Gemba Walk: Kaiser Permanente Colorado

Finally, the opportunity to shadow one of my favorite physicians, Paulanne Balch, MD! This is her in her practice environment, at Kaiser Permanente Hidden Lake Medical Office, near Denver, Colorado. I’ve known Paulanne for at least 6 years, but have never seen her practice. I think this fills out the knowledge of who a doctor is – seeing how they care for patients. And as expected, I was impressed.

Paulanne Balch, MD

My visit to Paulanne is part of a visit to innovative medical practices in the Kaiser Permanente, Colorado Region (now with it’s own Twitterfeed in 2009: @KPColorado). I happen to have come at at time full of pride for KP Colorado, as they have just been named the #1 Medicare Health Plan in the United States, which makes them the best for customer experience, prevention, and treatment, as measured by NCQA.

We're in the top 10

Actually, it’s top 1 ….

And…the practices that I have been visiting are demonstrating how KP Colorado got there. As I have written previously, it’s remarkable to watch clinicians in this system, who have been using a robust electronic health record linked to a robust personal health record (at for over 2 years now. There is good understanding of the advantages of being electronically connected to patients and to each other, as well as a continuous drive to leverage these systems to their fullest potential (and maybe beyond what they can handle, even in 2009).

I was also able to shadow Kathy Mayer, MD and Michael Pate’s practice at Kaiser Permanente Southwest Medical Office in Denver. I have mentioned this practice previously, as one that is known inside and outside of Kaiser Permanente as one with a very well formed team approach to caring for patients. And, as the rankings reflect, they have great quality results. In a mature EHR environment like this, support of whole populations of patients is possible, no more hoping that a patient will come in and have their preventive care performed. In fact, as I was there, Dr. Mayer completed identifying the last few patients on her panel that did not have necessary preventive care performed so that they could be contacted to be up to date.

I plan to be here for a few more days, to see more practices in different parts of the region, and to learn about several innovations and potential innovations in care that are being developed here. I also did something new this time, by inviting colleague Jan Ground, a project manager from Colorado Permanente Medical Group, to shadow with me. We have been able to compare notes on what we see, and Jan has been able to contextualize what I have been seeing as someone aware of the operations here.

The most important thing, though, is that we are seeing things at the level of the patient, the highest level there is in health care.

Here are some more photos of our journey – Denver is enjoying the aftermath of a snowfall earlier this week….



Thanks for the kind words, I respect your perspective. For me, both of the above are true. At the same time, I think the true amazingness is that patients, nurses, doctors, no matter how busy, are willing to teach. All we have to do is listen. In my case, that means going to where the care is delivered. Maybe in another case, it's asking patients how we can improve, inside and outside of the exam room. Once I discovered that, the rest was magic.

How do you keep your job amazing?

Ted Eytan, MD