Episode 035

Dr. Jonathan Ellen talks leadership, transformational change and the importance of altruism

On this episode of SPx, Joe and Ashley are joined in the studio by Dr. Jonathan Ellen of John's Hopkins All Children's Hospital. Dr. Ellen spent much of his extensive career as a social epidemiologist studying HIV/AIDS. In 2012, he was appointed President of All Children's Hospital. Over the next five years his visionary leadership, along with the selflessness of its Board of Trustees, brought the transformational partnership of what would become John's Hopkins All Children's Hospital. But, as Dr. Ellen explains, the work is not over. He shares his insight on the importance and challenges of public health, changing social norms and St. Pete's own transformation.

"It is possible to change norms. It just is very difficult in an individualized setting with one bullet to get people to change what they do."

One possible solution is a broader strategy of information transmission. Despite the checkered past of information campaigns surrounding public health, there is some merit to the idea that dispersed information changes norms, and ultimately changes society.

As such, media can play a role in spreading narratives, news and policy changes regarding health to larger populations. “Putting a fine point on ideas, articulating ideas that are perhaps not as well described … you bring thought to someone else’s voice, all those things matter over time and it works in that context,” says Dr. Ellen.

It comes down to this: “Do we believe the public discourse is good and can help improve society? I do believe that.”

"If you stay on anything long enough with the right leadership you’ll get some change."

Full Transcript:

Ashley: Are you recording?

Joe: I’m recording.

Ashley: Okay.

Dr. Ellen: He’s recording since I told him he had a circulation of five.

Joe: [laughing]

Ashley: [laughing] We shouldn’t – I shouldn’t…

Joe: Let’s start with which…

Ashley: …you shouldn’t laugh at yourself.

Joe: It’s funny, we kind of do a circulation of five, I don’t mind saying that, I… We come from humble roots, we are salt of the Earth, growing St. Pete business news…

Ashley: But you used the word…

Joe: …one listener, one reader by reader…

Ashley: …you used the word…

Joe: I will run out of relatives soon, but…

Ashley: You used the word magnate.

Joe: Yeah, magnate

Guest, Yeah, it’s all in his mind.

Ashley: What does that… [laughing]

Dr. Ellen: [laughing]

Ashley: Let’s look up delusions of grandeur…

Joe: No, I was relating a funny story, I went to a lovely event at the Dali with – that was I believe you were technically the host, John’s Hopkins was technically the host.

Dr. Ellen: Yeah.

Joe: And got to meet Ian Anderson from the Business Journal for the first time and so…

Dr. Ellen: Not from Jethro Tull.

Joe: Not from Jethro Tull, no. No flutes. And he joined us for dinner which is lovely, and so we had a little fun with them.

Dr. Ellen: Walter was there.

Joe: Walter Balser was there, yeah, Jim Aresty, the whole OPEN crew was there and Irv Cohen so there’s three SPG members, which was nice. And so we had a little fun with Ian and we… Paul Tash was there as well so I said that Ian had to join me for a picture with Paul to make sure that all the publishing magnates in St. Pete got in one frame. Historic moment.

Ashley: Yeah, and then Dr. Ellen was looking for a definition of magnate.

Joe: And that’s five or more readers.

Ashley: And then he’s using his one hand, the digits on one hand to have that conversation.

Joe: Alright, I’m just gonna take a deep breath and get through this title. President, CEO and Physician in Chief of John’s Hopkins All Children’s Hospital and Vice Dean and Professor of Pediatrics at John’s Hopkins University School of Medicine.

Ashley: To what do we owe the honor…?

Joe: We’ve stepped up a little here in our guest-dom…

Dr. Ellen: You guys have, first of all, fixed your technology, so good improvement, that’s why I’m here.

Ashley: Okay, so in full transparency here second time around we had an interview with Dr. Ellen a couple of weeks ago that went a little bit rogue where technology failed us, but it was a brilliant interview, we were hoping to resurrect some of that brilliance in round two. Do you feel up for it?

Dr. Ellen: No, not at all, but I’ll go for it anyway.

Ashley: Your arms are crossed so you…

Joe: I note the body language.

Dr. Ellen: I’m cold. Yeah, there’s no way to sit my arms and my belly is my best place, so that said…

Joe: Makes a good cup holder, I’ve done that before.

Ashley: Well I think… So when we…

Dr. Ellen: Well I could lean back, and you wouldn’t hear me, right? Unless I do this. Very good, I get comfortable in it.

Ashley: It’s good, get comfortable. So when we introduced you the first time around I asked you what is it that you don’t do, and you said you don’t currently practice but you used to.

Dr. Ellen: No, I actually do practice, two… two weeks a year I supervise residents, taking care of patients. I usually do it at the end of the year because by then there are really all timers and good docs and so then I really can’t screw up too much. So I come up at the end. What I don’t do is research, that’s the thing that I used to do. I started doing research in about 1985, looking at doing research on HIV and… HIV/AIDS… in ’85 and I didn’t stop until probably about 2015. But I don’t do research anymore, that was it.

Ashley: So pediatrics is your background?

Dr. Ellen: M-hm.

Ashley: How did you get into that? What I mean is – so how did you get into that? You have an…

Dr. Ellen: You can say it any way you want to.

Ashley: You have an interesting family dynamic in terms of your parents’ practice.

Dr. Ellen: Right, exactly. Oh, so you remember from the last segment that you were in.

Ashley: I do.

Dr. Ellen: My father is an obstetrician gynecologist; my mother is a social worker so by definition you become an adolescent medical provider. So I was a pediatrician trained to take care of children, zero to basically teen, 20, 21, 22. And in the process I became very interested in the social determinants and social factors that shaped health. And so I knew I was going to do that and then I started looking at different post-residency opportunities for training. And the one I fell in love with had to do with decision-making the teenagers made and why would a teenager make a high-risk decision. So the place to go for that turned out to be in San Francisco, so I moved out to San Francisco in ’91 and then when I got there the people were also really engaged in HIV, as you can imagine, because it was the height of the epidemic going on and San Francisco being an epicenter for that epidemic. Most of the social behavioral scientists were being funded to do work in HIV. So I ended up getting trained by all the behavioral scientists and mental health scientists on how to study social and behavioral factors that associated with the transmission and acquisition of HIV and then other sexually transmitted infections. And then when I started doing that I got involved with the epidemiology, so I ended up in the end of this all being a social epidemiologist studying STDs and HIV and that’s what I did until… 2015.

Joe: So all of that to me has a large… because you’re studying the what happens when, but there has to be some facet of that is how do we cause when, which is a PR/Marketing element that says, ‘We know that this is how things spread or this is the kind of information that people receive, the inputs they receive.’ How much of your work was put into controlling that messaging?

Dr. Ellen: I ended up rejecting that whole approach, I was not a big believer particularly with teenagers that you could change behavior easily. What I really believed was that we could intervene on factors that were happening in the community that set up the determinants of transmission. So half of my work was studying things like how people chose their sex partners, how much geography affected where you chose your sex partners from, how much the nature of the people who lived in your community shaped the sex network. I did a lot of network mapping and all that kind of work. And then when you have that context you say okay, what affects that? So it’s kind of root cause. And we went back to saying well, there are policies and practices and programs in communities and around the city that shape what happens. So whether it’s the incarceration process that then changes the male-female balance in the community, whether it’s the fact that you have young women… In an impoverished community you can have very well-intentioned I’ll say church-going families living next to high-risk, they can be anything from if you want to say drug dealers to… even – I don’t know the word if it’s still relevant, but the content of a gang banger drive-by shootings. So you can imagine if you think of a drive-by shooting, you can be an innocent kids walking to school and get shot. Well, the same thing happens to innocent adolescents sometimes living in certain communities. So that whole concept of the community being a risk factor and that it’s not the people as much as the context.

Ashley: So you’re looking at delinquency and…?

Dr. Ellen: Well we looked at things like trying to figure out how to keep kids in school, things at that level.

Joe: So you didn’t see examples of ways people could actually change context from an informational standpoint, like the Truth campaign with smoking or something along those lines?

Dr. Ellen: The Truth campaign… There’s two reasons it did not, one is the sustainability of those messages – the Truth campaign has been going on since the tobacco settlement. And there’s a lot of money in that tobacco settlement and it was a long-term commitment that the settlement had. For most… take sexual health issues, there’s not long-term funding. Every three years, every four years depending on who is president everything changes. They can gut CDC, it’s been getting gutted over and over again and their job was to stop – one of their early jobs was to stop the spread of syphilis. And our syphilis rates are higher than they have ever been almost, and the reason is because we gutted the public health departments. And so the concept that we have sustained action around something that is stigmatized is not something I count on. So could we change social norms, do we change social norms is a whole much bigger question, but it doesn’t happen in over – Just Say No is not a campaign that worked very effectively on the drugs and that was a very short lived burst approach and I don’t think it works.

Ashley: Do you think that the shift in focus, one of the most recent STDs taken under scrutiny is HPV. Do you think that that has to do with the same social constructs—

Dr. Ellen: The HPV thing is a perfect example. If you think about the reason we care about HPV is because it is the cause of cervical cancer. Period, end of story. You know you get cervical cancer with HPV. Problem is… and we developed a vaccine for two of the four high-risk types and they could probably develop a vaccine for more high-risk types.

Ashley: And is it not detectable in men?

Dr. Ellen: Oh, it is.

Ashley: It is?

Dr. Ellen: And now they inoculate men for it too or vaccinate men. It’s harder to test in men, it just – you don’t normally go around swabbing men, we do a lot of perhaps pap smears on women. We actually don’t do as many as we used to do but the concept was that HPV was demonstrated to be the cause of cervical cancer, it can also cause throat cancer. So the answer is get a vaccine that builds the immune system to protect against the development of cancer or development of the HPV. Turns out everybody who’s ever had intercourse has probably got HPV. The prevalence of HPV, it’s so prevalent that it’s not even worth talking about. But the vaccines stopped the acquisition of two of the high-risk types because not all the types cause cancer. The ability to get that into – you’d want to get it into – we didn’t want to put another one for babies, so we said okay, we’ll put it in the 12-year old’s. Most 12-year old’s have not had sex, it’s a great age to do it and there’s already a routine visit for your Tetanus boosters and several things going on at 12 and school physical, so why not put it there? Well the uptake of that vaccine is like 30%. And the reason that people aren’t getting it is because the question is, ‘Do you think my child is having sex?’ No, but they will eventually. And that whole storyline keeps people from vaccinating their kids. There’s always the autism people too, but in terms of even people who are not crazy about the myths of autism being related to vaccines there’s still a lot of people that just don’t do it because they’re like, ‘My kid doesn’t have sex.’

Joe: So then taking that, assuming with that…

Dr. Ellen: Is that why you brought me here by the way, to talk about sex? Because I can do it forever if you want to hear, so…

Ashley: Did you bring a vaccine with you? Can you administer it onsite?

Dr. Ellen: [laughing] No. I could, I know how to.

Joe: I’m worried about our five readers …

Ashley: Press pause, press pause.

Joe: So taking this example further, you said that context-changing messaging doesn’t work here. So what does work? What’s your best hope of increasing the vaccination?

Ashley: Is it not just access to contraceptives? It’s a bigger issue than that?

Dr. Ellen: Well, different questions. Okay? So access, in places where there’s high access we still have plenty of disease so it’s policies around access, it’s policies around testing and treatment, it’s policies around safe neighborhoods, it’s policies around schools. It’s all these different policies. What’s been shown to be effective? I think the most important thing is getting communities mobilized around caring about kids, period. And all these things that I’m talking about require that communities care about teenagers. And a lot of communities have written them off, so a lot of people write off teenagers in general.

Ashley: Yeah, you can get a lot of attention for the younger school age but once you get into middle school, teen, there’s a little bit of a drop off in…

Dr. Ellen: Yeah.

Ashley: Attention and sentiment.

Dr. Ellen: They’re not as cute anymore.

Ashley: Right. Little punks… roving around. Well, it’s interesting though, just for context, your fervent involvement in HIV – because it was not – I don’t want to call it flash in the pan, but the attention around it was pretty poignant and you saw it in media, you saw it in movies being made and you saw it in… which is part of the rhetoric. And for whatever reason it started to trail off.

Dr. Ellen: Well, white gay men got cured. Black gay men are dying. So the epidemic is still alive and kicking.

Ashley: Just not as widely talked about.

Dr. Ellen: Well it’s two reasons; one is the death rates dropped dramatically because we have medications now that are long-term effective and preventing the destruction of the immune system. So even though the virus may – we keep the virus to almost undetectable levels, if you take the medicines all the time and you keep your virus down your immune system will stay intact and you won’t die. So it’s become a chronic disease for that. The two things that are… Unfortunately we’re still having people get infected and that’s predominantly among black gay men, it’s really where the – and so again, another disenfranchised population as you can probably guess. So that’s why there’s no – if you watch enough movies you’ll see it in the subtext but you’re not gonna see Angels in America again, you’re not gonna see…

Ashley: Or a Tom Hanks, what’s the Tom Hanks movie?

Joe: Philadelphia?

Dr. Ellen: Philadelphia, yeah.

Ashley: Yeah, that’s right.

Joe: So it keeps bringing me back to information, I guess, this is just the world that I live in. So you know this, you know that this is disenfranchised black gay men or high-risk. Who do you give this information to, who are you looking to empower with this information and partner with to help make the changes to fix this?

Dr. Ellen: Their community. I mean you put band-aids on and the band-aids will make the curve slow down but eventually the question becomes whether the actual – the big thing right now for prevention is PReP, and it’s pre exposure prophylaxis. So they found that if you took regularly a small amount of anti-viral medicine on a regular basis, every day, you will not get infected. So it’s pre-exposure prophylaxis. And in fact in a lot of places if you know you’re gonna go out that night and hook up, if you start taking it a couple of days before it’s pretty damn effective if you take it like you’re supposed to take it. That therapy, the uptake of that therapy in the black gay community is very limited as well. So the question becomes what do we need to do to get there? And… again, it’s how you mobilize any community. I’m not an expert in mobilizing in that community, I’m much more an expert in understanding how they’re getting infected and why they’re getting infected as an epidemiologist more than anything else.

Ashley: Well, there are some communities that have not been fostered to care about consequences to the same degree. And we had a conversation with a mayoral electoral candidate and he was talking about car theft and in some of the work that we’ve been doing around circumventing that behavior, but when you get into the mind of a teen who is looking to get into some trouble or have a fun Saturday night they’re just not, even if they do get incarcerated, they’ll be out just as quickly as they got in. And it’s just the processing of what’s the worst that could happen, it doesn’t happen…

Dr. Ellen: Well they’re not wrong in their process. That was the thing when I first started doing work with teenagers and I had a grant for 15 years and then I had to study teenagers’ decision making. And the question was are they irrational? Well if you know you could steal the car and you’re gonna get released within 24 hours of having stolen the car…

Ashley: Game on.

Dr. Ellen: There are no consequences.

Ashley: Right.

Dr. Ellen: So you could sit here and do all the messaging you want, there’s no consequence. Now they are trying to show, get empathy. That’s their next pitch, right? Is to try to create empathy. But there is a consequence maybe not to you but to the people whose cars get stolen and they’re trying to create that empathy.

Ashley: That’s interesting.

Dr. Ellen: That’s what I think they’re doing, I think that’s the next step in this thing, it’s to try to create empathy.

Ashley: So are you focusing on…?

Dr. Ellen: Not me [laughing].

Ashley: So that concept…

Dr. Ellen: I’m not doing that [laughing].

Ashley: So that consequential piece, does it work with STD issues?

Dr. Ellen: Well that was actually the big question, is that when we got to… the study showed that if you take your medicine every day, if we’re a couple and… we don’t use condoms and you have HIV and I don’t and you take your medicines every day I will not get infected.

Dr. Ellen: But the point of the story was that… there is an altruism that’s built into that kind of approach just like there is by – if you know you can take your meds every day, get yourself so you’re not virally… you are completely suppressed and therefore the likelihood of transmission is almost nil. That is an altruistic gesture if it’s not just about your health, and that idea of preventing a secondary transmission is one of the strategies that we’ve tried over the years, and sometimes it works and sometimes it doesn’t.

Ashley: So with the gay black men, are they aware that they are infected or are they unaware? In your… in what you’re studying, in terms of that, evidently. Because I’m thinking more about their processing of consequence, on one hand…

Dr. Ellen: Well I think in most cases what you find is – so there’s a thing called the cascade now. And the cascade says, how many people know what their status is? How many people have been tested? How many people know what their status is, meaning they went back for the test? How many people who are positive got linked with care, how many people who got linked with care took their meds, how many people who took their meds are actually suppressed? Right? So that gets down. And you’d like it to stay at 100%, right? Right across. But it drops down to about 15% when you get to the end of the cascade. And it probably, the number who get tested is only about 70%, 65% – and I bet you 5% or 10% of those don’t go back. So you’re probably at about 50% of the people who are infected and know they’re infected.

Ashley: So can we talk about opioid addiction?

Dr. Ellen: [laughing]

Ashley: Happy Monday.

Dr. Ellen: Thank you.

Joe: We sure have fun doing this.

Ashley: Well you have to, you can’t, it’s just an tension reliever.

Dr. Ellen: Sure.

Ashley: But so if you think about… Johns Hopkins was recently the beneficiary of an anonymous gift for children who were born of opioid addicted mothers and it’s certainly been on a tip of some of our guests tongue, we talked to a foundation a couple of months back and he had to predict where the funding would go for non-profits over the next probably five to ten years. And opioid addiction was an area that he defined from a regional foundations perspective. So talk about your work there and what you’re learning about that issue.

Dr. Ellen: Well, years ago… My involvement with the topic goes back – well first of all when I was a resident we took care of drug addicted babies. When I was a resident it was crack, it wasn’t as much opioids at the time. They hadn’t pushed oxycodone as far as they pushed it today, but it was crack at the time because it was cheap. And we learned how to take care of – those kids came out, we had two issues that always arose with those kids. One was the physical consequences of being addicted and exposed, and then the social consequences of having a mother at the very least who has been using. So there’s always that connection of those two. When I got to Baltimore… and Baltimore was probably one of the stronger heroin towns, I don’t know why but it seemed to be really big into heroin. They had set up a program, by the time I moved out to Bayview, which is where I went for my first chairmanship. They had already established a program called the Center for Addicted Parents, called the CAP program, and it was a program ran by pediatrics, OBGYN and psychiatry, and psychiatry did the addiction work and we took care of the kids. And one of the investigators and one of the faculty members in that group studied opioid addicted babies and was trying to figure out which drugs to give the babies because the way you treat a baby when they’re addicted is when they’re born you either give them methadone or something where you actually help them wean off or detox just like you would anybody else. That doesn’t change if they’ve had either physical consequences in utero that are permanent or potentially…

Ashley: Cognitive too, right?

Dr. Ellen: Yeah, anything affects the brain development at that stage… and then also the social factors. But at least you can stop the addiction. So we started studying different drugs, methadone versus buprenorphine at the time. Fast forward I come here and one of the first really public health approaches to opiates that’s going on, this is before that all the studies were coming out that were telling us what was going on particularly in Sarasota at the time, there was a big push for helping opioid addicted children in getting treatment and wrap-around services for the children and to some degree the parents. Since we’ve been here a lot of the work has been focused on not only how you treat them and what treatment the family needs, but where you treat them and how long you treat them. There is a protocol for treating opioid addicted babies, and that protocol has gotten tightened up and I think we do a much better job at all our sites in treating those babies, and they’re very standardized in a much more protocolized way. But also the concept that we could actually have babies go home and receive their methadone at home rather than sitting in a hospital day after day after day, separated from the mother if there’s a good relationship there. So that’s really the kind of work we’re doing, also now dealing with the mom’s addiction is part of it, is the whole wrap around approach that we’ve taken. So they’re just one of the casualties of the oxycodone world. Like I said earlier on it was heroin but now it’s predominantly oxycodone. So… Anything uplifting you want to talk about?

Joe: It’s interesting.

Dr. Ellen: It was Easter.

Joe: Yeah.

Ashley: This is probably going to air soon.

Joe: How many eggs did you find?

Dr. Ellen: None.

Ashley: So just on the same realm of…

Dr. Ellen: …uplifting stories?

Ashley: …uplifting stories. Well maybe just due to commitment to community health issues that we’re dealing with, and this will have already aired but tomorrow you are part of an event with some big players, you’ve got Randy Russell of the Foundation for a Healthy St. Petersburg, you’ve got Michael Grego with the Pinellas County Schoolboard…

Dr. Ellen: Are they both gonna be there?

Ashley: They’re both gonna be there.

Dr. Ellen: Oh, really? Nice!

Ashley: I think we have Kanika Tomalin representing the City of St. Petersburg, other nonprofits will be present. And this is an opportunity to really emphasize the importance of a partnered approach to health. Talk to us about some of the initiatives that we’ll be reviewing.

Dr. Ellen: Well first of all, you asked your question what the… intervention is based on the root causes – this is it! So the model for this program…

Ashley: By the way, if Randy doesn’t come… he RSVPed.

Dr. Ellen: Okay. But if he doesn’t come we’ll say what the chairman says and then we’ll just… get off the hook. I hope he’ll show up, he always shows up. But this model of collaboration and mobilization is what we came to around the structural determinants, was the idea that you need communities to make a plan to collaborate and change. I had another grant from the NIH for about 15 years and the whole goal was to get communities together, identify their high priorities, create a strategic plan to make policy changes. So we’re gonna be looking at mental health, we’re gonna be looking at asthma, I forget…

Ashley: Diabetes?

Dr. Ellen: …diabetes, obesity and there’s another one which I forget.

Ashley: But all youth-based?

Dr. Ellen: They are youth and children based but they are pretty predominantly… they’re all pediatric, put it that way.

Ashley: Will you be showcasing some research or is it more of a community conversation event?

Dr. Ellen: I think it’s a community conversation – the way I understand it because I wasn’t involved in the planning, they just told me to show up and talk. So I do that.

Ashley: Right, no 3D presentation or anything.

Dr. Ellen: Not yet. Not virtual reality but the model of care and I have is based on the idea of they’ve identified – so for each of those different areas there’s four or five strategic goals that they’ve identified, some of which are very much looking at policies that need to be changed. And my assumption is what they’re doing is they’re presenting them and thinking about ways to start mobilizing around making those policy changes. All this stuff that I feel – it gets back to your communication. If you continue the communication and persist and have a… I’ll call this a theoretical framework for keeping it going, with the idea that you change norms. And then the norms both change individual and also support individual change of attitudes over time. There’s no question that somehow, whether that’s intentional or not, has an impact. Our whole impact about gay marriage, same-sex marriage has changed, and it’s changed over time. So it is possible to change norms. It just is very difficult in an individualized setting with one bullet to get people to change what they do.

Ashley: Bullet aside, though, if you think about all of the forums and workshops you’re a part of, are you seeing some… all roads lead to Rome – are you seeing some… consistent topics repeated again and again, whether that’s poverty eradication, whether that’s racism? Are you seeing some big keywords that we should be focusing on?

Dr. Ellen: The big ones are employment, employment, employment…

Ashley: Jobs.

Dr. Ellen: Jobs. Jobs…

Ashley: i.e. then poverty eradication, i.e. then better mental stability…

Dr. Ellen: I think the availability of jobs and the development of a workforce that can take those jobs is probably the essential step in sowing to… reduced inequities, that we’re seeing. And if you can reduce those inequities there will be… then you’ll start having better health consequences, you’ll see a lot of things. But without the existence of jobs…

Ashley: And good paying jobs. If you remember the city of St. Pete, their economic report is out. Job growth is happening, but the wages continue to be suppressed. So even if you have available jobs you have many community constituents working several just to make ends meet.

Dr. Ellen: Yeah, absolutely. Now I think… but then you have to decide what… certain things get monetized different than other things. Even if you say, ‘I’m gonna give someone a living wage,’ it’s hard to have enough living wage jobs in the city that…

Ashley: So then back up a step. So is it education… before jobs?

Dr. Ellen: Well, no. Jobs are the outcome. Now, that’s where education becomes important.

Ashley: Is there a step before education?

Dr. Ellen: Preschool… what you do in terms of early parenting.

Ashley: And then before that… healthy birth. Not drug addicted birth. I’m trying to get to the root cause.

Dr. Ellen: Right, but there’s a moment you stop. I appreciate the point but it’s actually a really important point, is where do you stop the why?

Ashley: Well, I think…

Dr. Ellen: It’s a very good point.

Ashley: It’s a very good point and we’re having the same… it all has merit. So you have educators in the room, you have nonprofits in the room, you have those who are committed to academic advancement.

Dr. Ellen: You got to do it all at once because you can’t wait…

Ashley: That’s the way to name the campaign.

Dr. Ellen: Yeah, ‘You can’t wait’. If you look at the Harlem Children Zone project and…

Ashley: And right, so they took a concentrated block or two and then they…

Dr. Ellen: Reach a bit, yeah…

Ashley: …they launched…

Dr. Ellen: They gave them everything.

Ashley: …everything.

Dr. Ellen: And they got a lot of money because they were the only one of its kind, they got a lot of money…

Ashley: Right, but you should…

Dr. Ellen: Now it’s 20 years later.

Ashley: They didn’t scale.

Dr. Ellen: Well, it’s hard to scale. I’ve been…

Ashley: Which is why…

Dr. Ellen: …involved with different projects where we’ve tried to scale, and the problem is resources.

Ashley: Right.

Dr. Ellen: It’s just very expensive. But what you can do is at each way boost a little bit on each way, which would be the alternative, which is to say, ‘Let’s make sure we have healthy babies, let’s make sure that…’

Ashley: …they go to preschool.

Dr. Ellen: They go to preschool. If we have preschool and it’s available to everyone. Then you say ‘Okay, then let’s make sure we have a pipeline for getting kids into college but let’s not start the pipeline in tenth grade, let’s start the pipeline in sixth grade. And let’s start orienting six graders to getting’ – back to your consequence thing, is get them started, orient them in sixth grade. So then you work on a program that goes sixth to eighth grade…

Ashley: And while we’re in education do you find our community as invested in education as much as other communities you’ve been a part of? So Baltimore being an example.

Dr. Ellen: Yeah, Baltimore has horrible schools.

Ashley: Really?

Dr. Ellen: Oh, yeah.

Ashley: Okay.

Dr. Ellen: If you want a good education, Baltimore – unless you live in the one simple enclave that has a great charters where the parents have taken control of the school, you basically have to send your kid to private school.

Ashley: So objectively would you say that we are a community invested in public education?

Dr. Ellen: More so than Baltimore.

Ashley: That’s not a selling point.

Dr. Ellen: Well, I like… I think the commitment is pretty there, I just don’t know if we’re pulling it off.

Ashley: Why do you think?

Dr. Ellen: I don’t know enough to know. I like Grego, I like what’s happening…

Ashley: Do you think it’s our tax payers, they’re not interested in…?

Dr. Ellen: Well nobody cares about kids.

Ashley: You can go to some communities and it’s a… if you go to Massachusetts, if you go to New Jersey…

Dr. Ellen: Yeah.

Ashley: …you have some communities that are invested…

Dr. Ellen: It’s some, but affluent communities usually.

Ashley: Right.

Dr. Ellen: Going nowhere because it’s not happening, it’s…

Joe: And this is where I come back to beat the information horse yet again because…

Dr. Ellen: Go for it, because we haven’t beat it in a few minutes…

Joe: Because you talk about in the ‘50s you’d never see a gay person on TV and now you can’t have a sitcom without a gay person in it, a hit sitcom.

Dr. Ellen: Right.

Joe: And there’s a reason for that, there is some journey that happened and there were people that marched in the streets, there were people that got the right kind of jobs in Hollywood. But at some point, there were also advertisers who decided to support the programs and so on and so forth. So you can look at that process and say that it just happened, but I think that there are…

Dr. Ellen: No, I wasn’t implying – I was agreeing with you, I was saying but it takes time – the problem with it as a public health strategy is that you never have that long-term stick-to-itiveness that comes from a movement.

Ashley: And now you’re talking about the information for those policy makers and those that can execute on solutions, or you’re talking about information of the constituencies that are impacted?

Joe: Ultimately, I’m talking about seeding an intellectual perspective that could go out and be executed upon. So you look at immigration, right? So you go… immigration, a lot of people have a lot of opinions about it and it’s become – it’s a national topic. And so that’s driven by certain publicity, by politicians, by groups and so if you can do that, if every average American can have an opinion about immigration, you think they could have an opinion about kids’ health.

Dr. Ellen: What you’re saying I agree with.

Ashley: May I suggest that we… we are processing and distilling that information, that I don’t think it’s a lack of information if you look at even the effort…

Dr. Ellen: Yeah, no, I think what we’ve got to, and I’ll just beat this thing to death.

Ashley: No, bring us back home.

Dr. Ellen: Okay, because there’s different questions. We were talking about HIV, we were talking about whether you could get behavior change through communication devices and I was arguing that most of those campaigns have not worked. The only time they’ve ever been effective was when everyone was dying, and they were scared to death. Second point you’re making which I happen to agree with and I said which is that over a period of time we do get to see norms get changed and they are due to a multiplicity of factors happening, including communication and amplification, which is your point, about ideas. So the idea that you’re communicating, putting a fine point on ideas, articulating ideas that are perhaps not as well described but you bring thought to it, you bring thought to someone else’s voice, all those things matter over time and it works in that context which says, ‘Do we believe the public discourse is good and can help improve society?’ And I do believe that. That’s different than just…

Joe: I would say, is there an X factor, another skill or another job, another role that is to be the communication glue between these different entities? So…

Ashley: I’m gonna suggest one…

Joe: Okay.

Ashley: And we’ve talked about it before but I’m going to suggest that we have very competent entities that can get involved on a very systemic level to eradicate issues before they are even created. I don’t think we have a system to plug them all in interdependently governed by the same metrics, governed by the same process.

Joe: It’s a talking point so I’m talking about that. So if you look at the Republican party…

Ashley: I think we’re full of talking points.

Joe: Well, but… I disagree, I think that if you watch the talk shows that make fun of the… cohesiveness of the Republican message and they all show 75 different local news channels all owned by the same people or all 75 different Republicans talking, they’re saying the exact same thing. So there’s a strategy in place that dictates the message, it dictates the distribution of that message and I feel like you have these meetings that are coming up where you’re gonna have these talented people running these different organizations and they’re gonna come with their unique perspectives, and they’re all gonna go in and act change because of it, which is all a good thing, which it ultimately moves the foundation and the norms. But I think perhaps is there a missing skillset in there which is there…?

Dr. Ellen: It’s called leadership. I know what you’re trying to get to, but it’s leadership. And whether you do it as talking points, whether you do it as…

Ashley: …execution…

Dr. Ellen: But leadership is what…

Joe: Cohesiveness, though. And where does the leadership come as part of that?

Dr. Ellen: Leadership creates cohesiveness, that’s…

Ashley: That’s what I say, that governing – if there was a governing entity that could say, this is what you are proficient in, this is the role you can play in this interdependent framework to get us to point B and I can say that to another entity, another entity, and certainly communication has a role in that. But I think that the conversation, the talking points, even the buy in to what we’re talking about is there. I think it’s understanding how we all…

Dr. Ellen: Leadership isn’t one person. I don’t mean that there is a leader, I mean that there is distributed leadership with a vision. So two things, one is there’s vision.

Joe: But there has to be a cohesiveness to that vision and by definition…

Dr. Ellen: That’s the thing, yeah, right, there has to be a vision.

Joe: But there has to be a… something that renews the cohesiveness and keeps the vision alive. Because if you have that meeting and Dr. Tomalin goes and brings in 1,000 new jobs or 2,000 new jobs but the schools do this or do something different and you guys…

Ashley: That’s that interdependent execution.

Joe: And that’s where the whole – I should call it the whole supply chain of being a human, from birth to growing older.

Dr. Ellen: That’s why somebody has to be accountable for it and that’s where leadership comes in. Leadership is accountable. So the idea is you’ve got a – everything we do, Sylvie can tell you, everything we do as a leadership team is to make sure that everything aligns and focuses. We’ve got up to 25…

Joe: Under your umbrella though, which is one specific area you address once…

Dr. Ellen: I would say it’s a pretty complicated system that we monitor and when I say leadership it’s the fact that we have ten people, 12 people with a vision, we constantly re…

Joe: …in the community?

Dr. Ellen: …state the vision. No, I’m talking about in our hospital, in our health system. I’m looking back here but it’s pretty complicated.

Joe: I don’t doubt that.

Dr. Ellen: No, no.

Ashley: Yeah.

Joe: But you’re not bringing jobs to St. Pete, right?

Dr. Ellen: No but let me say something to you. When I think about the complications of what we’re trying to do in the hospital and having done community work for, like I said, 20-30-40 years, they’re all just as complicated. The difference I have is I have resources to pay for leaders. That’s the biggest difference because they can stay on task and they can help go with the vision, and the vision – and we do all work on the vision, but I can afford because there’s a return on investment, over the period of time – it gets back to my whole point, if you stay on anything long enough with the right leadership you’ll get some change.

Ashley: I think about the… I want to take it back to opioids…

Dr. Ellen: Okay, if you want opioids you can have them.

Ashley: Okay, so that example about the weaning of the baby off, the weaning and then the support for the mother. So if I am a nonprofit and my mission is to get women clean and to get their lives back in order and I’ve been operating at full tilt, I’m bought into my vision which I believe others share. But then you create a framework for me to plug in exactly what I’m doing, to scale it, to join forces with other entities that will take care of the baby, that will take care of the family, that will have education handled, and you’re able to give us all a cohesive, unified roadmap, determinants of success, measurables – I think that that’s what’s lacking. So if you look at our execution there’s a lot of bumping into one another, there’s a lot of redundancy, we’re all speaking the same language, but it’s not plugged into…

Dr. Ellen: Well think about the FBI, the CIA and NSA and everybody else, they can’t even get – every time there’s report about a failure in intelligence it’s because the CIA, FBI and NSA won’t talk to each other. It’s not an unusual thing that you have people with similar job descriptions bumping into each other for turf reasons because they have leaders who are more interested in leading their business than they are about the outcome.

Ashley: So the new type of leader that you laud, what do they have in terms of their own characteristics that isn’t that proprietary to the board…?

Dr. Ellen: I think there has to be… a selflessness, a certain amount of selflessness. There has to be a drive for whatever the outcome is, they have to feel passion for it. We’ve been interviewing people for so many jobs that Sylvie and I have this conversation I think on a regular basis. There’s a certain amount of ambition that becomes passion, but it can’t be so much that it’s about them. They have vision. I believe in the distributive leadership model so that they don’t rely on them being the center or the charismatic leader. My biggest worry in my whole life is that I would be a charismatic leader and I failed in that when I’ve done it; nothing bad has happened…

Ashley: What does that mean?

Dr. Ellen: A charismatic leader…

Ashley: Well I know what that means, but how did you fail?

Dr. Ellen: Oh, because at the end it all depends on you. And so if you don’t do something or if you don’t move it along, if you leave… it goes away. But I think generally a distributed leadership model is a better model. It gets back to your point.

Joe: Sure, yeah.

Dr. Ellen: It gets back to your idea that you need collaboration.

Joe: Well, my point is that it doesn’t matter because no matter how great or how selfless the leaders are in Johns Hopkins, they’re still contained to Johns Hopkins and I think that we’ve looked – there’s too many mature… the school system is still the school system, the city is still the city, the hospital is still the hospital and I think the missing X factor is the cohesive spread of that message in a way that can be… that can at the very least accelerate the change that happens over time, because there’s a skill to that. But where I end up is that you can never make it a top down, I think it has to be a… a messaging platform that everybody can be a part of without it being a top-down authoritarian thing. People are always trying to bring in the one organization to rule them all…

Ashley: We talked about you being the face of Johns Hopkins All Children’s hospital and in take one, our interview with you, you illuminated our listeners as to that development and what it meant for you and your career. If you could do us a justice of telling that story. And I believe you have identified phases of your evolution.

Dr. Ellen: I don’t even remember them. But I remember…

Ashley: You had a stage one… Oh yeah, transformative…

Sylvie: Transformative.

Dr. Ellen: Oh, Sylvie is right, I got it!

Ashley: Wow! And so…

Dr. Ellen: I make stuff up as I go on.

Ashley: And just for reference I had the opportunity to listen to you share the story – you were very transparent about the grueling nature of this type of merger, and most importantly the years that follow all of the acclaim and all of the…

Dr. Ellen: Yeah. So we got to – I don’t remember where you heard this but…

Ashley: I think our technology cut off right in the middle of it.

Dr. Ellen: Okay, so I did start with that. Okay, so the story basically is in the 2000s, 2007-08, the trustees of Johns Hopkins All Children’s or All Children’s at the time – recognized they needed to supplement their academic partnership that they have with USF with another institution that they thought could push them towards a level of excellence that would allow them to be a ranked hospital in the country. And whether they were completely aware of how Johns Hopkins could help them do that or not they did have, getting back to selflessness, the selflessness to say, ‘We will give our hospital and our assets to Johns Hopkins with the promise,’ and it’s nothing more than a promise, ‘that they will do everything within their power to elevate the quality of our care and to enrich the academics at the institution.’ And over the next – from 2011 when the deal was completed, actually it was yesterday?

Sylvie: M-hm.

Dr. Ellen: Seven years ago yesterday.

Ashley: What’s the actual date?

Dr. Ellen: April 1st, 2011.

Ashley: Wow! [laughing] There are three things I could say to that.

Dr. Ellen: Okay, well it was real, it wasn’t a joke. And then the next five years was really about the first level of foundation building about creating leadership, a high-level leadership that were able to transmit the ideals of a Johns Hopkins hospital, on a Johns Hopkins University system. And when we had that in place and we had the quality metrics and we were driving towards quality in place Johns Hopkins and the community here both thought – the community here started asking, ‘Why are we not just Johns Hopkins All Children’s hospital?’ Because we’d been All Children’s hospital, a member of Johns Hopkins, and there’s only – there’s Johns Hopkins University, there’s Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center. And everybody else who is affiliated with Johns Hopkins at the hospitals are just their name of the hospital as a member, and we were a member, but it was determined… the community was like, ‘Why aren’t you changing our name to Johns Hopkins? We want to be Johns Hopkins.’ And then when we took the idea to Baltimore they said, ‘Well, your quality is there, and your faculty are there at the high level and we believe that you will continue and sustain yourself as a Johns Hopkins quality institution.’ And they walked in the door they said, ‘We want Johns Hopkins quality care, we want Johns Hopkins quality academics, so get it here.’ That was in 2016, April 1st, 2016 that the name got changed, so five years later. Now you go around, and this is the part you were talking about, now becomes the grind. Because the simple two to three years they’ll pat you on the back because it’s very ostensible, it’s very tangible what changes you’re making, because you’re going from nothing to something.

Ashley: Yeah, the visuals and…

Dr. Ellen: Yeah, it’s very easy.

Ashley: Right.

Dr. Ellen: But as you go from something to something more, and it was once said, getting back to your friend Jobs – Steve… There was an argument made that Steve Jobs actually was not that creative, that he went to a Xerox Park and he stole every idea that he had that made the GUI interface look different than anyone else’s. But what the argument is is that just some people go from nothing to something, but other people take something and take it to something else. And that we always laud the nothing to something, but the something to something else – great! You should also be lauded, and there’s a lot of creativity in that. And we are at the stage where you’re going from something which we’ve achieved, and it was there before we got there, added to it, but it’s something – into something else. And the problem is that’s a much more behind the scenes, much more… less pop, as you said, it doesn’t get the fireworks. And a lot of it it’s just ground game. And during that ground game you’ve got to keep people focused because in some ways you’re actually doing more disruption in the classic sense than you were in the beginning. In the beginning you just put a new coat of paint on and as you got to this later stage you’re now actually going into the guts and ripping things apart. And with hoping that you’ve built a strong enough structure or infrastructure around it that it can take the vibrations when they happen, but you don’t have that same… you now are really getting at the heart of a lot of things. And what you hope, again, is that you’ve built the resiliency into the organization to tolerate it. Because it’s not as exciting because it’s a lot smaller and finer work, it doesn’t come with big flashy appointments, it’s really basic blocking and tackling big things like making sure your faculty and staff are very engaged, making sure that there’s a culture of safety, that people feel everything you said is necessary, that the vision – everyone has the vision, there’s collaboration, the care models are efficient and effective, you get paid for what you do and you bill for what you do and you don’t bill for stuff you don’t do and you don’t not get paid for stuff you do. So all kinds of things have to get worked out. And then you go out and recruit people who are the next level down, whether they’re scientist or nurses or physicians, and hoping you get them in and get them on board and get them acclimated to your culture or part of your culture.

Ashley: Your transitional culture too.

Dr. Ellen: And all that is – so that was the phase two. Phase one was what happened from the time we closed the deal 2016, which we called transformation, we transformed it from a known as a community hospital to an academic, and now it’s an evolution as we evolve that concept.

Ashley: That was arguably more poignant than your first go around, I’m actually glad that we got back in and… it was great. So I want to talk about you referenced job interviews and you referenced bringing candidates in and what you’re looking for. So you probably had – I don’t want to imagine what your interview process looked like becoming the man in charge of this entity. What do you remember about that interview process?

Dr. Ellen: Well I was in Baltimore and they needed somebody to be the content expert on the transaction, so they had me come down to… I had come down here in 2008, then I came again in 2010… and in 2010 I started working on the transaction, and when the transaction closed I was the basically chief academic officer, I was the vice team.

Ashley: Did you think it was going to be temporary, or…?

Dr. Ellen: Initially it was and then it was going to be a little less temporary and then it was okay, it’s not so temporary anymore – as we were completing the deal. Because if you look at drafts it was like – it was…

Ashley: Interim?

Dr. Ellen: …interim, then it stopped being interim and then it became… I forgot what the next step was, but… And then when the decision was made to consider me for the CEO position, given all the factors they wanted, someone who was at Hopkins who knew their place, who knew academics, who knew hospital administration… there wasn’t – it was me.

Ashley: There was no competition.

Dr. Ellen: Well, wait a second. So then what they do? They didn’t want to be accused of making a mistake. So they went, and they interviewed 75 people, they did a 360 on me with 75 people with…

Ashley: Did you have a say who?

Dr. Ellen: No. They basically found everybody who ran either healthcare or ran a University in this region, they went to Baltimore to look for everyone they have ever trained or talked to, they went to all my supervisors in Baltimore and all the students I’ve had and basically interviewed them all and asked them…

Ashley: Did they share that with you, so now you know who is dead to you and who is – you’re alive on front?

Dr. Ellen: No, I have no idea what they heard. I don’t. I have no idea.

Ashley: But you knew that they were going through the process.

Dr. Ellen: Yeah, it was killing me, yeah.

Ashley: How long was it?

Dr. Ellen: It took about three months?

Ashley: Worth it!

Dr. Ellen: Right.

Joe: Was it worth it?

Ashley: So I have sort of a personal question, are you a stoic? And the reason I ask you that is because if you are…

Dr. Ellen: [laughing] Not even close.

Ashley: Can we leave it that? I’d like to – leave it, that question. So if you think about the… I don’t even know how I would describe it, if it’s a resilience or it’s maybe even just cognitive dissonance or it’s just true empathy and true connection to the work that you do but having toured All Children’s to look at the mission and to understand the foundation a little bit better, it’s a little bit of a punch in the gut when you see some of these families and these babies and these young, young children so ill. And I heard a story about some of the… construction work that was happening outside the hospital and I heard that every Friday there was a dance party and essentially construction workers to entertain the children, stop what they were doing, blare to music and danced and entertained the kids as they moved into the weekend off duty. And I think about just having continuously infuse your operations with a certain amount of levity and hope. So I would assume that somebody who is governing all that does have some level of…

Dr. Ellen: Well, see, most of the people going to pediatrics… go into pediatrics and not adults because kids are resilient. And the belief in their resilience and the joy that you see, and we have an incredible marketing department that reminds us of the joy and shows us the moments of great spirit that kids have, and it makes it… it’s a lot different than working with older people, it’s much more – I believe it’s much harder to deal with old people who are dying. And a lot of the kids get better, a lot of the kids we take care of get better.

Ashley: Right.

Dr. Ellen: Even the really sick ones get better. And…

Ashley: Maybe it’s just more of the…

Dr. Ellen: And they have spirit to the end too. So they take care of you.

Joe: You mentioned the evolution phase, the transformative phase and moving into the evolutionary phase. And I feel like St. Pete is going through that a bit now, I feel like we’ve enjoyed calling what we have here something special is happening, we’re calling it a renaissance. And I feel also that we’re at the point where we need to transition that renaissance into maybe the evolution phase. And you’ve been here through most of that in the time you’ve been here. Can you talk a little bit about, in working with a lot of the key leaders in St. Pete, what you’ve seen happening and what might need to happen?

Dr. Ellen: I’m laughing because I think I’d never thought of it until this second and you’re absolutely right, I think where we are is tipping over from boy, we have a buzz, we’ve created a buzz, we have a lot of institutions that are – two new museums opening up, we have our research building opening up, we have growth in the USF St. Pete campus… We have companies moving here, Jabil is doing well… And so I think you’re right, I think we have – and we have branded ourselves if you will, getting the name change concept. And you’re right, now comes the heavy pieces and the key to get everybody engaged, which is I think a key element of our transformative phase for the hospital is gonna be key. And maybe that’s what you’ve been trying to spit out for the last half an hour, but it is the point, is that we do need to get everybody on message, engage and understand the plan. I think our meeting – I’m going to try to tie every one of our conversations together – I think our meeting with the community meeting tomorrow is an attempt to start bringing those folks together. The work that the Healthy St. Pete is doing is trying to bring those folks together. What’s important is that no one get left behind because it will put a drag on the system if it doesn’t. So part of the transformative action is what you’ve been pushing for which is we need to get all elements now aligned and working together, whereas before we just needed the top elements, we needed the infrastructure, the big things, we needed buildings, we needed the right mayor, we need the restaurants to open, we needed the stuff that’s the high-level stuff – and now you got to get down to the guts. So you’re right, it’s a great analogy.

Ashley: Not to refer to another guest that we had, but Craig Sher was talking about the need in this transformative phase of our growth to not be too granular in our approach, and he is definitely a fan of more regional, even broader scale and collaboration. So one of the things, one of the hindrances to that as he saw it was really the caliber of leadership that are now evolving to the level of I guess a C-suite exec internally in the city. Outside of Johns Hopkins, certainly not commenting in leaders that you’ve created…

Joe: He said that there was a lack of them. He didn’t see where the next Tom James’s were gonna come from in that lot.

Ashley: Or the next John Ellen.

Dr. Ellen: I’m more hopeful than him. Craig…

Ashley: He was one of the 75 that was probably interviewed.

Dr. Ellen: Oh, Craig was doing the interviewing of the 75, Craig was one of the interviewers of the 75.

Ashley: Was he really?

Dr. Ellen: Yeah.

Ashley: All of the stars aligned.

Joe: Oh my God…

Dr. Ellen: He’s one of the people that was doing the interviewing. I do think there is a…

Ashley:  …a bench?

Dr. Ellen:  No, I think to get into his consciousness it’s much harder now because as much as he is still a city treasure, and I still consider him a mentor of mine, he’s not as engaged just on a daily basis with the people that you all see. And so I am actually much more hopeful than… I could do Leadership St. Pete and I look at the – I’m gonna call them ‘kids’…

Ashley: Thank you, class of 2017.

Dr. Ellen: Okay. Yeah, that’s what I’m saying, they’re kids.

Ashley: Baby.

Dr. Ellen: But they’re gonna emerge in places and make an impact. I think the harder part is what made Tom unique. Tom, because of his business and because of his personality reached across the Bay and this is probably more the point. There aren’t a lot of people who had that inspiration that he has seen to reach across the Bay.

Ashley: Or broader.

Dr. Ellen: One of the reasons that – the whole reason I think with the fountain got to be was an attempt to create something, that created collaboration across the bay. Particularly that’s why Judy Lissie from Straz and Hank and me and Gary got together, the overall goal was to create a dialogues that spread across, and ideas. We have our own – Hopkins has its own innovation hub in Baltimore and the head of that innovation hub is gonna be coming down here this week I think, actually.

Dr. Ellen: Vinik just hired a person to run his hub.

Ashley: Innovation?

Dr. Ellen: Yeah, his innovation hub. And so we have…

Ashley: How many innovation hubs…?

Joe: Lakshmi, I can remember it was…

Dr. Ellen: It’s in the paper today, so she’s in the paper. And she came from Chicago. So I’m having – her and him and I have breakfast next week. The different opportunities we can to create connections across the bay, that’s what I think Craig – because Craig, when he talks about regional stuff that’s his – because remember, he was part owner over the hockey team, right? Wasn’t he for a brief period of time with…

Ashley: …Lightning?

Dr. Ellen: …the Lightning.

Sylvie: The Lightning or the Rays.

Dr. Ellen: No, Lightning. But where is he…? The guy that I’m thinking of, the guy who is his partner in that, the Ashley Furniture. Not Ashley…

Sylvie: Brian?

Dr. Ellen: Kanes.

Sylvie: Oh, Rothman.

Dr. Ellen: Yeah, but who is this?

Sylvie: Irwin Novak.

Dr. Ellen: Irwin Novak, yeah. So the point was those guys rallied as a regional group and said ‘Okay, we’ll keep them.’ So that’s what he is I think referring to more than he is that there’s not local leadership.

Joe: Thank you very much…

Dr. Ellen: You’re welcome.