Alumni Profile

Brody’s Paradox

Johns Hopkins University president William Brody says improving patients’ hospital experiences will cut costs at academic medical centers

By Amy Adams
Photograph courtesy of Johns Hopkins University

William Brody, MD, PhD

The Stanford Medical Alumni Association honors William Brody, MD, 1970, PhD, 1972, as the Sterling Distinguished Alumnus for 2003. Details about Brody's career and a collection of his essays on matters academic and medical are online at

William Brody, MD, PhD, suspects that health care is overdue for a switch to some form of universal coverage, but until that day comes he is improvising as fast as he can to keep Johns Hopkins hospital one step ahead of the red. “I don’t know exactly where health care is going, but if you aren’t a survivor at the end you can’t be around to participate in whatever the new order is,” Brody says. “My goal is to survive.”

Brody, who is president of Johns Hopkins University, has taken an unusual approach to survival. “I decided that we aren’t going to focus on cost,” Brody says. At a time when university hospitals around the country are struggling, Brody decided to turn the hospital’s focus to quality. “If you drive quality up, costs will go down on their own.”

Brody is prone to taking the unusual path. While at Stanford he juggled medical school (class of 1970) and an electrical engineering PhD program during a time when the fields of medicine and engineering had little discernable overlap. Brody went on to become a professor of both radiology and electrical engineering at Stanford before his combined interests led him to co-found three medical device companies. He became president of Johns Hopkins in August 1996.

Johns Hopkins faces some of the same challenges as other university hospitals around the country, Brody says. These hospitals provide care to a disproportionate number of people without insurance and therefore have fewer patients paying in full for their care. The only way to bring in enough money to fulfill the hospital’s education and health-care missions is to lure patients with comprehensive health insurance.

Wooing those patients, Brody says, comes down to little things like better food and a smoother hospital stay, in addition to the specialized services that academic hospitals such as Johns Hopkins and Stanford excel at.

“Until now nobody has optimized the hospital’s operation from the patient’s perspective,” Brody says. Instead, many cost-cutting efforts strip money from individual departments, which cope by making internal changes. Each individual department might end up more cost-efficient, but unless those departments work efficiently together the changes only make the patient’s stay more prone to glitches, he says.

Take prescriptions, for example. Brody found 107 steps that a prescription must go through between a doctor’s pen and the patient’s bedside. With so many steps comes many opportunities for errors, which are expenses that negate any cost-cutting gains. By optimizing hospital operations from the patient’s perspective, he reduced the ways medications could go astray.

Brody likens a patient’s usual hospital stay to a car in an old-fashioned assembly plant. In the past, each stage of assembly acted independently with no person taking responsibility for the final product. “It’s an assembly line with units optimizing their own function,” he says. Except that in his case the units provide specialized health care rather than install transmissions. Car manufacturers dramatically improved quality and cut costs when they put more responsibility in the hands of the assembly-line workers.

Mimicking this advance seemed like an obvious step to Brody’s engineering mind. “The way you do that in a hospital is you assemble a team of doctors and nurses and identify key safety issues,” Brody says. His team has started evaluating each step in the patient’s hospital stay to look for ways to improve care. “We are now empowering the doctors and nurses to stop the assembly line and say, ‘We have a problem.’ ”

Encouraging doctors and nurses to take personal responsibility for a patient’s care has already paid off. Infection rates in the cardiovascular ICU have gone down significantly since Brody began his tenure. “If you can reduce infection rate, which you can, you can drive cost down,” he says.

Helping nurses spend more time with patients is one thing Brody sees as essential to improving care. Brody says nurses spend 60 percent of their time tracking down information, looking for equipment, answering the phone and doing other activities that have nothing to do with patient care. His team looked for low-tech solutions to eliminate these distractions.

One such solution was voice mail. Nurses complained that they were constantly updating patients’ families rather than taking care of the patients. Now, each patient has a voice mailbox where nurses can leave status reports at the beginning of every shift. “Now if all the family members want to know how Aunt Matilda is doing, they can call in and get that information from the message,” Brody says, leaving the nurses free to make sure Aunt Matilda gets the best possible care.

“You do a hundred little things like that and you’ve made an enormous difference,” he says. “It’s empowering because people responsible for the care can come up with the ideas.”

Although Johns Hopkins and many other university hospitals are innovative enough to hold their heads above the financial water, Brody thinks eventually the system will break. When that day comes, he thinks universal health care will be the only long-term way to keep costs in line. “It’s definitely coming either through the government or through the private sector,” he says. “It’s just a matter of when we will hit the tipping point.”

Brody has a hunch that the growing ability to predict disease risk is what will finally usher in universal health care. “If I say that you have low risk of breast cancer or heart disease, you would maybe not buy much health insurance,” he says. That leaves only high-risk people seeking insurance, causing insurance premiums to skyrocket. “The idea of insurance is that everybody is in the pool so it is an average risk. The only way to get costs in line is to make sure everyone is insured.”

Even if universal health care does eventually ease the financial burden on hospitals, Brody says that improving the patient experience will continue to pay off with better quality care—a worthwhile end result, even without the associated cost savings. SMD

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