Being a mentor, enjoying colleagues who are millenials. Look at these SMARTER Goals



I used to read about mentorship programs at other organizations with envy. Then I found out that we had a mentorship program at Kaiser Permanente. That was 2 years ago, and now I’ve been engaged in 2 mentorship relationships, each for a year. See my previous one: Walking with Generation Y – From Bricklayers to Cathedral Builders | Ted Eytan, MD.

Sometimes these are called “reverse mentorship.” I like “intergenerational mentorship” or can we just say “co-mentorship” so that there’s no age overlay? Us Generation Xers are sensitive (not really…).

In any event, I asked Motoki Bandai (@mbandai), who I’ve been working with for a year if I could share his SMARTER goals here, and he said I could.

SMARTER stands for “specific, measurable, attainable, relevant, time-specific, exciting/energizing, reviewed.” Our mentorship system places emphasis on setting good goals in the relationship. We’re here for good outcomes / forward movement / better health for the people we serve.

Here they are, see what you think.

GOAL #1

To support the growth of our team and capabilities, I will manage and mentor our newest team member through the early parts of her career. By the end of 2014, I will support her to successfully complete a significant project that will be presented to our director.

5 Chunks

  1. Give good, constructive feedback in various situations
  2. Balance “being a friend” and being a boss
  3. Create a well-structured work plan, increasing her responsibilities step-by-step
  4. Ensure she gets good exposure and opportunities to network with members on my team and elsewhere
  5. Give her the necessary autonomy to run with tasks/projects. Do NOT micromanage.

GOAL #2

To become an excellent collaborator across organizational boundaries, I will not drop an executive’s name once this year to get the cooperation of our stakeholders in any of the deliverables we put together for our key initiatives.

5 Chunks

  1. Keep my ears open for the latest information related to the project
  2. Understand, as much as possible, the motivations of stakeholders
  3. Find common ground in all of the discussions I am involved in
  4. Communicate. Talk in terms of our common ground and common motivations
  5. Escalate when necessary. Don’t drop names if things aren’t working out.

I think these are great. Why? They completely speak to the idea of building cathedrals vs. laying bricks in one’s career. I think it’s very mature / forward thinking to pursue a path of problem solving that’s dependent on one’s own assets rather than assets that you may / may not have control over.

If people think that leaders who happen to be in Generation Y or Millenials are focused on accessing senior leaders or career advancement, goals like this show that not to be the case. And just to be clear, I didn’t come up with these goals, they were generated after some thoughtful reflection. I am only happy that I got to see the finished product.

These meet the standard of SMARTER, and they are just good models for others to follow. 

Motoki mentioned to me that some of ways we segment the Generations are not as appealing to him, and I agree. These goals speak to me, because if everyone adopts goals like this, in all parts of society, we’ll wake up to a sustainable, accountable health system, and society, where everyone can achieve their life goals. That’s the part where this is co-mentoring. Enjoy, and thanks for a great year, Motoki!

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Design for Action is having its first ever conference, Washington, DC, 10/14/14!



Who uses behavioral science? Who doesn’t? If you don’t you should. View on Flickr.com

Disclosure: I am a volunteer Board Member for Action Design Network, the 501c3 that supports Action Design DC, SF, New York and Boston….

…and I have been a Board Member since March, 2014, because the Action Design Network is interested in connecting the best behavior design to health, and as I always say, if someone is doing something better than I, I’d like to know about it.

The Design for Action conference is happening October 14, 2014 in the Washington, DC area

The conference builds on everything we’ve done here with the Meetup. We’re bringing together leading practitioners and researchers from around the country, all to share their lessons on applying behavioral economics to product design. Thus far, we’ve announced speakers from Airbnb, Jawbone, Harvard, and more.

So yes, the speakers are going to be great, as will the networking, because the whole week is going to be filled with fun actitivities, including a Kaiser Permanente Technology Forum at the Center for Total Health on October 16 (more on that to come, it will be open to the public), and then MoDev’s Wearables + Things conference October 20-21.

Action Design DC is one of the largest meetup groups in Washington, DC, clocking in at almost 1,300 members. There’s a lot to learn about behavioral economics that can be used for good. The other thing I say is that there are a lot of analogies to health care in the things I learn here. Come join us…

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MakerDocsDC – August – Being a physician entrepreneur



Co-mentoring – Nishi Rawat, MD, Brian Masterson, MD, Kevin Maloy, MD (@MaloyKR), Ed Tori, DO (@DrEdTori) (View on Flickr.com)

It’s hard enough to be an entrepreneur (I can only guess, I am more of an intrapreneur), being an entrepreneur and a physician at the same time brings its own special challenges. And a lot of advantages, too, around connecting innovation to patients and patient stories and the greater purpose of excellent health and health care (see the article linked below).

I’ve written about MakerDocs previously (Formerly called “MakerMDs”, now inclusive of all physicians). Washington DC has a rich entre/intrapraneur community that is continuing to get together. It’s a good thing for physicians to mentor each other, it helps us be better servant leaders :). Thanks to our California colleagues Rebecca Coelius, MD and Connie Chen, MD, and the entire community there for putting us on the launch pad. Here we go!


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In the future, patients and families will help design and govern the health system. We’re from the future.



@KPSanDiego innovates. Dr. Susan Mahler and Dr. Jeff Benabio with Susan’s daughter Patricia, TEDMED, 2013 (View on Flickr.com)

A patient on a governance group for workforce Information technology? Yes!

For some reason, I haven’t posted about the fact that I am part of the National Quality Forum’s (@NatQualityForum) Patient and Family Engagement Action Team. We first got together in February and now it’s August.

I am also part of an effort at Kaiser Permanente to envision the future of health, AND at the same time an exciting part of my job is that I’m the medical partner to the Senior Director of Kaiser Permanente’s Digital Workforce Group, Melina Linder. The Digital Workforce Group exists to help the Kaiser Permanente workforce connect and collaborate, as part of the Digital Services Group, which also produces the world famous kp.org.

How does all of that come together?

For me, to a place where I envision the (not “a”) health system of the future as being one where patients and families are involved everywhere, from individual treatment experiences, to design, governance and policy.

There’s a great paper that reviews all of this: Carman KL, Dardess P, Maurer M, et al. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Aff. (Millwood). 2013;32(2):223–31.

We shouldn’t say patients should only be involved in governing parts of the health system that touch them in certain ways. Every part of the health system touches them. I grew up in a health system where member governance is not the exception, it’s the norm (@GroupHealth, you know, the magical health system of the future, in Washington State).

A member (patient) on the Digital Workforce Executive Governance group: Susan Mahler

(Dr.) Susan Mahler is an exceptional person, as exceptional as any one of our 9.5 million members. She has been an educational leader for 35 years, and is now a health system leader in her role as Kaiser Permanente member. Let’s allow video to do the teaching…

As she says, she is also the recipient of a heart transplant, and she is here today because of excellent medical care.

Earlier this year, we asked her to become a member of the Executive Governance group for Kaiser Permanente’s Digital Workforce Group. She said yes!

It’s a journey

I would not be telling the truth if I said, “everyone instantly saw the value of this idea.” I am telling the truth when I say, “everyone said, let’s try it,” because we work in a place where we understand what it means to be there for our members, and…our DNA is a powerful force for good :).

We actually thought about this for awhile – why should a patient helping to govern a group that primarily serves the workforce? Couldn’t she serve purpose better elsewhere? Maybe; however, who does the workforce serve? And as another leader, Gilbert Salinas, BS, MPA told me when I asked him about it (and I will never forget what he said):

Health systems have patient happiness committees and employee happiness committees. They should all be the same committee.

I created this short slide show for my colleagues and also showed it to colleagues on the NQF team, to show the impact of having members involved at the level of governance and more importantly the impact of not having them involved. The story of Mid-Staffordshire in England is beyond sad.

Kaiser Permanente happens to have a Patient and Family Toolkit available to the organization internally. I am working to see if it can be made more widely available, because it covers so many of the basic questions people have about making this happen. Susan herself has been engaged with Kaiser Permanente at multiple levels in the extremely innovative KP San Diego (@KPSanDiego) service area. This includes being part of several unit-based teams, which connect the workforce in solving problems for our members. Voila.

It’s happening + this is the future

So Susan is now with us as part of the team. When we speak of things “Digital Workforce” this includes technologies, tools, and people that enable our workforce to finance and deliver care. There are a lot of acronyms. A lot of systems. A lot of organizations and departments coming together. Susan asks awesome questions, and is patient in the not knowing what she doesn’t know.

The only downside/fear I have in all of this is that she is too much of an examplar. Will people expect every patient and family leader to have the same skillset and background? Not every patient who will design systems with us will. Will some patient and family leaders not work out? Sometimes. We deal with that with our colleagues all the time, though, and there we celebrate the diversity. It will be no different here.

If I envision a health system 10 years from now, yes, there will be more technology, a different generation, sustainable buildings, food and transportation :), all awesome.

I want the health system to think about something that’s not new technology that will have just as much impact, if not more…. listening. When we think about the model of health, it won’t just be about what we do for or to the people we serve, it will be how we do things with the people we serve.

This is what Susan had to say when I asked her if it was okay for me to talk about her role:

Trust me when I say -”I’m loving it!!!” My background includes a music and drama major from UOP with dreams of becoming “discovered”…….however, I did get my teaching credential just in case it took some time…..Well – after doing some stints in summer stock – Starlight, Music Circus, and Melody Land……..I did head into the education arena and really never looked back……..I loved education – However, if I’d known that there was a bit of fame in my future – gosh – I might have had the transplant (that which started all of this) years ago! No – kidding aside……I am thoroughly honored to be part of this vision – the true partnership between Kaiser Permanente and its members (customers)……….I am here today because of Kaiser and so, with that, I’m absolutely here for Kaiser in every way possible……….thanks so much, Susan

I’d say maybe the cross-irony here is that it’s Susan who’s making Kaiser Permanente famous, for showing the world what happens when a health system makes an investment in our members through excellent coordinated medical care, and then supporting our members in investing back for millions of other people who will come after them. 9.5 other million at least :) .

PS Writing this blog post doesn’t mean that “I” did this. That’s never how these things happen. Thanks to a very supportive group of business partners including Melina, the Kaiser Permanente San Diego team, Arlene Pergamit specifically, all of the other members of the group who’ve welcomed Susan as a co-student and teacher, and all of the nurses, doctors, family, and community members who have helped Susan stay healthy so that we may enjoy this innovation in listening.

I love living in the future, don’t you? 

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The People of Washington, DC’s Anacostia are Building a Culture of Health



The last time I was in Anacostia, Ward 8 of Washington, DC, was almost exactly 2 years ago (!) when I walked with Kait Roe (@Fuse_Kait) and Pierre Vigilance, MD (@PierreVigilance) (see: My #walkwithadoc and patient, exploring the determinants of health in Washington, DC Ward 8 | Ted Eytan, MD). Well actually, I was *near* Anacostia when I walked the future 11th Street bridge (@DCBridgePark) (Photo Friday: Walk With a Doc over a future, beautiful park over water, in Washington, DC, USA | Ted Eytan, MD).

On the ride back to much-less-obese Ward 2 in 2012, I remember asking Pierre about the determinants of the social determinants of health in Ward 8. If people didn’t want to die any earlier in Ward 8 than in Ward 2, how did they want to live? There was so much in the media about dog parks, bike lanes, and food deserts at the time, what was the answer?

It’s now 2 years later, and this time, I didn’t go to Anacostia to go see Anacostia, I was invited, along with my friend Lane (@tlanehudson), to meet Khadijah Tribble (@tribbleme), who is a person who lives in Anacostia. We chatted in the brand newish NURISH Anacostia (@NurishAnacostia) cafe, one of only 3 sit down restaurants in the Ward, one of which has a sign on the door that says, “Please have your shirts on.”

Khadijah used to be over 300 pounds. She’s now at 208 and she let us know that she’s working to create a culture of health in Anacostia, because when she looked for one, it wasn’t there.

“Culture of Health” were her exact words – she said she picked the phrase up from the Robert Wood Johnson Foundation’s newest initiative. Hey I know some people that know a little something about that @RWJF :).

The Maps

Thanks to the still awesome Community Commons platform (@CommunityCommon) I ran some maps of Washington, DC with data on food access, poverty, and high school education. Poverty plus high school education gives you a vulnerability index.

It doesn’t matter which map you look at, you can tell which parts of the city are most in need. The Northwest part of Washington, DC is the least obese, has the greatest income gradient, lowest poverty rate, highest educational attainment, highest access to healthy food. The Southeast part of the city, across the river, where Ward 8 is, the opposite:

The county level obesity data is not useful, as you can tell, and actually tends toward being harmful, because it implies that Washington, DC is in the top quartile of obesity status and that there isn’t a problem. I’ve explored this in a previous blog post – you have to look at sub-county level data (Do national numbers inaccurately represent Washington, DC’s obesity condition? what electronic and personal health records can do to help | Ted Eytan, MD). There is a problem. There are impressive disparities in this city.

I ran a comparison of San Francisco, CA on the food access data, which shows that even the less vulnerable parts of Washington, DC are more challenged in food access than in San Francisco.

The Walk

Khadijah took us on a walk down Martin Luther King, Jr. Ave SE, past “The other U Street” (Southeast, we inhabit U Street NW, which a generation ago was strikingly deprived itself). We passed the largest chair ever made (“The Big Chair”), rededicated as a sign of hope for this community in 2006. The convenience store that I visited in 2012 didn’t seem to be open this time.

I took photos. See if these images are the signs of a healthy community:

I was so lucky that I got to meet The Advoc8te (@TheAdvoc8te), fellow blog writer of the I’ve-been-following Congress Heights on the Rise Blog. She’s in the photo with myself and Khadijah. It was a cool moment for me :) . I also got to meet Dr. Lisa Fitzpatrick (@askdrfitz), who’s currently enrolled at the Harvard Kennedy School mid-summer program.

The Culture (of Health)

Lisa and Khadijah are part of (founded?) The Community Wellness Collective (@comemovenlearn) which is based at the Anacostia Arts Center (@AnacostiaArts), where NURISH is also housed. So where I left Ward 8 2 years ago with a lot of questions, this time I left with a lot of ideas, that are not from me. Those are the best kinds of ideas.

As Khadijah explained, there isn’t yet a sense of “comfort” for women in the community who want to exercise. A lot of messaging (and the assumptions that go along with them) are not appropriate for this audience. Here’s a great example of that: How Low-Income Commuters View Cycling – CityLab. People don’t know how to use health services well, and they don’t know how to shop healthy within their immediate environment, based on what’s available. These add up to challenges that need to be solved at many different levels, because as the data shows, there are large disparities.

The Community Wellness Collective is working toward this, with exercise classes and food instruction. I hope to attend some of these, because all I know is that I don’t know about what’s needed.

Our Cities are Changing

The new Ward 8 7-11 looks a whole lot like this Ward 2 7-11 from 2012, and that’s a healthy thing View on Flickr.com

I just noticed this post on CHOTR: Congress Heights on the Rise: Anacostia welcomes it’s 1st national retailer to the neighborhood!, which is about the first 7-11 opening up in Ward 8. And guess what. The photographs of the Ward 8 7-11 show a similarity to the photographs I took of the Ward 2 7-11 in 2012, right down to the fresh fruits and vegetables..

She writes:

As we were exiting I noticed that several discount stores on Good Hope Rd had undertaken a little upgrade of their own. The shop directly across from 7-11 was sporting some freshly cleaned windows (possibly a first in the 6 years I’ve been in the neighborhood) and a newly organized window display. It seems consumers aren’t the only ones taking notice of the new kid on the block. ;) Here is to hoping the upgrades continue.

I came to Anacostia for the same reason my generation came to health care – we are not satisfied with the status quo, we love the places that we live in, and we’re here to change everything. Yes, here is to hoping the upgrades continue, because, to quote community leader Ruby Corado (@CasaRubyDC):


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Photos from HIT Briefing – Reminder about Oral Health and Transgender Person Health



#HITBriefing dentists use EHR’s too #oralhealth

I didn’t know what I would learn at the HIT Briefing yesterday in Washington, DC  sponsored by the Robert Wood Johnson Foundation (@RWJF) and supported by the Office of the National Coordinator (@ONC_HealthIT) and it wasn’t what I thought, thanks to social media commentary on the photos I took/posted.

I maybe took a few photos (telephoto lens, lighting not optimal, I did my best) below, and here’s what I was reminded of:

  • Besides nurses (the number one clinical users of EHRs – patients are number one overall :) ) and doctors, dentists use electronic health records as well.
  • When (not if) we remediate electronic health records to collect and respect sexual orientation and gender identity, we need to include all of the other health records too, such as oral health / dental care

Worth the trip / glad I asked/posted, especially since oral health care is delivered by Kaiser Permanente in some of its regions (Northwest, specifically), and we are working to remediate the EHR. More on that later.

I did some checking/review of what I have on the topic of collecting sexual orientation / gender identity information as part of meaningful use, and there’s this excellent public comment from The Fenway Instituteas well as another study performed of actually asking these questions in practice. There’s also a really good presentation from Kellan Baker, MPH, MA (@KellanEBakeron the topic here.

I’ve written about the issue of transgender person health and EHRs contributing to (or today, detracting from) health previously: Now Reading: Electronic medical records and the transgender patient – to eliminate, not create, disparities | Ted Eytan, MD 

I don’t want to try and repeat/summarize the briefing here – it has a hashtag: #HITBriefing , and there are a few papers published in HealthAffairs as well as the Jason report which was discussed.

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Just Read: Walkable Urban Places – Boston poised to surpass Washington, DC?



This  new report, continuing on 2012’s “The WalkUP Wake-Up Call” (see: Now Reading: Walking and walkable urban places will drive an economic as well as a health renaissance | Ted Eytan, MD), goes beyond celebration of Washington, DC as the national model for walkable urban places (WalkUPs – get it?), to look at impact of WalkUPs and future trends for 30 metropolitan areas who may compete with our national model in the future. And competition is good, the best innovations are the ones where the innovator is overtaken, which means something is catching on :) .

The report is written by Chris Leinberger (@ChrisLeinberger) and Patrick Lynch, a team that’s been regularly connecting the art and science of real estate development to economic health, which drives and supports physical health. They are great allies to the health system – thank you!

Changing our terminology

A far more useful understanding of metropolitan1 America is “walkable urban” and “drivable sub-urban” development . Because both types of development can occur in a metro’s central city and in its suburbs, the old dichotomy is now obsolete.

Walkable urban development is characterized by much higher density and a mix of diverse real estate types, connected to surrounding areas via multiple transportation options, such as bus and rail, bike routes, and motor vehicles . For those living or visiting a walkable urban place, everyday destinations, such as home, work, school, stores, and restaurants, are within walking distance.

Better places to be, growing in importance

WalkUPs appear to be the most appealing places to live (to me anyway), and they are better for communities anyway. WalkUP development is correlated with higher education and higher metropolitan GDP, as well as higher real estate values (note: correlation doesn’t mean causation, as is stated in the report).

And… Washington, DC continues to be the national model, because:

  • It has the highest percentage of office and retail space in WalkUPs (43 percent)
  • It has a good split between the central city and suburbs (51 and 49 percent) – not just a downtown phenomenon

New York is “only” number 2 because its WalkUP inventory is mostly in Manhattan (89 percent worth), covering just 0.3 % of the land area of the city. In the future, it’s predicted that New York is going to be number 3, behind DC still, because…

Boston, the future

..mostly because it’s believed that Washington, DC has reached a plateau:

In general, metro Washington, DC, developers have mastered developing walkable urban real estate . This method is much more complex and risky than the simple, well-known drivable sub-urban formulas that many real estate developers use to zone, plan, build, construct, finance, and market their projects.

So hooray Boston, as well as some other rising stars, like Miami, Atlanta, Detroit, and Denver, and some surprises like Los Angeles, Phoenix, and maybe Houston. Bummer Orlando, and San Diego near the bottom of the list? What happened?

Entertainment gets into WalkUPs

I love how our cities are not only changing, the stories we are telling about them are too.

The 2013 Oscar-nominated movie, Her, shows a Los Angeles in the near future, where the main characters live in high-density towers, walking to work and restaurants . None of the actors are seen in a car—they even take the subway directly to the beach.

(what’s a car?)

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