Seeing the future 45 years later at the Brookings Institution: CHF and Payment Reform

When I was at the Brookings Institution ( @BrookingsInst @BrookingsMed )with fellow Permanente physician, cardiologist Priti Sood, MD, for MEDTalk: Treating Congestive Heart Failure and the Role of Payment Reform | Brookings Institution, this quote immediately came to mind:

We believe any group of physicians, or a foundation working with physicians, can easily duplicate the Kaiser Permanente success….freedom of choice is important; we believe that the choice of alternate systems, including solo practice, is preferable for both the public and physicians. – Sidney Garfield, MD, Scientific American, 1970

It’s this one because I noticed how changes in our health system are inspiring physicians today to learn and grow as leaders.

I also thought of this image comparison, from yesterday (shown by Darshak Sanghavi, MD @DarshakSanghavi)

And one of Sidney Garfield’s diagrams, drawn more than 45 years ago:

“Rationally organized medicine” – Sidney Garfield, MD (click to enlarge)

In the diagram, the physician is sleeping, there’s a metaphysical spider web in their office because patients are now being cared for within a system of care, that includes prevention and sick care in the right amounts, on a foundation of pre-payment and integration. Hospitals and a sick care system still exist in this world, they are used and available when needed, and they are top notch, fit for purpose. Today, the spider webs are still metaphysical (no doctor is sleeping in their office today, far from it), and the system of care is today’s Kaiser Permanente.

The innovation at Duke University and University of Colorado can be found on the Health Affairs Blog here (see: Payment and Delivery Reform Case Study: Congestive Heart Failure – Health Affairs Blog) , the blog about Sidney Garfield’s innovation 45 years ago can be found here (Where we came from – Sidney Garfield, MD, 1970 | Ted Eytan, MD). Compare and contrast, the future is coming true :).

Dont’ forget about leadership

Larry Allen, MD, MHS, Cardiologist from University of Colorado, touched on this in his talk when he mentioned that the better way of providing care that was developed wasn’t instantly adopted by his physician colleagues – it required leadership and cultural humility on his part to protect change in the interest of patients. This is true regardless of the payment model. Aligned incentives are important (and great), they do not magically change behavior though, they facilitate good leadership. That’s the part of Sidney Garfield, MD’s diagram above that isn’t obvious to many who see it for the first time.

Patients included

As it says on their web site, the format yesterday was very “un-Brookings,” more modern, intimate and maybe exposed/vulnerable of all of the discussion leaders, including the patient, Lee Satterfield, who is really Lee Satterfield, the chief judge of D.C. Superior Court, also Lee Satterfield, cancer survivor and heart failure patient secondary to the use of chemotheraphy, stroke survivor.

If you click on the first link about Lee, you can see the last four years of his service, in photographs, to the people of our (awesome) District. It’s a very important reminder about our role to focus on people’s life goals and how health makes that possible. Sometimes that’s forgotten. In the ideal health system diagrammed by Garfield above, the physician earns their salary, the hospitals start to empty (or in reality get used when needed) when the patient is achieving their life goals.

I was so glad that in the final panel discussion – a short sojurn to the pre-modern Brookings Institution – that Mark McClellan, MD made a point to ask Judge Satterfield for his thoughts, because the patient voice often gets lost when they are the one “non-expert” on a panel:

I have to say what I say on here all the time for cermonial purposes, I see many analogies to health and health care in this statement :)

You can watch the entire session here, and it’s embedded below. Thanks again for your time, Darshak, Brookings Institution, Judge Satterfield and our future health care leaders, including patients and their families.


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Leadership and Professional Ethics | Dana Beyer – Huffington Post

Leadership and Professional Ethics | Dana Beyer – Huffington Post.

Great post by colleague Dana Beyer, MD (@DanaBeyerMD), and not just because I am quoted :)

I’m in agreement with her. In practice, I say it is the physician’s role to bring the patient story into every conversation. Our other role is to create an environment where the patient can be heard, and then let them speak for themselves.

In the same piece, she also touched on what it means to be in the sausage making of creating change, which I mentioned yesterday ( see: Thanks for publishing my photo about equality, Mashable.com | Ted Eytan, MD).

On an occasional basis, people ask me how they can be exposed to innovative ideas/thoughts/people. It’s in places where this is happening, often because most people don’t want to be there. That and the world belongs to optimists, pessimists are bystanders :).

Thanks for a year of great writing, Dana.

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Presentation: Why be Social (Media) – Kaiser Permanente Colorado – “Destination Leadership”

I realized when I uploaded this presentation to Slideshare that it didn’t have a title, so I made one up just now. Everything doesn’t have to have a title, does it?

I was invited to be a part of a great learning program put on by the HR/Talent team at Kaiser Permanente (@KPColorado) yesterday, for all the managers in the 6500-person, 550,000 member-health-improving, every-day-innovating organization.

I was joined by one of my mentors in this honor as well, Diane Gage-Lofgren (@dianelofgren), who you can see on stage telling a personal story about her journey to take risks while taking great care of people, in addition to a roster of leaders across the spectrum of industry and the generations.

As it shows in my slide deck below, you’re more than worth it for all that you do, Kaiser Permanente Colorado!

I’ve included the video snippet that features Regina Holliday (@ReginaHolliday) talking about what she’d like from health care in social media. There’s a little bit of science in there about social networks, which I’ll expand on in another post. 

The last slide’s call to action brought me pages of SMS’s that I am just looking through now – we learn a lot in integrated care, every day, as I suspected :)

Enjoy, comments welcome.


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Honoring Kate Christensen, MD

I sometimes tell secrets on this blog about me, and one is that I have never been to a retirement celebration in my entire life. I guess I waited for the most special one :).

Yesterday was the first full day at Kaiser Permanente without Kate Christensen, MD, who was the Medical Director of kp.org, one of the world’s most successful personal health records ever. Kate is known locally, regionally, nationally, and internationally for her work. From the comments at the celebration and from my own life experience, it’s easy for me to say what differentiates Kate – she is an amazing doctor. Who is also a leader.

Kate and I go back about 12 years, when we were both attached to similar projects in sibling organizations. If you are ever as lucky in your life to be involved in something that has never been done before, and then to meet someone who shares your DNA in an organization with the same mission and values, you will know the feeling I have.

Waaaaay before meaningful use several of us were creating the role of medical director for a web site in health systems. There was no precedent for this role. I’ll go far to say that at times, we didn’t even believe such a role should exist, or that we deserved to have it. And yet, our leaders said it should, and they were right.

The thing about being in this role is that it is not  “I am in charge of this, I own this, people will follow my lead,” that would be a recipe for failure. Instead it is, “I am a part of this, it is not mine, I need to collaborate with anyone and everyone who will talk to me, because I will be spending most of my time listening.” 

It’s like a proxy for being a physician in general.

Kate is generally unflappable, has an extremely high humility/experience ratio, and isn’t afraid to ask for help. She knows how to laugh and she knows what it means to put members/patients first. 

Throughout my journey, Kate was on the end of a telephone receiver with me (once I figured out what her phone number was, she was also the Medical Director of the Martinez Hospice Program), or on my right or left side for a walk through name-your-city. 

Kate also founded her medical group’s ethics program, and this is important, when I didn’t know what was right sometimes (and the goal is always to do what’s right by our members), Kate served as reaffirming counsel and she didn’t hesitate in empowering me. 

Another secret about me is that it’s sometimes better to aim me than manage me, and Kate served as a continual spark to make sure that members/patients were part of health information technology, not a sideline to it. Our organizations followed in each others’ footsteps for quite some time and soon her organization’s accomplishments outpaced ours, and we were glad. This meant that this was the right thing for patients everywhere.

Speaking of the right thing for people, Kate celebrated diversity and was instantly easy to connect with – she was one of the people who welcomed me into a new era of the medical profession, where everyone has the opportunity to achieve regardless of their background, sexual orientation, gender, gender identity. It just wasn’t an issue for Kate, when for many people it was an issue, and she helped many people soar, myself included.

At the celebration itself, there were many stories about how Kate was there for people. She was there for me. She shaped my career, she changed my life. That is what a doctor does.

The generation of physicians that Kate has led are continuing on the mission we started to involve members and families in their health and health care. She’s created physicians, too- her daughter is now in residency, completing her training to be an amazing physician as well.

Speaking of diversity, Kate always talks about how she belly dances to relax, and so I finally got to see her in action. Which is where she’s always going to be in my mind.

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Washington, DC 2013 Sheroes of the Movement, Leadership

The Office of GLBT Affairs 2013 Sheroes of the Movement Award Winners – Lately I have been meeting people who have what I call I high “humility/experience” ratio. This is a compliment, it means someone who is approachable, and human, and has at the same time accomplished so much that it’s expected that they wouldn’t be.

Diana Bruce, Julie Ost, Reverend Dyan Abena McCray, Ruby Corado, and Ellen Kahn – View 2013 Sheroes of the Movement Award Recipients for Washington, DC on Flickr

Last evening I got to attend the Washington, DC government Office of GLBT Affairs (@GLBTAffairsDC) second annual Sheroes of the Movement Awards, which honor “five lesbian, bisexual and transgender women who have made a significant contribution to the GLBT movement and community in the District.”

A few things I learned just during this time together:

  • The average age when a child comes out as LGBT is now 12 years old. They need more support than ever in our schools and in their communities.
  • Transgender health support is inappropriately inadequate, I am not alone in feeling this, and specifically behind that for lesbian, gay, bisexual persons (and they’re behind the rest of society).

These women are years if not decades ahead of their time in changing society. And with all that comes with being a change agent, they are still open to all. As it says on the Casa Ruby web site:

Today, after 20+ years of precious life experiences with my LGBT family, Latinos and otherwise, I have the opportunity to continue to be the voice of those who can’t speak for themselves, I have the honor to continue to be in their life and tirelessly work to make their lives better.

Casa Ruby, is a Multicultural Latino LGBT Community Center, A Resource Center A Recreation Center, A Place You Can Call Home.

EVERYONE IS WELCOME

No matter where you are in your life, if you have nothing or maybe have all the material things but something is lacking, We Want You Here.

Leadership versus Followship

It’s wonderful in 2013 that so many other public officials are saying that they’ve changed their mind about equality – this bodes well for our society (and proves that love always wins). The reason they’ve changed their minds, though, is because of the work of the 2013 Sheroes of the Movement, who are the ones receiving awards. This is the difference between leadership and what I call “followship” – leaders are the people who say “this is the right thing to do, so we just did it.” Who would you rather follow….

Thank you Washington, DC Office of GLBT Affairs for introducing me to these women and for the powerful leadership lesson during 2013’s National LGBT Health Awareness Week.

Oh, and also, thanks Fathom Creative (@fathomcreative) and all of the other local businesses who supported the event. I’m used to coming to this space for monthly WordPress meetups, nice to know that community is created around many topics here :).

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Photographs from the Supreme Court, Day 2, Courage

All photographs are Creative Commons licensed. Click to enlarge or download original

One difference from this day was that the signs are more humorous.

What does it take to make a sign and stand in front of the highest court in the land, in front of international media, asserting your right to live in peace?

When I think about this, I also think about the fact that when President Clinton signed DOMA into law, he did it in the middle of the night, to avoid visibility of the action that he took.

I don’t know if he knew that he would inspire so many people to demonstrate what courage really is.

Either way, it’s easy to see from this example why love always wins.

Enjoy. Comments welcome.

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Dr. Ted Eytan: Family Medicine Physician and Director at the Permanente Federation | OtherDoctors

Dr. Ted Eytan: Family Medicine Physician and Director at the Permanente Federation | OtherDoctors.

- This blog post is the result of an interview by Emily Park:

Emily Heykyung Park is currently a 4th year medical student at Rutgers University – New Jersey Medical School in Newark, NJ and a ’07 graduate of Columbia University with a BA in English Literature. See herLinkedIn here.

In it, I reveal that I’m from Arizona, and that location really matters in terms of what you/I decided to do. I know, these were closely guarded secrets :).

Feel free to comment there or here, and enjoy the company I am keeping there, including friend and innovative leader Geeta Nayyar, MD (@gnayyar)

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