Dr. Jonathan Ringo fuses heart and hi-tech at Baltimore’s Sinai Hospital
Photos: Eli Greengart
he first thing you might notice about Dr. Jonathan Ringo, the charismatic South African-accented, yarmulke-clad president and COO of Baltimore ’s Sinai Hospital is his ID badge: It simply reads “Physician.” Because even as he oversees a staff of close to 5,000 employees and deals with everything from contract negotiations to overhauling patient-care protocol in Maryland’s largest teaching and research hospital, he’s first and foremost a healer with a huge heart, and still takes shifts on the ward as an OB/GYN in Sinai’s labor and delivery unit.
And if anyone knows a hospital from the other side of the bed, it’s Dr. Ringo. As a six-year-old growing up in a Johannesburg suburb, following an uncontrollable nosebleed, he was ultimately diagnosed with a rare type of blood cancer known as acute myelogenous leukemia (AML). At the time, with the prognosis for survival of that type of leukemia less than five percent, the doctors told his parents, “There’s nothing we can do for him — just take him home and keep him comfortable.”
But the Ringos were undaunted. With no treatment available in South Africa at that time, they contacted various medical centers around the world. The one facility willing to chance treatment was the Dana-Farber Cancer Institute in Boston, Massachusetts. While local medical personnel thought the Ringos were being cruel and unrealistic by taking their little boy out of the country to die, they knew they couldn’t sit back until every option was tried. In Boston, Jonathan was given experimental chemotherapy — mega-doses of powerful chemo cocktails, even though at that point there was an active debate about whether to treat the cancer at all because the feeling was that it wouldn’t make a difference. But both six-year-old Jonathan and his dedicated staff of doctors were fighters, and today, at 49, he’s one of the oldest survivors of pediatric AML.
Being in and out of hospitals for three years on brutal chemotherapy regimens made Dr. Ringo especially sensitive to the importance of compassionate as well as quality medical care.
“I’ll never forget what it’s like to be a patient — what it feels like to be miserable in bed,” shares Dr. Ringo. “When I was having chemotherapy, a lot of the medications that mitigate the side effects, or even the ports, weren’t available then. Often, it meant being reinjected again and again and again in order to get the chemo into the system.
“Sometimes, I’d have a treatment in the middle of the night, and in those days, parents couldn’t sleep over — my mother was the last one out and the first one in the hospital,” continues Dr. Ringo, whose little body had so many infusions that the doctors resorted to using the veins in his legs for procedures. “I was often alone when I had to get the IV re-stuck and get the chemotherapy, and I remember how I felt then and how scared I was at the time. It’s something that stays with you forever.”
Dr. Ringo says his experience as a patient is what fashioned his dream of becoming a doctor, as the care and compassion he felt from his own medical team became his role model for how to take care of other people. He took a detour, though, working as a senior scientist and global strategy manager in the biotech field for six years before earning his medical degree.
Dr. Ringo’s packed day starts with Shacharis at Yeshivas Ner Israel — just steps away from where he and his wife, Dvora Meira, live with their six children, ages 6 to 18, on Yeshiva Lane. Dvora Meira is the daughter of Ner Israel mashgiach Rav Beryl Weisbord and psychologist Dr. Aviva Weisbord, who is the daughter of past rosh yeshivah Rav Yaakov Weinberg and Rebbetzin Chana zichronam livrachah. (Chana Weinberg was the only daughter of founding Rosh Yeshivah Rav Yaacov Yitzchak Ruderman).
Dr. Ringo remembers how, when he was coming to a decision on whether to stay in learning or go to medical school, Rav Weisbord (who was his rebbi but not yet his father-in-law) told him to speak to his own father-in-law, Rav Weinberg.
“I think about the eitzos Rav Weinberg gave me almost every day,” says Dr. Ringo. “His point was that HaKadosh Baruch Hu could have designed the world in any way, but the fact that he created every single piece of the briyah in the way that he did is a critical point for us to understand. As you go through medical training, part of what you have to do at every turn is to try and understand why HaKadosh Baruch Hu made the things the way He did — and that is another way to relate to Him.”
Some days after davening, Dr. Ringo drives his children’s carpool; on other days, he might have an early-morning meeting with another physician or a meeting with a board member at the hospital. Throughout the day, he has meetings with peers, with members of his team, and with staff members, all in service of the operational and clinical aspects of the hospital.
These meetings are as varied as the different aspects of running a hospital, “from negotiating a physician’s contract, to how long it takes for a cleaner to turn over a room, to how many operating rooms are used on an ongoing basis, to the progress of an individual patient,” Dr. Ringo explains. Some days, Dr. Ringo is lucky enough to leave the hospital by six or seven p.m.; other days it might be dinner meetings with board members or physicians. One thing that’s not negotiable is his night chavrusa — and then there’s Maariv, phone calls, e-mails, and finally, four to five hours of sleep.
And he doesn’t waste a minute: Much of our discussion — everything from administrative issues and Obamacare to how he keeps employees happy — took place while he was walking on his office treadmill desk (he’s in great shape — his breathing was never labored).
Dr. Ringo, who was officially appointed to the new position on May 2 of this year, had been acting president and COO for a few months prior. Still, he never lost sight of the people behind the statistics. Just a few weeks into assuming his new role at Sinai, there was warning of a massive impending snowstorm for which he had to prepare the hospital by opening up an Incident Command Center. A representative from each department met to ensure that, should the roads shut down, the hospital would have enough medical supplies on hand; that mattresses were set up for staff members who would have to sleep over; that there were enough electrical generators. It turned out that the second day of the storm, the roads were impassable for almost a day.
“We had a pediatric patient in our oncology ward who was dying and wanted to have strawberry ice cream,” recalls Dr. Ringo. “One of our chefs walked three miles from the hospital to go and try to track down this ice cream and bring it back. We have many people who work here who are incredibly devoted and go above and beyond.
“This is what makes a hospital tick, day in and day out,” continues Dr. Ringo. “People who work here could have worked in a bank or in a hotel, but they came to work in a hospital and it shows — they really, really care. The patients are having some of the worst days of their lives. If you are in the ICU, you are having the worst day of your life, and staff members have to deal with it daily, and they really, really care. It makes the biggest difference. I know.”
r. Ringo says his father-in-law’s motto of “Ve’ahavta lerei’acha kamocha” — of treating every person as you would want to be treated — is what drives him to push the limits of good patient care. “A patient who comes into a hospital is under a great deal of stress. If someone is in our ICU, it’s tremendously stressful for both the patient and his family. That also means it puts a lot of stress on our teams and on our staff, so we have to understand that we’re not just taking care of our patients, but we’re taking care of our staff and team members as well. So we’ve implemented programs that understand the pressures that our staff members are under and make sure that we’re looking out for them, too.”
One of these initiatives is the Sinai ICU’s policy of never having more than a two patient to one nurse ratio. “This way the nurses aren’t getting stressed and the patients are getting the best care. We’ve done a lot of work in the last year and a half to decrease patient wait times. Two years ago, when someone came to our emergency room, the average wait time might have been 60–70 minutes before they saw a doctor. Now, it’s routinely under 20 minutes.”
While the doctors need to do their best, Dr. Ringo emphasized that so do the patients. “They have to do whatever they can to understand the plan of treatment and be as committed as their doctors are to their healing. If they don’t fully understand something regarding their treatment, they have to verbalize that so the physicians understand that things aren’t clear. We always encourage asking questions. If the doctor isn’t there, we tell the patient to write them down, so they don’t forget to ask something important. Our expectation of every single caregiver who works here is high quality, compassionate care — that means top care given with understanding, empathy, and compassion for what the patient is going through.”
s Sinai was one of the first hospitals to train and treat Jews back over 150 years ago, I’m curious to peek inside the hospital’s homey, well-stocked Bikur Cholim room today. Sinai’s Director of Patient Experience Katie Starkey mentions that Sinai has a partnership with the local Bikur Cholim, and the Sinai ER has an additional Bikur Cholim pantry for Hatzolah’s first responders. Rabbi Pinchas Rabinowitz, Bikur Cholim’s liaison to the hospital from the frum community, works together with her department.
As we pass an elevator with the Hebrew quote, “Whoever saves one soul is as if he’s saved an entire world,” Dr. Ringo shares that a few months ago the hospital participated in a signing ceremony in Jerusalem with Deputy Health Minister Rabbi Yaakov Litzman and Nadav Chen, CEO of Laniado Hospital, Sinai’s sister hospital in Israel.
A walk down the corridors indicates how Dr. Ringo is clearly at home in every ward. “Before I took this position, I went to discuss things with Rav Yaakov Hopfer of Shearith Israel Congregation and president of the Vaad HaRabbonim of Baltimore. One piece of advice he gave me was, ‘Get out of your office, get out from your desk, and walk around.’ I try to put that into practice every single day. He felt it was very important to understand firsthand what’s going on, what the problems are and what some of the areas of opportunity might be. It makes a huge difference.”
As staff members pass by, it’s obvious even from their short on-the-go exchanges with Dr. Ringo how venerated he is here.
One of his innovations is what they call the VP Huddle. Dr. Ringo explains: “I meet with my entire team of vice presidents every week for an hour or two. Before that meeting, each one of us gets assigned a different area of the hospital, and then we come back and discuss it at the meeting so the issues can be addressed right away.”
Katie elaborates, “For the first 30 minutes of the Huddle, all VPs are assigned areas to go around to talk to staff, patients, and families — what’s working well, what could be working better, what things need to be addressed, what plans need to be put in place.”
“Last March, we started a Safety Huddle,” adds Dr. Ringo., “We start at nine a.m. every morning. Every single department sends its manager or a representative to a ‘huddle room,’ where they report back on the events of the last 24 hours and every problem they anticipate in their day, so they can be acted upon immediately. Those managers then report back to their departments so the information is spread very rapidly.”
In addition to being president and COO of Sinai Hospital, Dr. Ringo is also the senior vice president of LifeBridge Health, Sinai’s parent organization. Sinai Hospital is the flagship member of LifeBridge Health, and Dr. Ringo is responsible for the health system’s move from fee-for-service to value-based care.
“Previously, someone with a hip fracture would come to the hospital and the insurance company would have to pay the surgeon, anesthesiologist, hospital, as well as for medication,” Dr. Ringo explains. “If there was a complication after going home and they returned, they would have to pay for everything again. In the new world, the insurance companies may look at things more globally, encouraging taking a longer-term view of the patient so that the patient will hopefully stay out of the hospital. A lot of the programs we put in place are to take care of patients not only while they are in the hospital but when they get home, to keep them safely at home as opposed to having to come back in. We want to see patients getting the right care at the right place at the right time as opposed to requiring care in a more high-cost environment — and we want to see them become advocates for themselves.”
e pass a wall of handwritten notes written from one staff member to another. “They were put up to remind staff members how appreciative they are of one another for what they do,” Dr. Ringo explains. “It ’s a real hakaras hatov.” Cutting through the Physicians Service Center, we exit the main building and walk outdoors to the adjacent building where Sinai’s most recent innovation lies — the command center that monitors, among other things, the Israel Call Center.
Sinai’s Israel Call Center is a program that was implemented in July 2018 to fulfill the wide-ranging ongoing needs of patients. “It allows us to use American-trained and licensed nurses now living in Israel to work for our hospital,” explains Dr. Ringo. “They’re based in Israel, but they make phone calls and are in touch with patients in Baltimore.” The program started out with six employees; today, there are 20.
Widescreen monitors on the wall connect the Baltimore staff to the Israel-based employees, who are making sure, from afar, that patients are taking their medication, that they’re keeping follow-up appointments, and that they understand the ramifications of their medical situations.
Abo Suyonv, a confident, well-spoken physicians assistant, steps close to the camera to tell a bit about himself. Prior to making aliyah about 2½ years ago, he worked in the US with internal medicine, urology, and infectious disease patients, in both facility and home-care settings. Abo used to travel back-and -forth between Israel and America on a monthly basis working for his previous employer. Now, however, he works exclusively from Israel. Another employee, Vicky Rosales, shares that she moved to Israel from Cleveland last March, where she worked in hospital, hospice, and home-care settings.
Leah Pollack recounts that when she got married 12 years ago and subsequently moved to Israel, her background in commercial mortgages gave her the know-how to run a call center. “My brother-in-law met Dr. Ringo at a bris and connected us, so I landed a job in this unbelievable company,” she says long-distance. “They have the zechus of having all of us — kollel wives and yungeleit — who come work at night.” The call-center staff is primarily in touch with patients, but is sometimes in direct contact with physicians as well, who want updates on their patients.
It ’s evening in Jerusalem, confirmed by a clock on the wall — one of three, indicating the current time in Israel, Baltimore, and Manila. Because there is a Philippino call center, too. Still in the development stage, employees in Manila participate in a daily conference call with the command center and handle some of Sinai’s transfers. Prior to its opening, if a patient who suffered a heart attack, for example, transferred from another hospital, the physician would have had to call the cardiologist, anesthesiologist, cardiac interventionalists, and technicians, among others. Now, the doctor makes only one phone call to the nurse in Manila who coordinates everything.
Noting the three different time zones the call centers work from, Jonathan Moles, associate vice president of the command center, explains the advantage of working around the clock, and notes that in Israel, there are also non-Jewish employees who work from Friday afternoon Baltimore time when the Jewish nurses in the US go home.
In addition to the Israel Call Center screens, there are other monitors as well in the command center. “You can see every single room in the hospital,” Dr. Ringo explains, pointing out the color-coded stats charts. “You can see if a patient’s room is dirty and waiting to be cleaned. For example, the patient in this room left 31 minutes ago. If this green color doesn’t turn to white-and-brown stripes, the command center staff will call and make sure it gets cleaned, so we can keep people moving the whole time.
“You can also see the stats of how many people are waiting for beds,” continues Dr. Ringo, pointing to yet another screen. “We partner with a company called PeraHealth. It takes about 80 different measurements from the patients’ electronic medical record — vital signs, lab signs, physician and nurse findings — and incorporates them into an algorithm that predicts if the patient may have some clinical deterioration. If they see someone with heart symptoms, for example, they can contact the nurse taking care of the patient, have him get an extra set of eyes to watch over him, or call ahead for a rapid response, so a new team of physicians and nurses will go to the patient’s room and evaluate him.”
Jonathan Moles points to the screen and explains, “If patient #11 arrived into this red lane in the middle of the night, Abo could be the quarterback of the care team that comes together to say, ‘This patient has worsening symptoms; why did this happen and what ’s our plan to make sure that he improves?’ ”
Dr. Ringo adds, “The nurses in Jerusalem have access to the electronic medical records and they can see everything that’s going on with each patient at all times.” They make sure that the patient’s managing physician is involved, and they have a rapid response when it comes to reacting to patients with deteriorating conditions.
Off to the side of the Israel Call Center are three telemedicine rooms, where medical staff are remotely managing patients. “For example, when patients show up to the Sinai-Northwest Hospital Emergency Room triage, they are actually seeing a provider who is standing behind the camera over here, giving instructions to try to get things moving along. Right now, he ’s overseeing two ERs at the same time,” explains Jonathan Lerner, associate vice president of Advanced Practice Providers, a trained PA with an MBA.
“Basically,” clarifies Dr. Ringo, “a physician or PA can sit here and view what is happening in the emergency rooms at Sinai and Northwest. If a patient comes in with a stomach ache, the person here can interview him while he is next to a nurse, understand what is bringing him in, and decide if it’s necessary to order a chest X-ray or blood test. If so, it will be ordered from here, so by the time the patient goes from the ER waiting room into the back to see the doctor, the tests have been run. Soon, we will be able to have the staff in Israel doing the same thing.”
Sinai is not the only hospital that utilizes this type of telemedicine, although it’s unique in that it has bundled five or six different protocols together into one package — and no other hospital has an Israeli call center.
“You can think of all this as the air traffic control that directs both the patients and their providers. You don’t want patients lying on a stretcher for six hours waiting for something, and it is often much easier to get a test or a procedure in a more comfortable environment so you don’t have someone waiting for three or four hours for a test. The decrease in wait time alleviates the anxiety patients experience over an extended period of time.”
The Call Center also means that overnight patients can be discharged first thing in the morning, when the day shift begins. “It alleviates the doctor coming in at seven a.m., saying to the patient, ‘I want to let you go home but you still need an X-ray.’ So, at two a.m. in Baltimore, when it’s nine a.m. in Jerusalem, the nurse will have seen the patient and by seven a.m. he or she can go home,” Dr. Ringo explains.
r. Ringo says that, all the medical innovations notwithstanding, the most compelling aspect of his position is the very real and intimate connection to the entirety of the life cycle. He can be covering the labor-and-delivery floor during the day, and later be dealing with oncology services and terminal patients. “So you can literally go from someone being born and, five minutes later, dealing with someone at the very end-stage of life,” Dr. Ringo says. “In a flash, you can see the circle of life, from spending time with a family experiencing one of their happiest times, to helping a family who is going through one of the worst times. But isn’t that the shlichus of what being a healer is all about?”
(Originally featured in Mishpacha, Issue 767)