Does your physician know how to lead? A view into the Kaiser Permanente / Group Health Physicians Medicine and Management Program

Interviewing “Pat Permanente, MD” – will he succeed in our medical group? – a Kaiser Permanente Care Actor View on Flickr

It’s hard to become a Permanente physician. It’s difficult to stay a Permanente physician, if you are not prepared to be a healer, leader, and partner.

Fortunately, there are programs like Medicine and Management, designed to train 40-50 Permanente physicians from the Hawaii Permanente Medical Group, Northwest Permanente Medical Group, Group Health Physicians, Colorado Permanente Medical Group, Ohio Permanente Medical Group, and The Southeast Permanente Medical Group (@TSPMG) , in advanced topics in physician leadership.

The course is taught in 3 sessions. I just returned from the second session, hosted by the Colorado Permanente Medical Group. This session included a focus on recruiting and retaining the best physicians. In our health system, this is not a task that is taken lightly. Physicians are actively involved in deciding the fit of a physician candidate in our groups. Training in a top notch medical school and residency is not a guarantee of an offer being extended to take care of Kaiser Permanente members. In some cases, physicians will fly to observe surgeon candidates in the operating room.

To know how to recruit well, we have to be trained – this is not something that’s taught in medical school or residency. I loved the technique used this time – Kaiser Permanente care actors were brought in to adopt the roles of “Kim Kaiser, MD” and “Pat Permanente, MD,” both with top notch educational credentials, but with (very) different approaches to working as part of teams and being there for patients.

The care actors are part of the Kaiser Permanente Educational Theatre Program . I thought they were a brilliant use of this group. Following each interview session, the actors stepped out of their roles and critiqued the physician leaders about their approach and offered suggestions as well as compliments.

You can’t have a health system if you don’t have clinical leadership, and you can’t have clinical leadership unless you have training in its art and science. In this program, the training comes from the senior most leaders in each medical group, and Jack Cochran, MD (@JackHCochran), the Executive Director of The Permanente Federation (where I work).

I went through this program myself when I was a Group Health physician, and it was transformational. It allowed me to reach beyond knowing what the right things to do for/with patients were, to shaping a whole system to do those things every day, and not just for our patients, for every patient in every health system. Imagine that happening every year for 10+ years for 40-50 physicians and the impact adds up very quickly. And…the program is coming full circle for me, because in 2012, Group Health Physicians and Group Health Cooperative (@GroupHealth) are going to host session 3, for the very first time. See everyone in Seattle!

Photos below, including a birthday celebration for Jeffrey Grice, MD (@jeffreygrice) – Happy Birthday Jeffrey!

Presentation: 4 ½ Reasons WHY : Social Media for Physicians in Integrated Care Delivery – Ignite format

This is the second presentation I gave on social media last week. The first audience was interested in the “how,” this audience is interested in the “why”. (see: What does social media mean, in an integrated care system? A conversation at @KPGarfield | Ted Eytan, MD)

This audience is 42 physicians, in their leadership journey, from 6 Permanente Medical Groups (Hawaii Permanente Medical Group, Northwest Permanente Medical Group, Group Health Physicians, Colorado Permanente Medical Group, The Southeast Permanente Medical Group, and Ohio Permanente Medical Group). I’ll post on this leadership program separately.

And….I can’t believe it but I actually decided to do this in Ignite format. The disbelief is because I recall how challenging the Ignite format was for me when I first did it (see: Slides, Script, References, Photos, from my #ONCmeeting Ignite Talk – Acceleration and Tipping points – Consumer E-Health | Ted Eytan, MD). This time it was easier….and it was right for this discussion. Following the presentation I was asked more about the format, which none of the physicians had heard of. A little diffusion of innovation on top of diffusion of innovation.

My attempt to record a video of me giving the talk didn’t work out, so I’ve closed captioned the YouTube video of the slides above (just hit the “cc” button), and/or you can access the slideshare + the script as well as sources of the data (for an Ignite, you typically want the source information separate, to keep the slides clean). Let me know what you think.

The YouTube is timed at 5 seconds per slide instead of 15 seconds, to accommodate the attention-deficit web/mobile viewer of the content.

Script

Washington, DC, is the most social city in the United States. It’s the most walkable city in the US, it’s compact, and it’s a place with shared challenges and leadership in society. We can’t vote like residents of other states; however, we’ve had marriage equality since 2010. It’s a great place to understand the “why” of social networking, with information that I’d like to share with you about why it’s important to us as physicians in an integrated, non-profit, care delivery system.

This is where my “why” started, in 2005, when I was helping to lead a statewide EHR/PHR project. I needed to use social media because it was the only way to communicate authentically, honestly, and frequently during a time of immense change.

Reason 1. We value communication. The ways people are communicating is changing.

Look at 2005: Just 7 years ago, very few people were using social networking sites, even among people aged less than 30 years old.

Now, look at the generation after Generation Y. If you ask teens how they communicate with their friends, they cite text as most common way they communicate with friends. Social networks are #2, in person is #3.

At the same time, their FAVORITE way of communication is in person, followed by text, followed by social networks. In person will always be valuable. Think about social networking as an ADDITIONAL method to all of the ways you will need to communicate as a colleague and as a physician with the people you serve.

This is what I hear from our patients today, like Mackenzie Marsh, who’s pictured here. She told me, “social networking does not replace the way I communicate. I talk with people in person, on the phone, in text, over facebook, all at the same time.”

This brings us to reason #2. We want to be there for our patients (and they want to be there for us).

If you look at the data from 2002 to 2011, health professionals are still the #1 place that people go to get health information. Notice, this percentage hasn’t gotten lower since 2002.

The data is even more significant for caregivers, 78% of them cite health professionals as the most common place they go to get health information.

Reason #3: We came here to change the world. I took this photograph at the AIDS Quilt display in Washington, DC, the first time the quilt has been shown there since 1992.

There are so many stories like this, during a time when the medical profession was not as compassionate as it could have been – causing people to ask “why?” about the death of their loved one.

Our ancestors, at Kaiser Permanente and Group Health Cooperative, wanted our organizations to demonstrate a replicable model, that gave people the choice to practice medicine in a higher quality, more compassionate way. We want to continue this tradition.

At Kaiser Permanente, this is not the case. We made an announcement in 2012 with the White House that we have eliminated disparities in care for HIV/AIDS patients. You don’t have to be white, Black, Latino, straight, gay, female or male, to achieve comparable outcomes at Kaiser Permanente. We have posted the HIV challenge online because other care providers and health systems should have this option (and really, a requirement) to eliminate disparities, too.

This is my blog post about that announcement. I blog because I want people to know that there is a voice for change, that we don’t have to do things the same way they have always been done. When I was in training, there was NO voice that I could turn to to understand that what was going on in my environment was not right, that the profession was not behaving professionally. I use social media to hopefully be that voice for others.

This is reason #4. Play at http://youtu.be/_vwxL59tWhc

Our ancestors led the way before anyone else did in thinking about environmental causes of good or poor health. Sidney Garfield recognized the benefit of sunlight for healing (the photograph on the right is called “sun bath”). Today, we are still thinking about the determinants of health beyond health care. We want physicians’ work to not be defeated by the environment, at Kaiser Permanente and beyond.

We have an amazing culture here, that allows us to innovate, and tell the world about it. People know that I’m passionate about walking meetings, and I can use social media to talk about the benefits and get feedback on what this means for others.

The ½ reason is that our leaders want us to. Bill Marsh, MD, is interested in exploring the lives of our patients beyond their health care through social media. We recently hosted the Permanente Executive Leadership Summit, with its own social network. This allowed 300 of leaders at Kaiser Permanente and the top health systems in the United States (and world) to engage in frequent, informal, small bits of communication + LISTENING, which is what social media ultimately is – listening.

With those why’s, it’s easy to see why you can find me here, here, here, here, here, and here. Glad you’re going to join me.

Sources of the data used above

Shadowing in the paperless, mobile-accessible practice of Sharman Reed, MD, at Kaiser Permanente Colorado

Sharman Reed, MD, OB/Gyn Physician, Colorado Permanente Medical group

I realized while shadowing Sharman Reed, MD, an OB/Gyn in the Colorado Permanente Medical Group that physicians are going to have to change their scripting in the era of mobile.

Instead of asking, “Would you like me to e-mail you or call you with your results?”, which they’ve been doing for several years already, now they may have to ask, “Which method of delivery to your cell phone would you like?”

That’s because since January, 2012, Kaiser Permanente physicians are available via the web, mobile web, and dedicated apps on their smartphones (you can download the iPhone app here). A look at the data shows that 16 % of all accesses to My Health Manager are now happening via mobile devices.

I came to shadow Sharman because she’s a participant in the 2012 class of Medicine and Management (see: You haven’t been to Kaiser Permanente if you think everything’s been invented – Innovation Retreat 2012 | Ted Eytan, MD which includes information about this course), sponsored by 6 Permanente Medical Groups, including her medical group, Colorado Permanente Medical Group (CPMG).

We scheduled the session at her medical office, in Aurora, Colorado, several weeks before the national tragedy that happened just minutes from where she practices. What I saw when I was there, though, is that the need for high quality health care in the community continues on.

Sharman’s practice style is what she calls (and what I observed as)  “bringing a sense of calm” to health care. And this is not just because she poured me a cup of chamomile mango herbal tea.

She is from the generation of physicians who transitioned to the comprehensive electronic health record (KP HealthConnect) that Kaiser Permanente uses, and has adopted the best practices of physicians in a post-EHR organization.

For example, she reviews information in the chart before she sees the patient, quickly locates any historical information and can tell instantly if any preventive care is needed,  provides an after visit summary for every patient, and completes documentation at the same time. She makes the use of the EHR look very natural in the flow of a visit that doesn’t appear rushed. She also does a morning huddle with her team, which also contributes to the calm, by anticipating any issues that might crop up during the day.

I wondered about behavior change in the treatment of obesity in her practice. She said this is very relevant, especially in the management of estrogen-sensitive conditions, including polycystic ovary syndrome, fibroids, menorrhagia, and cancer (breast, endometrial, ovarian) (this is because fat tissue promotes the creation of estrogens that are less healthy – “not of the loving kind,” she says).

Sharman told me that the Kaiser Permanente Colorado region just completed its latest upgrade of the system and she’s seen a new feature that’s near and dear to many hearts here – Exercise as a Vital Sign (EVS for short). This innovation is continuing its adoption across the country in the Kaiser Permanente system ( you can read more about exercise as a vital sign here  ) and I think it will spark important conversations. 

I am shadowing as part of this course to bring physician as “healer, leader, partner,” to life, and to respect the skills of our participants (there are 42 this year) on a deeper level. It’s a big investment for a health system to make, it’s a gift from the members, staff, and physicians to support it, and  a great asset to the members, and society when it’s completed.

Session 3 will be hosted by Group Health Physicians in Seattle in September, the first time they have ever hosted a session of this program. I’ll be shadowing a great physician leader there as well. If you’re interesting in shadowing, I highly recommend the PFCC Partners at UPMC Shadowing Toolkit.

Thanks to the members, staff, Dr. Reed, and Colorado Permanente Medical Group for hosting me and supporting physician leadership.

 

You haven’t been to Kaiser Permanente if you think everything’s been invented – Innovation Retreat 2012

The title of the post is real quote by Lynda Applegate, who is the Sarofim-Rock Professor of Business Administration at Harvard Business School and serves as the Head of the Entrepreneurial Management Unit. She said it to us while sharing this famous quote

Everything that can be invented has been invented.(Charles Duell, 1899, the Commissioner of the US Patent Office)

She’s been spending time with innovators at Kaiser Permanente, and so have I. This post is not just about the annual Kaiser Permanente Innovation Retreat, it is also about another signature program, Medicine and Management, that brings together 43 physicians from across Kaiser Permanente to learn how to be better leaders.

These two programs are related because they demonstrate what I learned at both:

Innovation in the post-EHR health system

What’s it like to be in a health system that has had a fully functioning EHR for 2 years? This year for the first time, Innovation Fund awards were incorporated into the learning program, and the completed projects give a great glimpse of the future of health care. 

In the post-EHR health system, the focus is not on what the EHR will do, it’s on the people who will use it (including patients). For example: the innovations developed place EHR data/access in ambulances so sick children being transferred across distances are warmly received, they combine EHR data with evidence based guidelines and rules engines that watch over patients with kidney stones or osteoporosis (no hitting the refresh button on your desktop computer needed), they create electronic mashup dashboards that take EHR data and provide guidance on how to build facilities or operate them in real time.

The innovations also come from all parts of the health system – physicians, primary care and specialist, nurses, information technologists, health educators, you name it. The thing that I see is not just the search for the idea, but the search for the cost-effective idea that helps the most people.

In this environment, an idea that allows people to have the right amount of health care, sometimes more, sometimes less, the right amount for total health (mind, body, spirit, individual, family, community, society), the most respectful of our members’ time, are the best ones. 

People don’t want to innovate, they need to innovate

Both the physicians in the Medicine and Management Program and the Innovation Fund winners have far reaching visions for health and health care. This quote from Urologist Ron Loo, MD, shows that the drive is unstoppable, and also that it’s not about the innovator, it’s about the group that they collaborate with to execute the good idea. Here’s the workflow he suggested to me on our internal social network:

  1. When you have an idea, find some friends who are much smarter than you.
  2. Convince them that your idea will change the world.
  3. If they agree with you, make a plan.
  4. Money will follow, especially if your friends are rich; if not, they will help you secure funding because they are smarter than you and they believe in your idea.
  5. Execute the plan (“Vision without execution is hallucination” T Edison)
  6. Repeat steps 1-5 as many times as you can before you die. It gets easier each time especially if you can complete step 5 more times than not. An added benefit is that your smart friends won’t consider you so dumb after a while.
  7. Embrace the risk, and feel really good about what you do.
Everyone can use a helping hand

These programs are a non-trivial investment. Even in a health system with aligned incentives, innovators need a helping hand, which is the point of this post.

If people say things to me like (which they really never do :)), “you could do that because you are Kaiser Permanente,” I might say back, “we could do that because we invested in the people who power Kaiser Permanente, and you have talented people who power your health system, too.”

What about health systems where incentives are not aligned? There are just as many people who need to innovate in all of health care, there’s no monopoly on that at Kaiser Permanente. Are they given the opportunity to do it? In many places, absolutely, and please post in the comments about your experiences having these opportunities.

It is all of ours/society’s responsibility to give health professionals (and the people they serve) the ability to innovate. This post is therefore intended to create the drive in all health systems to invest formally in innovation at all levels of organizations, with patients included, of course. Always with patients included.

There are places to learn about this such as The Innovation Learning Network ( @healthcareILN ). More innovation in more places means less, “we couldn’t do it,” and more like this quote from Jack Cochran, MD:

Special thanks to the team at Kaiser Permanente Information Technology, led by Phil Fasano, Kaiser Permanente CIO, and the Hawaii, Northwest, Group Health, Colorado, Southeast, and Ohio Permanente Medical Groups for their time and attention to the future.