Maximize Performance of Your Department of Medicine

Johns Hopkins Department of Medicine shares successful managerial and organizational strategies.

Academic Departments of Medicine are most effective with a mission-focused leadership structure, a thoroughly engaged workforce including nurses and administrators, and supporting faculty in scholarship achievements, recent research shows.

There are inherent leadership challenges at academic Departments of Medicine such as managing a diverse workforce and balancing the clinical and scholarly responsibilities of faculty.

Research published last month in The American Journal of Medicine shares how Johns Hopkins University School of Medicine has risen to these challenges.

The lead author of the research, who serves in a top role at Johns Hopkins, told HealthLeaders that the leadership recruitment process is crucial.

"Have a transparent process for leadership selection to develop a team with diverse experience and expertise. It is often easy to select individuals for leadership roles with whom we have a comfortable, pre-existing relationship; however, that may or may not be the best individual for the job," said Sherita Hill Golden, MD, MHS, professor of endocrinology and metabolism; executive vice-chair, Department of Medicine; at Johns Hopkins University School of Medicine.

At Johns Hopkins, all faculty members can vie for open leadership positions, she said. "A request for applications process that is disseminated to the entire faculty allows individuals with leadership aspirations and unique skills who may not be as well known to departmental leaders to be considered for important opportunities."

The Johns Hopkins Department of Medicine has more than 1,800 faculty, 900 nurses, about 900 trainees, and more than 1,000 non-clinical staff members.

The department's leadership structure features a vice-chair hierarchy. As executive vice-chair, Golden serves directly subordinate to the director of the department. There are four primary vice-chair leaders, who manage education, clinical care, research, and human resources.

Golden said there are three elements to attaining the best performance from a vice-chair leadership team.

• Develop clear job descriptions for each role so that the scope of responsibility is clear.
   
• To foster innovative programming across the academic mission, require vice-chairs to develop annual metrics and goals that are reported to the top leadership.
   
• Empower vice-chairs to lead within their mission area by entrusting them with responsibility. If the right leaders are in place, they should be given latitude to innovate without being micromanaged.

The Johns Hopkins Department of Medicine has developed sophisticated approaches to all four primary vice-chair mission areas, Golden and her coauthors wrote.

1. Managing human resources
 

The Faculty Development and Promotions Office supports all faculty in the pursuit of academic achievements in several fields such as biomedical research, medical education, clinical care, program building, innovation, quality, and safety.

There are several recognitions for clinical excellence, including enrollment in the Miller-Coulson Academy for Clinical Excellence at Johns Hopkins Bayview Medical Center in Baltimore.

Two associate vice-chairs promote retention and advancement of women and faculty who are underrepresented in medicine. Services offered include enhanced mentorship, access to career development opportunities specific to women and minorities, and leadership training.

2. Excelling at clinical care
 

The Clinical Affairs Office is split into two main divisions—overall clinical affairs and quality, safety, and service. Inpatient and ambulatory operations groups are also part of the leadership structure.  

The quality team focuses on four areas: patient safety; externally reported quality metrics such as hospital acquired condition rates; patient experience; and value-based initiatives that cut costs without compromising quality.

The inpatient team monitors and manages hospital throughput, inter-hospital transfer processes, length of stay, readmissions, and inpatient care policies. The ambulatory team has responsibility for clinical practices on both of Johns Hopkins' academic campuses and more than 30 satellite locations.

3. Driving research and innovation
 

A key feature of the Research Office is an innovation-to-market program called Innovation and Commercialization in Medicine (InCMed). The program is led by two Department of Medicine vice chairs in collaboration with the Johns Hopkins Carey School of Business.

The main goal of InCMed is to generate marketable healthcare products from discoveries in biomedical science and clinical care delivery. The program provides innovation networking opportunities across the medical campus and the applied physics laboratory.

4. Embracing education
 

The Education Office currently has four primary goals.

• All learners such as medical students and house staff have excellent clinical skills. Clinical learning experiences are encouraged—particularly bedside rounding.
   
• Multiple educational pathways and accelerated training foster careers in a wide range of healthcare fields.
   
• Faculty are incentivized to teach such as a compensation model incentive.
   
• Ambulatory medicine leaders are developed through measures such as enhanced curriculum and engagement of ambulatory subspecialists.