National Jewish: We try harder. We’re number 1.

ONE of those ad jingles that entered the culture was Avis Rent-A-Car’s “We’re number 2. We try harder.” Sitting with the president and CEO of National Jewish Health, Dr. Michael Salem, I thought his motto must be: “We try harder. We’re number 1.”

With NJH ranked the number one medical center in immunology and respiratory medicine for 13 years in a row, you just know that it’s not resting on its laurels. It’s only the details you don’t know.

Dr. Salem’s restless energy and endless ideas, in-reach, outreach, collaborations, interfaces, studies — these and more came through in every minute of the one hour I sat with him recently. Had I the same level of scientific expertise he has, he could have kept me there for days with a review of developments.

Dr. Salem’s background is in surgery, academic medicine and medical entrepreneurship. Those aren’t just credentials — they’re but a few of the fields of NJH’s leadership. Dr. Salem recreates his institution anew along so many axes that one wonders whether NJH is trying to be number 1 in other fields, too.

He speaks of departments — departments of immunology, of pediatrics, of medicine. He speaks of “three pillars”: charity care, a 10-year-vision and strategy, and research. His speaks of so much that the words whiz by . . . fellowship training, scientists, clinicians . . . culminating in “a transformative experience for patients.”

His bottom line is to pull it all together — the research, the new technologies, the sequencing of the human genome, the specialized knowledge, the new institutes, to get to three basic goals:

• individuality: taking the time to understand each patient individually. By the time a patient reaches NJH, the standard protocols for treatment have failed; NJH tailors a treatment protocol to each individual.

• prevention: to practice and disseminate preventative medicine — Dr. Salem’s answer to burgeoning health care costs. Keep healthy, so you don’t need expensive treatments.

• integration: truly integrating clinical care and research. NJH brings its research to bear on its clinical care, and learns from its patients to advance its research.

“Goal” is not the wrong word for these three, well, goals. For as good as NJH is — “we’re the best in the world in taking care of asthma,” says Dr. Salem — “we still haven’t figured out the genes that predispose a person to asthma.” That restlessness shines through.

“OUR board invested $25 million in getting our 10-year [2007-2017] vision started — invested in new tools for our institution to be successful,” he says with gratitude and a certain odd objectification, as if the board did this entirely on its own, with no guidance from him, with him just implementing it all. Hardly.

The 10-year NJH vision is to lead to:

• hiring the “next generation of brilliant faculty”; 75 new faculty, to be exact;

• building the Center for Genes, Environment and Health, to understand the genetics of lung disease;

• building the Institute for Advanced Biomedical Imaging, in partnership with the healthcare company, Siemens, “to help us find diseases earlier”;

• building a minimally invasive diagnostic center (“you have a small nodule in your lung; if we can get a sample in a minimally invasive way, you can find the answer without putting a patient with emphysema at risk”).

The bottom line: “On the clinical care side, to reduce the death rate.”

Interwoven somewhere in all of this is National Jewish’s recommitment to cardiology. For years NJH dropped cardiology, but cardiologists are back on the NJH staff because, says Dr. Salem, “a person comes in. He’s got shortness of breath. Is it his heart? Is it his lungs? It could be either. You don’t know. So you need both pulmonologists and cardiologists.” Again, that integrative thrust.

Restless — and reeling; that is, Dr. Salem’s restless recitation of all of the activities at National Jewish leaves me reeling. As if all the above were not enough, just a single one of NJH’s collaborations — a study of 10,000 patients — has thousands of slides coming to NJH, with NJH being the center of their analysis, assisted by 22 other major medical centers around the country.

“ . . . and we just completed a study that found a new genetic variant in patients with pulmonary fibrosis . . . the largest study in the world . . . may lead to a new diagnostic test . . . published in the New England Journal of Medicine   . . . we’ve had four articles in NEJM in the last two months . . . a substantial discovery here . . . ”

For each of these studies, NJH needs not just top scientists. It needs: a data coordinating center, to double check the data; a specimen collection apparatus; nurses; clinical coordinators; research infrastructure; institutional review board; patient consent; grant writers; statisticians; laboratory technicians to do the genetic analysis; etc.

DR. Salem likes that word, “interface.”

The researchers have to interface with the clinicians.

NJH has to interface with other medical centers.

NJH has to interface with satellites, cities, suburbs and medical centers throughout Colorado (“Rose; Highlands Ranch; south Denver; Aspen and Basalt; Vail; Littleton; Health One; Denver Health; Children’s Hospital”).

NJH has to interface with its immediate neighborhoods in east Denver.

NJH has to interface with the local Jewish community, for when all is said and done by this great internationally famous facility, 85% of its board still comes from Denver.

NJH has to interface with itself, coordinating its 2,000 people on the campus centered at Colorado Blvd. and Colfax Ave. — the ever expanding campus, with “patient encounters” having risen from 40,000 in 2007 to 86,000 now; and with the seven-and-a-half acre Gove Junior High site recently purchased by NJH. It is now being rezoned, likely to be torn down to make way for another research or clinical facility.

Mainly, NJH has to interface with “quality, all the time; we’re always worried about the dilution of quality.”

Did we mention the Kunzberg School? It takes care of the medical needs of 90 students who have dropped two grades behind ( “ . . . the only free school of its kind for chronically ill children in the country . . . ”).

“I think National Jewish is the best at what it does because of the way it started,” says Dr. Salem. He spells it out. National Jewish started with charity care and with collegiality.

“Otherwise, it wouldn’t get done — figuring out what’s wrong with people, no matter what.”

Copyright © 2011 by the Intermountain Jewish News