Kurt Newman, M.D., president and CEO of Children’s National Health System in Washington, D.C., recently wrote Healing Children: A Surgeon’s Stories From the Frontiers of Pediatric Medicine. The book provides insights on pediatric care issues, the resiliency of children and some of his most memorable cases. We asked him to share his views about the state of pediatric medicine and what can be done to improve it.
Where do you see opportunities to improve children’s health care?
NEWMAN: Instead of cutting resources, we should be putting more into research for some of the great potential advances and frontiers in such areas as neuroscience, mental health or genetics. If we discover the source and causes of some of the diseases that can become chronic like asthma, diabetes or obesity, we could have a big impact. If we do the research and identify the causes, then we can screen and correct things earlier.
One of the areas I’m passionate about is behavioral and mental health, where we’re just not doing enough. Twenty percent of children will have some type of mental or behavioral health issue during their childhood. And the time from when these things are first noticed to when they’re diagnosed if treatment is available and given is an average of eight years. If we focused resources here, we could have a big impact on our children’s health.
In the book you mention the need for more children’s hospitals. What would it take to make that happen?
NEWMAN: I use that as kind of shorthand for needing more investment in children and making their health a national priority. We do need a few more specialty centers — children’s hospitals that can do the things that only a children’s hospital can do. But I think we also need more focus on the special value of pediatric medicine — more specialty services, more focus on the unique types of medicine that children need.
It’s a complex problem because there’s also a pipeline issue. As part of the focus, investment and prioritization, we need to be training more pediatricians and pediatric specialists so that we don’t have shortages in these areas.
Technology can play a big role here because we can, in a sense, force multiply some of the resources that we have by using telemedicine to create better access in communities where there isn’t the possibility or opportunity for pediatric specialization because of the population. We can use telemedicine and other innovations to spread the expertise that we do have.
What impact is violence having on children today?
NEWMAN: This is a high-priority social problem involving a lot of factors. I’m proud of the fact that the American Hospital Association is taking a lead advocacy role on this issue. I look at it from the pediatric medicine perspective of trying to prevent and intervene early.
There are some things we need to do and look at as a society about creating opportunities for young people so they don’t turn to violence. I don’t have any magic answers, but one dimension involves mental health and the unmet need to identify early young people with mental health issues and getting them the help and treatment that they need.
We are really underserved in these areas, and a lot of these children are in urban communities. We can make an impact by increasing our mental health screening and removing the stigma of mental health that sometimes gets in the way of providing the resources. Also important is getting more mental health resources into the community.
I'm acutely aware of the impact of trauma in young people, and I mention a couple of related situations in the book. They're pretty amazing and inspirational young people. One was a child who was a bystander shooting victim. Hospitals have done a really good job developing trauma systems and the ability to respond to crises and take care of children after they’ve been shot or stabbed or endured trauma. That is great, but we need to do a better job of getting ahead of that and trying to identify causes.
Some experts have questioned whether emergency department designs meet the needs of mental health patients in distress. Is this a concern in children’s hospitals?
NEWMAN: That’s a great observation. We’ve certainly had to think through our process and take a look at things from the patient-family perspective because there are all of these great needs and mental health issues.
In a crisis like that, whether it’s anorexia, suicide, drug overdose or major psychiatric illness, what environment is going to identify and help to solve the problem? More and more, as we look at the importance of hospital design and the workforce, we want to coordinate those assets in a way that makes for a healing experience.
I talked about a scenario in the book where, when I first became CEO, we thought we were doing a great job for children with autism because we were providing a lot of services under sedation and anesthesia. What we didn’t realize was that we hadn’t really thought through what the environment was like for a family that was bringing in a child on the autism spectrum and how our staff would react and treat them.
What we were doing, in many cases, may have been misunderstood by the children because they didn’t have the normal frame of reference. When we talked with many of our families, we realized that we needed to do a lot of training: We had to reorganize the process; we had to understand what things calmed these patients down versus the things that might upset them; and we needed a tailored approach for each child. We’ve seen remarkable results with that. Kids who would be really upset and not understand what was going on now have a very calm and soothing experience.
You write about the value of mentors. How can hospital leaders foster these types of efforts?
NEWMAN: One of the things I’ve benefited from over the years was leaders who were able to make themselves vulnerable in a way by being open and sharing their experiences — not just their successes but their challenges and some of the difficulties that they have faced.
We have such great leaders in our hospitals and health systems and sometimes it gets missed, and people look at these leaders as though they were always in charge or were always very successful. One of the lessons that I learned is that all of these leaders are in these roles because they want to share, they want to have an impact. One of the great and most satisfying ways of doing that, and I’ve been around residents, students and trainees all my life, is to be able to share the difficult decisions, the tough calls, the things that sometimes did not go well. That creates a bond and a credibility and authenticity to the leadership. It’s also just so satisfying to have the opportunity to have young people be inspired by our leaders.
THE NEWMAN FILE
A native of North Carolina and graduate of Duke University School of Medicine, Newman has been a practicing surgeon and chief of surgery at Children’s National Health System in Washington, D.C., for more than 30 years. He is also a professor of surgery and pediatrics at The George Washington University School of Medicine & Health Sciences.
He helped to create the Sheikh Zayed Institute for Pediatric Surgical Innovation, dedicated to making children’s surgery less invasive and pain-free.
He and his wife, Alison (a neonatal nurse practitioner), are the parents of two sons and live in Bethesda, Md.
He is donating his portion of the proceeds from his book to the Pediatric Health Opportunity Fund, a charity that provides support for research in pediatric medicine.