so "magical" about a new
years, the Emory pediatrics department was housed in trailers behind
the children’s hospital. Offices, research laboratories, advocacy
programs, and outpatient services were all crammed into these temporary
modular units, where faculty and staff performed yeoman’s
work ensuring that patients and their families received the care
and attention they deserved. Plans for a new building remained in
limbo for decades, stalled by one impediment after another—including
a contentious divide that grew between Emory and the hospital.
But today one only has to look around
to know that things have changed. The new pediatrics building is
an apt symbol for a new era for Emory and Children’s.
Leading medical centers for children
all have one thing in common, says Stoll: a strong tie between a
children’s hospital and an academic pediatrics program. Emory
and Children’s have all the ingredients to become one of the
nation’s top five centers.
“The leaders of both institutions
share that vision,” she says. “And we now have an unprecedented
partnership to achieve it.”
partnership is born
has a long history with Children’s that stretches back to
1928, when Henrietta Egleston Hospital for Children opened on Forrest
Avenue in downtown Atlanta. Although privately owned and open to
all physicians, Egleston developed a special relationship with Emory
from the beginning. Emory’s pediatrics chair served as medical
director of Egleston as well as chief of the pediatrics service
at the public Grady Memorial Hospital, with Emory trainees getting
the benefit of instruction at both facilities.
In 1959, Egleston moved to a new 100-bed
facility next to the university, cementing its symbiotic ties with
Emory. As the medical school added new pediatrics faculty with unique
and highly specialized expertise, Egleston’s abilities also
grew. Emory’s relationships in pediatric care expanded throughout
the area, with faculty and residents at Grady (see
A Blended Family), then later at Emory Crawford Long
Hospital. Egleston, meanwhile, grew into a regional pediatric referral
center where community doctors sent their most complex cases. Each
time Egleston expanded into new services, this likewise broadened
Emory’s teaching programs.
In the late 1960s, Emory’s pediatric
reach began to extend far past Atlanta and achieved several important
milestones over the next few decades. Virologist Andre Nahmias,
for example, developed the first genital herpes clinic in the world
at Grady, in response to the devastating problem of transmission
of maternal herpes infection to newborns during delivery. The Poison
Control Center at Grady went statewide in services offered and funding
received. Emory’s Cystic Fibrosis Center, started by Daniel
Caplan, was the first such facility in the surrounding five states
and immediately drew children from across the Southeast. Richard
Blumberg, Emory’s pediatrics chair from 1954 to 1981, established
the first clinical genetics laboratory in Georgia, which eventually
led to the establishment of statewide screening of newborns for
genetic diseases. Meanwhile, pediatric nephrologist Barry Warshaw
set up the state’s first dialysis program serving children
at Grady, later moving to specialized kids-only dialysis services
When George Brumley arrived from Duke
to take the pediatrics chair in 1981, the title of a departmental
history published that year, “A Department Comes of Age,”
exuded confidence. The future looked bright.
But then a cascade of events caused
an unanticipated schism between Emory’s pediatrics department
custody battle ensues
In the late 1980s, as the specter of managed care loomed on the
horizon, Brumley and the hospital together decided to bring in an
outside consultant to help both institutions shape their growth.
Soon after the consultant’s report was finished, the head
of Egleston left, and the consultant, Alan Gayer, was named the
new hospital CEO.
In the meantime, changes were taking
place in the structure of the Emory/Egleston relationship. In hopes
of strengthening financial performance in the fast-changing managed
care marketplace, pediatric cardiology moved from The Emory Clinic
into a newly created Children's Heart Center, forerunner of the
Sibley Heart Center. Brumley also moved the rest of the pediatrics
section out of The Emory Clinic and created a new group, the Emory
Egleston Pediatric Care Foundation (EEPCF).
Things seemed to go smoothly at first.
But as the health care climate became more difficult, seemingly
irreconcilable differences in priorities grew between hospital and
EEPCF leadership. Hospital leadership was more focused on profitability.
EEPCF leadership, while also concerned about financial performance,
placed higher priority on university missions in teaching and research.
In this climate, architectural plans
for a new building grew yellow around the edges and then vanished
At the end of 1994, Brumley stepped
down from the chairmanship to devote more time to the work he started
with a private foundation on improving care for children in underserved
areas. He also hoped his resignation would be a quiet statement
of how important it was that Emory and Egleston repair their strained
The person selected to replace Brumley
was Devn Cornish, a division director in neonatology who had led
the successful joint effort between the hospital and department
to establish an extracorporeal membrane oxygenation (ECMO) program.
A former missionary, Cornish was as soft-spoken as Brumley and,
given the success of the ECMO program, someone who worked well with
both Emory and Egleston. Named acting chair in December 1994, he
focused on holding the department together and improving the relationship
between the hospital and the medical school.
In 1996, working with Egleston leadership,
Cornish developed the Emory Egleston Children’s Center, a
practice plan that integrated all 181 members of the pediatrics
faculty and all other Emory physicians who cared for children.
In February 1997, Cornish was named
permanent chair of pediatrics. But within a month, significant new
strains emerged as Egleston’s Gayer unilaterally began recruiting
Children’s Center faculty to leave Emory and become direct
employees of the hospital.
With this new breach of faith, the
joint clinical organization between Emory and Egleston became unworkable.
Cornish worked to convert it into the current Emory Children’s
Center, a subsidiary of Emory Healthcare that is parallel to The
Emory Clinic. But this new disruption hurt the department and morale.
Then, almost overnight, everything
The strength of many of Emory’s pediatric programs comes
from their connection with both Children’s Healthcare
of Atlanta and the publicly owned Grady Memorial Hospital,
which encompasses its own pediatric facility, Hughes Spalding
A prime example of collaboration
among these institutions is the far-reaching Emory Regional
Perinatal Center, established in 1977. Emory pediatrics professor
Al Brann, then head of neonatology, had been at Emory for
only a couple of years when he and then
gynecology/obstetrics chair Luella Klein helped Georgia set
up the state’s first statewide regional perinatal referral
network. Its goal was to lower death and disability among
high-risk infants (and high-risk pregnant women) by making
sure these babies and women got the highest level of care
they needed, no matter where they received it and without
regard for their ability to pay.
The Emory Regional Perinatal
Center, one of six in the state, has responsibility for the
area from Atlanta to the Tennessee border.
The center’s success can
be attributed to the pooling of the resources of Emory doctors
and three different hospitals: Children’s Healthcare
of Atlanta at Egleston, Emory Crawford Long, and Grady, says
George Bugg, the Emory neonatalogist who directs the program
today. Emory pediatrics is the connective tissue. Emory physicians
have always headed the center—Brann himself did so for
its first 15 years—and they provide the physician services
at all three hospitals.
It works like this.
A baby is born in north Georgia with problems beyond the expertise
and resources of the local hospital. The doctor calls the
Emory Regional Perinatal advice line at Egleston, where a
neonatalogist arranges both referral and transportation for
the sick baby.
Where the baby is taken depends
on the kind of care it needs. If a severely premature baby
needs ventilation and feeding, it may go to either Grady or
Emory Crawford Long, where level III neonatal intensive care
units and neonatalogists are waiting.
If the baby requires
surgery, it is likely to be sent to Egleston's level IV center.
Because of its state-of-the-art heart center, Egleston also
receives many babies with cardiac abnormalities as well as
many others in need of the hospital’s surgical subspecialties,
such as neurosurgery or otolaryngology.
The perinatal center's work
isn't over once the baby goes home. Doctors provide follow-up
care as long as is necessary, with clinics based at Grady
and Egleston as well as an outreach clinic in Dalton. Outreach
education programs are given regularly at many of the 50 hospitals
in the region that are likely to use the center's services.
Anytime hospitals can work together
like this, the children benefit, says Brann. And the relationship
between Emory, Children’s, and Grady may become even
closer. Children’s and Grady are discussing an agreement
that would allow Children’s to assume responsibility
for the management of Hughes Spalding, to further smooth the
way in coordinating services among the hospitals.
Speaking for many of the Emory
pediatricians he has inspired, Brann says doctors who care
for children have no choice but to be an advocate for them.
He also says that doctors in
Atlanta have extraordinary opportunities to learn how to help
children more. “No one can duplicate the unique set
of questions we are presented with by virtue of our location
in Atlanta. We are challenged with an urban center that has
issues similar to those in developing countries, along with
a complex history with respect to race and class and society.
But we also have the benefits of proximity to the CDC, the
Carter Center, and our own and other public health resources,
with all they offer to understand and improve the health of
children at home and abroad. Where else could you bring all
||The ideal patient
What should the ideal patient encounter look like? According
to neonatalogist Lucky Jain, it might go something like this:
8:30 AM: Mary
reaches out to check her Blackberry and smiles at the message.
“Good morning, Mrs. Smith. This is to remind you of
Andrew’s 9:30 appointment with Dr. Vogler at the Emory
Children’s Center clinic.
“We’re on our way,”
she replies. “Thanks for the reminder.”
9:00 AM: Mary
wonders why the traffic on Briarcliff and Clifton Road is
so light as she pulls into Children’s parking deck.
“Good morning, Andrew,”
chimes the clinic scantron as Mary scans Andrew’s clinic
radio-frequency ID card (RFID). “Welcome to the ECC
clinic, and thank you for preregistering. Please proceed to
the reception desk.”
9:05 AM: “Hi,
Mrs. Smith and Andrew,” greets the front desk staff
person. “You will be seen in room 108, the last door
on your right down the hall. I have approval from your insurance,
and Hillary knows you are a bit early.”
“How did she know
who we were, Mom?” asks Andrew. “I don’t
think we’ve met her before.” Mary tells Andrew
about the scantron-linked data, including the patient’s
picture that pops up on the screen at the reception desk when
his card is scanned.
Mary is happy that Hillary is
back from her honeymoon. Life is so much easier for her and
Andrew now that Hillary has become their “health solutions
coordinator.” When Andrew was initially diagnosed with
systemic rheumatoid arthritis, Mary had spent a great deal
of time coordinating his care with different providers. How
close she had come to losing her job! Now the clinic is a
one-stop shop for patients with complex health problems.
11:00 AM: Andrew
has already seen Dr. Vogler and the new physical therapist.
Ever since Andrew started being treated with the nanomedicine
approach, he is a different child. The side effects of the
steroids have disappeared, and he has regained all of his
joint mobility. Mary looks at her watch and is amazed that
they are done.
“Don’t forget your
flu shot while you are here. And we have a special parent
workshop on childhood obesity starting at 11:30,” says
Hillary. As Mary looks over the consent form for the flu shot,
she wonders how any health care facility could be better than
Last year, Woodruff Health Sciences
Center CEO Michael Johns made a presentation in which he challenged
the Department of Pediatrics to create the “ideal patient
experience,” combining state-of-the-art care with state-of-the-art
service. Jain, a pediatrics professor who also holds an MBA
from Goizueta Business School, is working with a group of
faculty and administrators to make that happen.
The days are long past when
an academic medical center could focus solely on the most
up-to-date care and neglect the patient (and parent) experience,
he says. And independent centers, focusing on customer service
as a way to compete, are starting to pull ahead.
Providing the best in
service means more than just scantron wizardry and Blackberry
reminder messages, he says. Techno bells and whistles aside,
the real focus is on examining the entire patient visit to
find out where problems occur. Is a backlog at the reception
desk throwing off the schedule? What causes that? How can
techniques like preregistration and embedding data on RFID
cards help, and what’s the best use of such technology?
Does miscommunication among specialists caring for the patient
contribute to delays or less than optimal care? How can this
“We are now looking at
every step of a patient’s visit to see where bottlenecks
and problems occur and where we need to make changes.”
The team also is examining ways
to make visits more efficient and optimize the time physicians
spend with patients, he says.
Asked how high the scantron
cards and wireless reminder messages were on the group’s
wish list, Jain says the electronic improvements could happen
sooner than many people think.
“If Wal-Mart can use this
technology to track packages, certainly we should be able
to do this for our patients.”
attempt at healing
addition to his difficulties with Emory, Gayer had been waging an
intense rivalry with Scottish Rite Children's Medical Center across
town. Once a small orthopaedic hospital for children, Scottish Rite
had begun a growth spurt in the 1980s, expanding both the size and
diversity of its services under CEO Jim Tally. Competition in marketing
and fund-raising had exploded between Egleston and Scottish Rite
throughout the late 1980s and into the 1990s.
By 1997, the boards of both hospitals
had had enough. Atlanta had a growing pediatric population, and
the increasingly bitter competition was distracting both institutions
from their mission. The boards announced that they would merge to
form Children’s Healthcare of Atlanta and that Tally would
be the CEO of the new system.
At the time, it seemed that this merger
might make Emory’s pediatrics situation even more difficult.
Emory had few connections with Scottish Rite. But behind the scenes,
Tally and the new CEO of the Woodruff Health Sciences Center (WHSC)
had been getting acquainted and talking about possibilities.
When Michael Johns arrived in Atlanta
in 1996 to head the WHSC, he and Tally had reached out to each other
and liked what they found. Having seen managed care in full force
in Baltimore, Johns had found Gayer’s approach to partnering
He felt that Tally understood the
value of academic medicine. With a doctorate in higher education
administration, Tally had held previous positions as assistant dean
at Southern Illinois University School of Medicine and as vice chancellor
for administration and finance at the University of Arkansas for
Medical Sciences before heading Scottish Rite.
Tally recalls that immediately following
the merger, members of the hospital board, including founding board
chair Larry Gellerstadt and current board chair Joe Rogers, spelled
out the new CEO’s principal responsibilities: “Focus
on vision, on new possibilities—and forge a new day in the
relationship with Emory.”
When the merger was announced, the
pediatrics faculty too had been pulling for Tally, and their instincts
“Dr. Tally turned out to be
a real healer,” remembers Barry Warshaw. “He understood
health care, and he understood what we at Emory were trying to do.”
Within three months of the merger,
Tally and Johns signed the Aflac Cancer Center agreement. A team
of leaders were designated from both institutions to meet regularly
and spell out shared goals and the road map to achieve them.
Six years after Emory and Children’s
mapped out their strategic plan, most items on the must-do list
have already been checked off or are well under way, according to
Johns and Tally. Desperately needed new facilities have been built
for pediatrics, and new facilities are under construction for Children’s.
A national search culminated in the appointment of Stoll to lead
the department after Cornish stepped down to pursue his interest
in children’s health in developing countries. Increased investments
are beginning to bear fruit in programs and initiatives to benefit
both Emory and Children’s.
kids on the block
Pediatric ophthalmologists around the world are eagerly
awaiting the results of a new national study on treatments
for infantile cataracts conducted at 12 centers across the
country and led by Emory eye specialist Scott Lambert. His
Infant Aphakia Study, funded through the National Eye Institute,
is the first to evaluate the two main treatments for this
condition, which affects approximately 1,000 babies each year
in the United States. But Lambert might never have obtained
the support needed to pursue federally funded research into
this rare disease without the help of an innovative grant
program at the Emory Egleston Children’s Research Center.
Established in the early 1980s
and jointly funded by the medical school and Children’s
Healthcare of Atlanta, the center is a powerful catalyst for
pediatric research, fostering studies in new areas and encouraging
The seed-grant program gives
clinicians like Lambert the resources to explore new avenues
for study and develop them to the point that they can compete
for federal funding. The center’s seed-grant
recipients sign a contract requiring them to write an NIH
proposal within a specific time period—or their division
must repay the seed money.
No one has ever failed, says
Ron Joyner, the center’s scientific
director. About a third of the seed grants go on to generate
federal funding, with $13 million in NIH dollars awarded in
just the past six years on projects begun with seed-money
Many of the most highly funded
researchers in the department can trace their start back to
these seed grants, says Joyner. For example, Ben Gold,
division director of pediatric gastroenterology, used one
of the early grants to gather preliminary data on the impact
of childhood infection with Helicobacter pylori bacteria,
a research area in which he has become a major contributor
And as Lambert’s work
demonstrates, the grants are not limited to the pediatrics
department. If research will benefit children, it’s
eligible, says Joyner. A panel of Emory researchers with no
connection to pediatrics makes decisions about who gets funded.
As research expands into studying
diseases at the molecular level—blurring the lines between
pediatric and adult medicine,
collaborations that include pediatric research in broader
areas of study also are being emphasized.
Lung researcher Lou
Ann Brown, who helped pioneer the development of
synthetic surfactant for use in premature babies, is working
with Mark Moss, chief of pulmonary medicine
in the Department of Medicine to study whether clinical use
of the antioxidant glutathione can help prevent lung damage
in premature babies exposed to alcohol during pregnancy or
if it can help patients who have become ventilator dependent
as a consequence of alcohol abuse.
The center also encourages collaboration
and clinicians to get cutting-edge treatments to patients
In the hematology/oncology division
of pediatrics, gene therapy researcher Trent Spencer
is taking special aim at neuroblastoma, an aggressive tumor
that arises in the sympathetic nervous system and tends to
metastasize rapidly. Although survival rates have improved
in recent decades, long-term survival for children with metastatic
disease at diagnosis remains poor.
Spencer and his colleagues at
the Aflac Cancer Center and Blood Disorders Service based
at Children’s are genetically engineering immunotherapeutic
cells to make them impervious to toxic
chemotherapy regimens and thus able to help the body’s
own immune system attack the cancer, bolstering the effects
of chemotherapy while lowering the dosage needed.
Spencer says the easy communication
between clinicians and scientists at Emory is one of the reasons
he came here. That and the fact that he, like his colleagues,
is firmly convinced that “Emory has everything it needs,
from the vision to the will to the resources, to become a
major translational research center for pediatric diseases.”
up at last
Emory’s and Children’s new goals will take more than
just good will and good planning, of course. It will also take money.
Stoll sees fund-raising as one of her biggest responsibilities as
chair. She knows that the country’s leading children’s
medical centers and pediatric programs all have large endowments,
whereas Emory pediatrics has virtually none.
But the financial picture is changing.
The Woodruff Foundation provided almost half of the $42 million
cost of the new building, and another $2 million came from various
donors, including the foundation established by the late George
Brumley’s family. Children’s contributed $8.5 million
to the new pediatrics building in return for a parcel of Emory land
adjoining its hospital. Construction is already under way on a new
hospital addition there.
The joint Emory Egleston Children’s
Research Center, founded in the early 1980s, is seeing new growth
in translational and collaborative research. (See Newer Kids on
the Block, opposite page.) A $2.85 million gift from the Marcus
Foundation will enable the department to recruit national leaders
in six pediatric subspecialties. The money will fund new division
leadership positions in four of the subspecialties—endocrinology,
nephrology, infectious diseases, and pulmonology—and add support
to the department’s existing strengths in gastroenterology
and neonatal-perinatal medicine.
“We want to recruit new talent
to the department,” Stoll says. “To build a truly world-class
department, we need nationally recognized programs in key areas.”
Meanwhile, Emory’s and Children’s
shared goal of becoming one of the top five pediatrics centers in
the nation is off to a good start. This spring, Child magazine released
its rankings of the nation’s top 10 children’s centers.
Children’s Healthcare of Atlanta was number 6, and four of
its specialties—cancer care, cardiac care, neonatology, and
orthopaedics—were ranked 3, 4, 3, and 3, respectively.
“Those services feature the
combined efforts of Emory, community physicians, and Children's,”
Tally points out, “so we all can be equally proud.”
Light pouring in through the windows
in Stoll’s new office provides almost miraculous illumination,
considering her previous environs. Like her faculty, she is in love
with the new building: its grace, its flow, the still-empty spaces
that promise recruitment and growth. And like her faculty, especially
those who have been through pediatrics’ hardest years, she
sees it as a "no-excuses" facility.
“It used to be easy to say,
‘We aren’t as successful because we don’t have
any money, we live in trailers.’ But now,” she says,
gesturing at her surroundings, with the corner of Children's at
Egleston visible through her window, “now, we have an awesome
obligation to be successful. All the pieces are in place. The children
are the center of attention. Failure is not an option.”
Sylvia Wrobel is
the former associate vice president for Health Sciences Communications
at the Woodruff Health Sciences Center.
Jon Saxton is special
assistant for health policy and communications, Office of the CEO,
and the executive editor of Momentum.