Abstract
Through his courage and convictions, this visionary otolaryngologist is pioneering new models of health and healing for the nation in this century.
Niccolo Machiavelli wrote in his 1532 treatise, Il Principe, There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. Yet this is exactly what Michael M. E. Johns, MD, Executive Vice President for Health Affairs at Emory University in Atlanta, does each day as one of the nation’s renowned physician thought leaders on health care reform.
The future of health care is a gigantic issue for America, as it will affect everyone and everything, said Dr. Johns, who is also the CEO of The Robert W. Woodruff Health Sciences Center, Chairman of the Board for Emory Healthcare, Co-Chairman of the Board of EHCA, LLC, and Professor in the Department of Otolaryngology at the Emory University School of Medicine.
In a country with multiple health systems and almost 50 million uninsured, reform is essential and we need to address this issue again, said Dr. Johns. Unfortunately, not until costs are so high, the burden on employers and government so great, and the noise of the press so loud, will we see more serious and in-depth conversations on reform in Congress.
Almost 50% of Americans say the country’s health care system needs fundamental changes and 30% believe it should be rebuilt completely, according to a survey, Public Views on Shaping the Future of the U.S. Health System, conducted by Harris Interactive for the Commonwealth Fund. Participants, regardless of political affiliation, are very eager for the president and Congress to address specific issues, such as prescription costs and the long-term solvency of Medicare, to name a few (see sidebar.)
Predictive Health
I think health care is going to change dramatically over the upcoming decades from a reactive and acute approach of caring for individuals to one that is more proactive-that is, keeping people healthy as opposed to treating their sickness, said Dr. Johns. Eventually, the onset of disease will be considered a failure of the health care system, rather than its focus.
This paradigm shift, concentrating on health rather than disease, will come from the science that is developing around the country in the areas of genomics, proteomics, metabolomics, structural biology, computational science, and other advanced technologies, Dr. Johns said. Predictive health and healing will allow us to provide care that is predictive, prospective, personalized and preventive-what we refer to as P4.
Not only is science making it possible to change our current health care model, but so is society, Dr. Johns stated in his recent Vision 2012: Transforming Health and Healing address. Globalization means that we have unprecedented opportunities for improving public health, but we also face unprecedented risks for the rapid spread of disease, in addition to threats to health from natural disasters and man-made terrorism.
Science is enabling and society is requiring that we quickly make this transition and move beyond simply being the best within the current model of health care, and instead, provide the leadership to develop new forms of health and healing in the 21st century, said Dr. Johns.
Physician Leaders
To achieve his leadership vision, Dr. Johns has led the reengineering of Emory’s health care system, as well as major initiatives to focus and expand the research mission and innovations in health professions education. More than 2.1 million square feet of new mission-critical space has been added and an entire hospital essentially rebuilt. He has forged key partnerships with local universities-including the only joint department of biomedical engineering in the country (with Georgia Tech)-and has founded synergies with both public and private companies and organizations that leverage strengths and opportunities across all mission areas.
Dr. Johns also established the Woodruff Leadership Academy (WLA) (http://whsc.emory.edu/_wla/index.html ) in 2003-a program designed to grow tomorrow’s leaders from the ranks of today’s researchers, physicians, educators and administrators. By leaving the silos within their academic health centers, fellows learn managerial and technical expertise, as well as interpersonal, communications, and presentation skills necessary to meet the challenges of a rapidly changing health care environment.
Most importantly, these leaders-in-training learn how to work in teams. Leadership is about how you submerge your own ego and get those around you to rise up, said Dr. Johns in Momentum, a WLA publication. Everyone has a role to play. There are no unimportant people. Fellows gain an appreciation for, and expertise within, the teamwork approach to problem solving, planning, and operational implementation.
Physicians need to take on more leadership roles, become more knowledgeable and take a broader interest in health policy, health professions education and national health system reform, Dr. Johns said. He also advises his fellow otolaryngologists to become problem solvers, but to do so within the context of the larger organization to which they belong.
For example, by recruiting world-class faculty, increasing research funding by 60%, and consolidating clinical enterprises under one umbrella (Emory Healthcare) during the past 10 years, Dr. Johns has positioned the Woodruff Health Sciences Center as one of the nation’s preeminent academic health centers in education, research, and patient care.
Prior to his position at Emory, Dr. Johns was Dean of the Johns Hopkins School of Medicine and Vice President of the Medical Faculty at Johns Hopkins University. Under his leadership, the medical school rose to first place in sponsored research, restructured its curriculum to meet the challenges of a new era in health care, and developed a state-of-the-art technology transfer program.
Dr. Johns always challenges you to see and to lead, said Jonathan Saxton, MA, JD, Special Assistant for Health Policy and Communications in the Office of the CEO, Woodruff Health Science Center. He strongly believes in bringing together the best people possible and tapping their deepest reservoirs of initiative and creativity.
Vision 2012: Transforming Health and Healing
Emory is in the process of establishing an initial set of five Centers of Excellence (neuroscience, cardiovascular, transplant, lung, and cancer) that will become models of the types of integrated, patient-centered research and clinical care that Dr. John envisions, as well as the benchmark by which other national centers are measured. The key characteristics of these centers include:
- Integrated and inter-professional care teams;
- Services based on discovery and innovation;
- Inter-disciplinary education and training;
- Outcomes-based research and feedback;
- Technology that enables on-demand information sharing; and
- Measurable impact on the health of the populations served.
Dr. Johns is passionate about achieving the highest-quality standards of care, said Mr. Saxton. He believes that that every patient should receive the best care and has, therefore, instituted a total revamping of Emory’s quality control, ensuring that everyone is responsible and knowledgeable about the standards of care, not just a single quality control officer.
Additionally, Emory has partnered with Georgia Tech to create the Predictive Health Initiative, composed of the Center for Health Discovery and Well-Being, that will pioneer clinical approaches to predictive health, and Biomarker Science Discovery and Validation to develop and validate novel biomarkers for specific diseases and conditions.
In his Vision 2012, Dr. Johns said he believes that Emory is the perfect place to become not just the clinical and scientific leader, but also the thought-leader in transforming health and healing.
He knows that no one leader can deliver a long-range vision to fruition, so he has created leadership development programs like the WLA to ensure that Emory and the Woodruff Health Sciences Center have the leadership talent in place to continue the vision for decades to come, said Gary Teal, MBA, Senior Associate Vice President for Administration and Dr. Johns’ Chief of Staff.
Legacy
The final test of a leader is that he leaves behind him, in other men, the conviction and the will to carry on, wrote Walter Lippmann in his article, Roosevelt Has Gone, published in the New York Herald Tribune, April 14, 1945.
If we are not careful as physicians, we are going to leave a lot of cynics behind, and that would be a disaster, warns Dr. Johns. As physicians, we need to reset our priorities, focus on what it means to be a physician professional, and leave a legacy of leadership, integrity, character, and honor for tomorrow’s physicians to emulate.
Adds Mr. Teal, Mike Johns is always pushing physicians-and all of us-to think in terms of ‘why not?’ instead of ‘why?’
As the paradigm shifts, it will create a new direction in terms of the kinds of health professionals we will need and how and when we will train them, said Dr. Johns. Presently, there is a need for specialists, but over the next 20 years there may be a shortage of general physicians due to the expanding population and aging baby boomers, thereby creating a role for advanced practice nurses and physician extenders at the primary care level.
Based upon changing physician attitudes and work/lifestyle demands, my colleagues and I at the Association of American Medical Colleges projected last year that we would need to raise the number of medical students by 15 percent. Now we are looking at 30 percent as to what is really needed.
I am concerned that America is not producing enough graduates in science and technology, so that we can continue to be the world leader in this area, said Dr. Johns. We are going to have to spend the dollars to enhance our science and technology education, support and educate more students in these academic areas in K-12 and beyond, as well as work faster, smarter and harder if we want to keep our leadership position.
As health care continues to evolve, so does medical education, adds Dr. Johns. The medical school curriculum of today is more about preparing medical students to go forward with further training. We are creating what I call ‘stem cell physicians’; they all learn the same core of medical knowledge and practice, but ultimately differentiate into their own specialties, work patterns, and place in society.
Dr. Johns’ own children exemplify this thought. His son, Michael, also an otolaryngologist, established and directs the Emory Voice Center, helping speakers, singers, and others with vocal problems. Daughter Christina is a pediatrician who devotes much of her time to medical communications and broadcasting for some of the major networks.
Who will be responsible for transforming health and healing in our time? asks Dr. Johns. I don’t have a crystal ball to know the answer, but hopefully, all of us in the health care profession will play a role in this new era of predictive medicine. Our science and our world need good and thoughtful leadership. I invite and challenge my fellow physicians to be those leaders.
Dr. Johns and Otolaryngology
Dr. Johns graduated with distinction from the University of Michigan Medical School, and remained at Michigan for his internship and residency. He then joined the Medical Corps of the US Army and was assistant chief of the Otolaryngology Service at Walter Reed Army Medical Center. Following his army service, he joined the Department of Otolaryngology and Maxillofacial Surgery at the University of Virginia Medical Center, where he rose to the rank of Professor. In 1984, Dr. Johns was recruited to Johns Hopkins as Professor and Chair of Otolaryngology-Head and Neck Surgery, a department he built into one of the country’s largest and most prestigious. As Associate Dean for Clinical Practice, he reorganized the faculty practice plan and planned and developed the Johns Hopkins Outpatient Center. As a cancer surgeon of head and neck tumors he was internationally recognized for his work and his studies of treatment outcomes.
Dr. Johns has served as member of the Board of Directors and as president of the American Board of Otolaryngology, as chair of the Association of Academic Health Centers, and as Chair of the Council of Deans of the AAMC. He served as editor of the Archives of Otolaryngology from 1992 to 2005, and serves on the editorial board of the Journal of the American Medical Association.
©2006 The Triological Society