Even as the Johns Hopkins University seeks a new president, trustees of the university and Johns Hopkins Hospital are searching for a way to defuse conflict between the leaders of the two proudly separate institutions.
For the past four months, hospital trustees and their university counterparts have met to consider proposals that would streamline the complicated relationship between the institutions, which were created as distinct corporations by law in 1867.
Sources indicated a joint committee of the boards has settled on the following steps:
* Giving the next university president a greater role in coordinating activities involving the hospital and the university's School of Medicine;
* Establishing more formal connections between the university and the hospital;
* Strengthening the authority of Johns Hopkins Medicine, a little-known oversight group that coordinates joint activities of the hospital and medical school. The group consists of leaders of the hospital, university and medical school.
The changes appear to enhance the university's authority in activities involving the hospital, while keeping the hospital as a separate corporation with its own board.
Hopkins University President William C. Richardson will leave this month to become president of the W. K. Kellogg Foundation in Michigan. Hopkins microbiologist Daniel Nathans will be acting president while a national search for a replacement is conducted.
The trustees are expected to make an announcement Monday about the structural changes, although details are still to be resolved.
"You're catching us in a position where we still have a few days of homework to do," Morris W. Offit, chairman of the university board, said yesterday.
In fact, some trustees said they were unaware of the joint committee's plans.
Although the hospital and university were funded by a bequest from Johns Hopkins about 130 years ago, they are separate, with distinct boards and presidents. Only twice has one person served as president of both institutions.
The unusual discussions between the two boards are occurring during a worrisome time for academic health care centers like Hopkins. Revenue from patient care and from the federal government appear threatened, raising concerns about the future financial health of the hospital and Hopkins' ability to educate doctors and perform medical research.
But Hopkins has another problem, which Hopkins sources say undermines the organization's ability to cope with outside threats. Two Hopkins titans, hospital President James A. Block and the dean of the School of Medicine, Dr. Michael E. Johns, are engaged in a fierce conflict.
Once friends, they have quarreled over power and issues affecting their separate jurisdictions. Dr. Block, although president of the hospital and the Johns Hopkins Health System, has no authority over the medical school and its 1,000 faculty physicians.
The School of Medicine is a powerful, nearly autonomous division of the university. The dean rivals the hospital president in influence on the East Baltimore campus.
Their conflict stems partly from Dr. Block's efforts to make the hospital and health system more efficient and more appealing to health maintenance organizations, which increasingly control where patients receive treatment.
To win HMO contracts, Hopkins has begun to recruit non-Hopkins doctors and to negotiate lower fees for its own doctors, actions that anger many faculty members.
Trustees, alarmed by the conflict between the two men, have attempted to smooth it over. But, in an example of the continuing struggle, Dr. Johns has supported creation of a medical chancellor position that would give the dean more clout -- a step Dr. Block strongly opposes, sources say.
Part of the conflict grows out of different priorities and values. While the medical school's faculty prizes its independence in research and education, the hospital must react to the pressures of the marketplace in trying to meet HMOs' demands.
One source who knows both men said these differences are personified by Dr. Johns, who came up through the faculty ranks, and Dr. Block, a medical administrator brought to Baltimore for his strategic planning skills. "At the core of this are a whole series of different values, aspirations and goals," the source said. "It's the wrong mix at the wrong time."
Both men declined to comment.
The university's trustees have different goals than the trustees of the hospital and health system, although some trustees sit on both boards. University trustees fear that the conflict might hobble their efforts to find Dr. Richardson's replacement, as candidates may be reluctant to take the job without control of the hospital.
The chairman of the hospital's board of trustees, George L. Bunting Jr., refused to discuss the talks between the boards.
Other sources familiar with the talks say there are huge obstacles to reorganization that would discourage the boards from taking stronger steps. "If they do come back with a recommendation for change, I think it's going to be real tough because [Hopkins has] operated for so long one way," said a trustee. "Think about it. . . . There are tremendous egos involved."