This story about a janitor in Johns Hopkins is a must-read for any hospital executive

All healthcare institutions proudly tout missions to provide high-quality, affordable medical care and improve the health of the communities they serve.

Rarely, however, are those communities defined or the individuals within them consulted, according to Benjamin J. Oldfield, MD, a resident in internal medicine and pediatrics at Baltimore-based Johns Hopkins School of Medicine.

In the article published in the New England Journal of Medicine, Dr. Oldfield comments on this great contradiction. He eloquently tells the story of a hospital janitor at Johns Hopkins, a young mother in her twenties, born and raised in East Baltimore. The janitor, who he refers to as Ms. F to protect her identity, had been working at the academic medical center for several years before Dr. Oldfield began his residency.

Through small interactions a couple times a month, Ms. F filled the gaps left open by Dr. Oldfield's medical training — such as where a piece of equipment was located in the hospital. She also offered him a new perspective. "From her, I hear about neighbors displaced by commercial expansion in East Baltimore, or the evolution of wage discussions between her and the hospital administration."

Ms. F dealt with financial troubles of her own, spending two months in a homeless shelter as a result of financial insecurity brought on by the death of her father. With the help of public assistance programs, she can afford to buy food, and Medicaid pays for her son's bronchodilators to treat his asthma. The Johns Hopkins family health plan is unaffordable on her wage of $12 an hour.

"Ms. F.'s story runs contrary to the purported mission of my academic medical center — and probably most others," Dr. Oldfield wrote. "We claim on banners, websites, and pamphlets that, in addition to pursuing excellence in research and medical education, we seek to improve the health of our communities. But rarely, it seems to me, are those communities defined — or consulted. The people who live near and work in these institutions appear to have no place in these missions: they are not celebrated as our colleagues, nor can they afford to be our patients."

When her son was admitted to the hospital for his asthma condition, Ms. F was worried she would no longer be able to make ends meet given the days of work she would have to miss to be there for her son. Dr. Oldfield said the experience made him realize his training as an internist — to foster healthy families — excluded his friend, colleague and patient.  

"Ms. F.'s story echoes through neighborhoods surrounding many U.S. academic medical centers," Dr. Oldfield wrote. "And it helped me realize that, as physicians who serve our local communities, we should advocate for policies that promote health, productivity, and dignity in the people who work alongside us. Ms. F. and her family deserve a place in our missions."

More articles on population health:
How hospitals are approaching population health: 5 survey findings
10 things to know about the Jefferson College of Population Health
Johns Hopkins explores advantages and challenges of clinical communities: 5 takeaways

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