15th Annual International Summit on Improving Patient Care in the Office Practice and the Community – Got what I wanted!

Team Kaiser Permanente #IHI15Summit View on Flickr.com

Since any summit with 1200 attendees is going to have at least that many journeys, I can assess my own to say that it worked for me 🙂 .

I was able to participate in several high energy impactful gatherings, along with learning from several of the leaders in my organization and beyond. Most notably:

  • Ed Ellison, MD , the executive medical director and chairman of the board of the Southern California Permanente Medical Group who taught about his commitment to defining a culture rather than having it defined by default, and focus in his leadership on innovation, interconnectedness, and wellness.
  • Michael Kanter, MD, and Kristen Andrews (@ldsklandrews) , also from Southern California Permanente Medical Group, who lead a completely full room through work I have mentioned on here several times, around the Proactive Office Encounter and Complete Care. Hint: if you rely on primary care for preventive care you’ll miss 60% of your opportunity. They don’t miss opportunities here.
  • Somava Stout, MD, who led our World Cafe experience, which I blogged about earlier this week (Our IHIEscapeVelocity: 100 million less forgotten humans by 2025 | Ted Eytan, MD).
  • Gilbert Salinas, BS, MPA, who co-led the first-ever excursion from the summit, to the Center for Total Health (@KPTotalHealth), and spent time with myself and the attendees demonstrating how a patient advocate transitions to a health system leader. There are very few models for this, it’s inspiring.

The Kaiser Permanente Mid-Atlantic Mobile Health Vehicle (@KPMidAtlantic) – which parked itself in the lunch room (how do they do that?) and connected attendees to a future of health care that’s mobile

Todd Sack, MD, who’s leading the medical profession in creating medical offices that heal rather than harm the environment via MyGreenDoctor (I’d love to see a Washington, DC medical practice sign up to certify – any takers?)

Photographs, as usual, below. The one thing I might do differently in the future is choose a location that can be reached via #activetransportation, I can’t help but say that 🙂 

Thanks to Maureen Bisognano (@MaureenBis) and the entire IHI team (@TheIHI) for inspiring us to innovate over the past 2 days, and for being open to inclusion of the people we serve in everything we do.

15th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Normally, I don’t spend a lot of time at the Gaylord Convention Center at the National Harbor, however, when Maureen Bisognano (@MaureenBis) asks….

This is the 15th Summit, it’s “near” Washington, DC (I’m told that those of us who live here are too distance-sensitive, maybe that’s true), and I’m assisting the Co-chairs, which means I’ll be there too :).

Links: More info and to registerScholarships and Discounts

Let’s Innovate!

IHI Photo (and culture) Safari, with host Maureen Bisognano

Just how does the IHI feel about sharing….Maureen Bisognano points this out (View on Flickr.com)

Maureen Bisognano, the President and CEO of the Institute for Healthcare Improvement (@TheIHI) knows her way around a camera. 

I discovered this yesterday when she graciously offered to give me a tour of the IHI’s headquarters before we sat down to plan for the 15th Annual International Summit on Improving Patient Care in the Office Practice and the Community.

She told me I am definitely not the first person to have such a glimpse of the workings of this iconic health improvement institution, I am the first to take photos though. As I’ve said many times on here, not because I want to take pictures, because I want to capture the human spirit.

What became pretty obvious was this was a tour of the organization’s culture, and the physical manifestation of the space conveyed the values that are printed on the coffee mugs.

A few things to point out as you view the photos (click to enlarge any)

  • Things move fast here, in 90 day cycles. People often tell me to slow down, and yet even my heart rate quickened when I saw how the IHI plans its work
  • There is celebration, joy, and creativity throughout
  • The IHI Conversation Project is visible, as is WIHI Radio and the IHI Open School
  • She showed me the not-often-seen “graveyard” as she called it – the names of all the people who have ever worked at IHI, tucked behind two closet doors. 
  • There’s chocolate on one desk in the office – Maureen’s, which she shares with the IHI fellows, to invite conversation
  • The photo of the coffee cup was taken when I asked Maureen more than a few times if it was okay to post what I learned and saw online. This was her response.

I was joined by a great team planning the Summit, including Co-chair Gilbert Salinas, who is the official “Patient” co-chair of the summit. He’s also, I learned, the Kaiser Permanente sponsored safety-net fellow this year (see: Gilbert Salinas, IHI Fellow – YouTube). By coincidence, he’s also a Kaiser Permanente member, receiving care in the Southern California Region. It was and is a pleasure to work with and learn from him. The other co-chairs are Steve Tierney, MD, from Southcentral Foundation in Alaska, Somova Stout, MD, from Cambridge Health Alliance, and Ed Ellison, MD, Executive Medical Director of Southern California Permanente Medical Group.

Come out of your comfort zone with me

Maureen knows the photographer’s secret – we like being behind the camera. When I asked her if she wanted to be in any of the photos, she politely declined. However, when her team surprised me with birthday cupcakes (hello Virgo!), we convinced each other to break the rules.

Sometimes, in front of the Camera; Ted, Maureen, and Jenna (Virgo, Libra, Virgo) (View IHI Photo Safari 29948 on Flickr.com)

I/we hope you’ll join us in Washington, DC-adjacent in 2014 at the Summit. It’s going to be a ton of fun.

Pursuing The Triple Aim Book Launch Event, at Kaiser Permanente Center for Total Health

“You talk about it (the challenge of change) like it’s past tense” – Kate Koplan, MD

These were the awesome words of Kate Koplan, MD from Atrius Health ( @AtriusHealth ) when I got to see her after a 5 year hiatus and let her know that I read the story of her work with understanding of the challenge that she faced as a leader.

This was just a few of the insights that brought the launch of the “Pursuing the Triple Aim” book launch to life, at the Kaiser Permanente Center for Total Health ( @kptotalhealth ) on June 22, 2012. You can read my review of the book itself here: Now Reading: Pursuing the Triple Aim Book (Launch Event in a separate post) | Ted Eytan, MD 

You can and should read the book; you can also become engaged with the people behind the work to increase the power of the stories, which I’ll attempt to do here.

The flow of the day

Pat McDonald, Intel – View on Flickr.com

To watch Pat McDonald, a technology executive, describe dramatic changes in health care as part of marketplace collaborative to a room of health care experts was something to behold.  She was joined by 7 other presenters, who agreed to whet the appetite of the audience in 6-minute increments, with 6 slides each (the “6 x 6”), timed, with each 6 minute block ended with a hug or a handshake (thanks for the inspiration, Laurie Ostrofsky @simplyleap / that’s how things happen at Center for Total Health).

These were followed with a facilitated discussion with the whole room, and then deeper dives in the afternoon with 4 smaller groups. There was a session of concentric conversations in the middle of the day. If you don’t know what that looks like, check out these images from January, 2012.

A few words: first, the T word = transformation

There’s no question about it, these innovators are interested in no less than changing all of health care, not just their piece of it. From the book chapter covering Intel/Viginina Mason:

They now declare that they are on a mission to “transform health care in the United States.”

Countdown to a hug! View on Flickr.com

 Each presenter made clear both the learning and the higher purpose that brought them to Washington, DC that day. When people are on a mission, they are close to unstoppable, no 6 minute slide deck with hug at the end is going to be a hurdle, and it wasn’t. Which brings me to the next word…

second, the H word = humility

When Tony DiGioia, MD told me the night before the event that he was practicing his presentation to the audience in between patients in surgical practice. I was floored. When we went around the room in the facilitated session that included Bellin Health and Virgina Mason/Intel and I asked everyone to rate their community on a scale of 1-10 on being able to transform health care and our innovators rated themselves a 4-7/10, I was again floored. Charlie Kenney was in that room and insisted that they upgrade their score. 

Regina Holliday ( @ReginaHolliday ) wanted the room to know that Bellin Health was “way more cool than their video showed” (which I will track down and post here) and told the story of how they named their electronic health record system after a patient who had a bad experience.

This seemed to be both a recurring theme and to create an extreme attraction to the work. There was, in every conversation, a desire to be even better, because excellent is not enough. This tracks what I hear from the most incredible innovators I have met, “There’s always room to improve.” On the one hand, you can’t believe it when you hear it. On the other hand, you can believe it, and admire it, because these are people you want to learn from because you know they want to learn from you. Which brings me to the next word…

third, the R word = resolve

Part of the Virgina Mason / Intel story includes the story of Mary McClinton, who Bob Mecklenburg, MD told me Virginia Mason killed. It’s actually hard to even type that word in relation to health care, but it is the word that Bob uses. He told us how Ms. McClinton was injected with chlorhexidine, an antiseptic, which was confused with another agent. This caused her organs to shut down, one after another, until Bob disconnected her ventilator, and she died, devastating her family and an entire community who depended on her leadership.

He told us how this was defining for him and for Virginia Mason, and of the resolve it created among the medical staff to be a leader in safety and transparency, which they renew in an award ceremony performed each year in Ms. McClinton’s honor every year.

I think the flow brought out resolve quite well on the part of all of the participants, which includes the resolve to try something new, to learn something new, and to work for the betterment of the people we serve. It’s why I hash tagged #TonyRocks . And to the folks at UPMC, Tony showed me the text message you sent him – I can tell you have great admiration for each other, it’s well deserved 🙂

Last word, the P word = patient (they were included)

We continue to earn the badge, thanks to the participation of Regina Holliday ( @ReginaHolliday ) and Kait Roe ( @Kaitbr ). We know two are not enough, and also that any patient is better than no patients. Me = choir :).

What’s next? I think there’s room to expose more of health care to the possibilities and people here. The Center for Total Health turned out, again, to be a great place to have this discussion and learn about the qualities of the people and organizations who pursue the Triple Aim with such dedication.

Thanks Maureen, Charlie, and all who attended to allowing us to see this first hand. Comments and additional thoughts. My photographs are below, click to see them in larger format.

Now Reading: Pursuing the Triple Aim Book (Launch Event in a separate post)

“We have manufacturing processes with 8,000 data points attached to them. We never had that in health care” – Pat McDonald, Intel Corporation

When I give tours of the Kaiser Permanente Center for Total Health (@kptotalhealth), I say two things relevant to our history:

  1. Sidney Garfield, MD, one person, was able to change the course of health care – the power of the individual should not be discounted
  2. Health care in 1938 was just as “complex” as it is in 2012 if you read Sidney’s writings. There’s nothing keeping an innovator in 2012 from creating as powerful innovations

This book proves both points.

Kenney and Bisognano at the Center for Total Health – Click to Enlarge – View on Flickr.com

This review is written from the perspective of a physician trained and working in an integrated, pre-paid care system, where Innovation is in its DNA. Authors Maureen Bisognano and Charlie Kenney chose to anchor the book with the Kaiser Permanente experience. I read the chapters carefully and I am still impressed.

The Triple Aim

I’ve of course heard of the Institute for Healthcare Improvement (IHI – @TheIHI ) Triple Aim, I honestly hadn’t stopped to carefully consider it previously (I say, authentically, spirit of social media). Here it is:

  • Improving the experience of care—providing care that is effective, safe, and reliable—to every patient, every time
  • Improving the health of a population, reaching out to communities and organizations, focusing on prevention and wellness, managing chronic conditions, and so forth
  • Decreasing per capita costs

Organizations targeting the Triple Aim have gone from looking inward to looking outward, getting outside their walls and reaching out to their communities to improve care overall for populations, whether the population is a panel of diabetic patients or an entire town. And they have gone from paying little if any attention to how money is spent—on tests, procedures, inpatient care, emergency department use, and much more—to recognizing that those dollars are a precious asset for communities, companies, individuals, and our nation.

What’s different about these innovations

From HealthPartners to Bellin Health and the East and West Coast in between :), there are a few things that differentiate these innovations in my mind. And remember, innovation is not “great idea,” as Chris McCarthy says in the book, “We call that innovation only if we know it provides value. Up until then, it is just a concept or an idea.”

  • These are not ideas just launched last year. The experiences detailed here cover decades.
  • They present their successes with data (and in fact the innovations themselves included innovations in analytics)
  • They all show dedication to culture change where necessary
  • They borrow and improve on each others’ work
  • They exist in the world where the majority of “health” is practiced, from hospitals serving a fee-for-service clientele to workplaces big and small, and interestingly to me, are venturing into the social determinants of health space
  • Technology is an enabler, but it is not the focus, this is a glimpse at what the post-EHR era looks like

My own parallel experiences are confirmatory

I was Medical Director of Health Informatics and Web Services at Washington State’s Group Health Cooperative (@grouphealth ) (and an affiliate of The Permanente Federation, where I work now) and knew much about Virginia Mason’s LEAN journey. I was starting a LEAN journey myself and regularly met with my counterparts there.

I have actually visited Kim Pittinger’s practice in Kirkland, Washington, where I saw the primary care “flow station” that was later adopted by HealthPartners in Minnesota. It’s as cool as it sounds.

I was fortunate to shadow Kate Koplan, MD in 2007 when she began her career at Harvard Vanguard Medical Associates, and the record of that experience is on this very blog (see: “When I walk in the room, it’s like going to medical school.” : PCHIT in Boston | Ted Eytan, MD).

Speaking of shadowing, I didn’t know Tony DiGioia, MD before reading the book, but I’ve been an avid shadower since about 2005 – it’s the most respectful thing a leader can do to understand the facts where they matter, where the patient is.

Actually, you can do that even if you aren’t Kaiser Permanente (it’s what Sidney Garfield wanted)

The quote at the beginning of this post describes the awakening that Pat McDonald and the team at Intel Corporation had about their purchasing of health care – it was devoid of metrics, in complete opposition to the way the rest of Intel’s business is run. She brought all levels of her company together with an interested and transforming health system, Washington State’s Virginia Mason ( @virginiamason ) to create a marketplace collaborative for health.

Work like this, or renewing Primary Care in the safety net that CareOregon finances, or an orthopedic surgeon, Tony DiGioia, MD, creating a patient and family operating system to improve all aspects of the triple aim at UPMC ( @PFCC_ ) are all improbable in a discussion of how the provision of health care is currently financed and incentivized.

And yet, they all happened, just like Sidney Garfield’s innovation did, and his vision was that this should happen by the way:

We believe any group of physicians, or a foundation working with physicians, can easily duplicate the Kaiser Permanente success. It only requires a dedicated group of physicians with reasonably well-organized facilities, a membership desiring their services on a prepaid basis and strict adherence to all these principles. All of this is not to say that US medicine should change over to the Kaiser Permanente pattern. On the contrary, freedom of choice is im- portant; we believe that the choice of alternate systems, including solo practice, is preferable for both the public and physicians. Any change to prepaid group practice should be evolutionary, not revolutionary. Physicians in general have too much time and effort vested in their prac- tice to discard them overnight. It will probably be the younger men, start- ing out in practice, who will innovate. Medical school faculties should point out the advantages and disadvantages of all methods of prac- tice to these young men so that they can choose wisely. – from The Delivery of Medical Care, Sidney Garfield, MD, 1970.

All of these experiences made me grateful that this work is honored in this book, because the success of Kaiser Permanente and all of these innovations can easily be duplicated, and they should be.

When someone says, “We can’t do that because we aren’t Kaiser Permanente” I drift to thinking about what that means – it means “we can’t eliminate disparities in HIV care, so Black Americans will continue to die 15 percent more often than their white counterparts,” or ” we can’t reduce heart disease using a simple medication regimen, so more people will have strokes and heart attacks,” or even more importantly, “we can’t bring the creativity and cognitive capacity of the people we work with to create a better home, work, community, society.”

As Kate Koplan, MD, and I discussed at the book launch event (which I’m covering in the next blog post…), a physician’s cognitive capacity was formerly harnessed for the single patient encounter only. These organizations discovered that this is wasteful, as much as it was found to be wasteful at UPMC that a parking attendant could not participate in creating an excellent surgical experience. I learned from the book and the launch event that health care is now changed. All of the exceptional qualities of people who are in health care (and by definition they are all exceptional, they have to be for a job this challenging) will be brought to solve every problem, big and small. 

The people and organizations profiled here didn’t say, “we can’t do it,” they are saying what Jack Cochran,MD ( @JackHCochran ) says, and you will, too 🙂

Open Notes and the Electronic Medical Record: IHI Audio Program

Open Notes and the Electronic Medical Record: IHI Audio Program

If you had the chance to look at what your physician wrote in your medical record about your last visit, would you take advantage of it? Would this make your relationship with your doctor or primary care provider more collaborative? More effective? These are just some of the important questions and issues bearing down on our health care system as an online universe and electronic medical records make shared viewing of what are often referred to as the “doctor’s notes” feasible. What’s contained in the notes and does transparency interfere in any way with their value?

For obvious reasons (I hope), I am a big fan of this project. I signed up to listen in, but I may not be able to make it do to a conflict. If someone else signs up, could they maybe post a summary?

Primary Care Improvement is Not Static – Summit on Redesigning the Office Practice, Vancouver, BC

I recently returned from Vancouver, BC, where I was able to attend the International Summit on Redesigning the Office Practice , hosted by the Institute for Healthcare Improvement. I tended to drift toward the sessions that focused on LEAN transformations in primary care, with a lot of impressive teaching about impressive work in a host of organizations.

At very large conferences like this one is, it’s useful to spend time with innovation happening within your own organization, which is the case with the session called “New Challenges, New Tools, New Work, and New Outcomes,” facilitated by Leslie Francis, MBA/MHA, and taught by Kathleen Mayer, MD and Michael Pate from Kaiser Permanente, Colorado, and Kellie Takashima, NP, Kaiser Permanente, Hawaii. Jack Cochran, MD, CEO of The Permanente Federation, was also present with us and added insights for the audience.

I’m glad I attended because the talk was a reminder that visiting any organization at a point in time is just that – a point in time. See for yourself in the slides below – the problems that we thought were problems the last time we checked in may have been solved the day after we left….