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Restructuring at Hopkins


With 10,000 employees at its East Baltimore campus, together with the presence of some 25,000 visitors, students and patients each day, the Johns Hopkins Medical Institutions constitute a major economic influence on this region. But as the medical marketplace is being revolutionized by managed care, institutions like Johns Hopkins are finding themselves faced with daunting challenges that, left unaddressed, could severely threaten their future well-being.

The restructured governing procedures announced this week by Hopkins' board of trustees for the medical institutions reflect a necessary response to a changing marketplace that has swept away the old certainties about medical care, demanding a business savvy that has traditionally been foreign to institutions geared toward teaching and research. One of the primary aims of the new governance is to streamline Hopkins' ability to react more quickly in the health care marketplace.

The story also contains its share of egos and personal rivalries, especially between Dr. James A. Block, the hospital president, and Dr. Michael E. Johns, the medical school dean. Some of this is inevitable in an institution with so many people at the top of their professions. But personality issues can easily be exacerbated by lines of authority that often conflict. The trustees hope to ease that problem by giving the university president more authority over the hospital than has been the case through much of Hopkins' history. That is appropriate, given the radically new environment in which hospitals and medical research institutions will have to function.

It would also be appropriate for the committee charged with selecting a successor to former President William C. Richardson to take all this into account. Many Hopkins departments, from liberal arts to the sciences, rank at or near the top of their field. But in medicine the Hopkins name represents a virtual franchise. It is enormously important to the university and to the community that this franchise be protected and nurtured.

At stake is not just the economic importance of these institutions to Baltimore, but also their role as an international leader in medical training, medical treatment and medical research. The arrangement announced this week reflects months of study and, apparently, is unique among academic medical institutions. It will be closely watched by other academic medical centers challenged by the rise of manage care and the threat to federal funding that sustains medical research.

Since its inception, Johns Hopkins has proven itself in medicine many times over. The challenge now is to prove itself both in medicine and in a shifting health-care marketplace. Much depends on its success.

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