to make the electronic medical record more navigable and point-of-care testing devices like ultrasound that require close physical engagement with patients. “And we have to build back a culture where assessment of a physician’s skills is part of all levels of training,” he says.

On Sept. 1, 2024, Garibaldi left Hopkins to become the Charles Horace Mayo Professor of Medicine and inaugural director of the new Center for Bedside Medicine at the Northwestern University Feinberg School of Medicine in Chicago, Illinois. His legacy at Hopkins includes the now well-established bedside medicine curriculum, the clinical skills assessment program, and the hundreds of students, residents, fellows and faculty who have participated.

October 30th, 2024

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