The former dean and the former hospital president had feuded openly, leaving Johns Hopkins in limbo with no vision for the future.
Within months, the school and Johns Hopkins Health System were merged and Miller became the first CEO and medical school dean in the restructured leadership.
Miller brought calm and for the next 16 years oversaw a building boom at Hopkins, creating a system with an international division, six hospitals and more than 30 primary and specialty health care facilities. He overhauled the medical school curriculum and built new research facilities.
His efforts cumulated in the spring with the opening of a $1.1 billion hospital for the East Baltimore campus.
There were also challenging times, including when Reisterstown resident Ellen Roche died in 2001 from lung damage and multiple organ failure after participating in an asthma research experiment led by scientists at Hopkins' Bayview campus. Also that year, 18-month-old Josie King died from severe dehydration and incorrect medication at Johns Hopkins Children's Center.
On June 29, Miller's tenure ends as he enters retirement. Dr. Paul B. Rothman, a rheumatologist and University of Iowa dean, will take over.
From his already packed-up office on the first floor of the Broadway Research Building, Miller talked to The Sun about his tenure, what he sees for the future of health care and how he now plans to spend his time.
What made you take the position?
Dan Nathans. Most people think of [then interim president] Dan Nathans as Mr. Hopkins himself. He is a great scientist and of the highest integrity. He only had the best of intentions for the institution. So when he asked me to consider being the interim dean, it was a great compliment. Then I called my friends around the country and my mentor, and they all said I should do it. I tried to put a time limit on it because interim roles are not always good roles. I said I'd do it for six months and figured it may get dragged out a little bit.
So you really thought it was just an interim role?
Yeah, they had a search firm, and the search firm said don't put your name in. You don't have an MBA. … And they were really bringing in pretty well-known people to look at this job who had big positions already in other cities.
But then Ron Peterson [president of the Johns Hopkins Hospital and Health System] and I started to work together. And we liked each other and we thought alike. But he has a whole separate set of skills than I have. We worked well together and neither one of us had a hidden agenda and our egos didn't get in the way and people trusted us.
So you proved yourself on the job not knowing you were proving yourself?
I actually think that is pretty much right. When you think about Johns Hopkins Medicine, it was something we were creating each day. There wasn't a playbook on how to do it. And when they formally made me the dean and CEO it was somewhat of a validation that we were working together well. And if you think about it — the crisis — it was that the two previous leaders couldn't work together. So now you had two that could work together and both were respected by the faculty and administrative staff, and I think that to the search committee and the trustees that was a good sign.
How did you approach the task of integrating the system?
First thing we did was take everybody away and spent a weekend talking about what are we all about. What's our core mission? What do we really stand for? We brought Jim Collins who wrote the book Built to Last. He used data and looked at how companies had done over 30 years in the stock market and he found that those who knew their core values and had aligned themselves with their values performed the best. So we had a set of core values that I think everybody resonated with and kind of got them on the right page. Then after that the issue was how do you address the issues that had languished for awhile because there was inability to move forward. So the first issues we had talked about is that we were doing very well in research. But we had little research space and we had very few plans for research space, so we had to tackle that problem.
Were people open to change?
Surprisingly so. All the directors [or chairmen of departments] changed during this period of time. The people chosen were people willing to be change agents. One of the things you find here is directors are incredibly important at this institution. We're very decentralized because a lot of the power, a lot of the money, really sits in the departments or institutes.
Why retire now?
I said that when the buildings are done it would be a good ending point. I'm 691/2. I want to spend a little bit of time with my wife. And we have a couple of grandkids we would like to see more. I didn't want to stop when somebody said, "When is that crazy guy going to leave?" I got a good platform for the next leader.
What was your biggest accomplishment?
The recruitment of the chiefs [department chairs]. The buildings are nice. There's no question the buildings are very symbolic. But in many ways it's the people that make it work. And we've been very successful because of the people. I spend a lot of time picking people. You have to pick them right.
What was the most challenging time?
The death of Ellen Roche. And Josie King. Those two deaths were probably the worst. That almost brought this institution to its knees. Handling those crisis situations are not necessarily fun, but you know you have to get in front of these stories.
How did you find out about Ellen Roche?
I was told right away: We got a problem at Bayview.
The first thing with Ellen was to get the facts right. Newspaper people want to get as much information as early as they can. But we didn't have all the facts we needed. So we withheld information so that what we said was correct. So we never had to retract anything. … Once we knew what the story was, we could go a couple of ways. You can say you have a stupid investigator who did a stupid thing and hang that person out to dry and wipe your hands of it. Or you can look at yourself and say, "What went wrong? What was our role and what are we going to do to fix it so it never happens again?"
We also had to deal with the government and the Office for Human Research Protections. That was a little more difficult partly because OHRP was trying to make a statement. There was some egos. They were leaking things out, I think, very inappropriately. I had to talk with Tommy Thompson, secretary of the Department of Health and Human Services, who I had actually known for a variety of other reasons. I said if you want to ramp the rhetoric up, I'm going to defend the institution. So you need to calm the rhetoric so we can do the right thing. This is not a battle that needs to be fought in the press. This is something that needs to be done together to improve the system. And he was incredibly reasonable. … So we actually came out on the other side with a better process than we ever had before.
So you changed the criteria and standards?
What I found was that there were a lot of people who thought "we are Hopkins and we know how to do this." But we didn't necessarily know how to do it.
Was there anything during your tenure that surprised you?
I would say fundraising became fun. I never really had to ever ask for money. I have a great product. When you think about the depth and breadth of this institution, whether it's academic, research or clinical, it all looks good. Fundraising is really all about relationship building. People get to know you and get to know what the institution is doing and want to help.
Why did you see the need to expand?
Howard County was the first expansion in '97. That was done in some ways as a defensive move. It had put itself up for sale. We had a significant number of patients come to us for more complex cases and we didn't want to lose that. At the time we were trying to understand if we could really use the expertise here and partner with a community hospital. … And we were already building a pretty good primary-care network in this region. Then Suburban Hospital put itself on the market. Then Sibley and the rest of the outpatient sites and primary-care sites also became available.
What do you think about Hopkins' relationship with the community and do you think it's improved over the years?
When Ron and I first started working together, one of the priorities was to work with the community. If you would have looked out here — out of this window right here — one of the things you would have seen was boarded-up rowhouses. You'd see drug deals going down right across the street from my office. There were bullet holes in one of the research buildings. The community was dying. We could let it continue to decline over the next 10 or 15 years. Or you could try to do something proactively.
There will always be questions about Hopkins' motivations. It is such a big institution. It always appears to the outside so rich compared to a lot of people in the community. But remember we employ a tremendous amount of people. And we employ people from all skill sets. We're one of the few employers who employ ex-convicts.
What are your thoughts on the future of health care and where it is headed?
If 17.9 percent of GDP is going for health care, that is unsustainable. Fee-for-service won't continue to work. There is no relationship between the number of procedures or visits and the improvement of health care for the individual. I think the only way you really get a handle on this is a fixed pot of money that takes care of a population of people, that not only takes care of a population of people but measures the outcome of those people. Preventive measures and screening measures become much more important than if it's just a fee for service. And so my view is the more population health [management] that we can do the better we will be able to improve quality of care. And maybe not decrease the cost but at least slow the rate of rise.
Anything you'll miss most about being at Hopkins?
The number of people I interact with on a daily basis. I walk the halls a lot and I see a number of people. That is what I will miss.