What innovation looks like in the medical offices of the future, Kaiser Permanente, La Mesa, California

What innovation looks like – View on Flickr.com

Like this. Click on the image to see larger size.

These are not medical charts (this is Kaiser Permanente, remember….no paper charts), they are folders of innovation projects being supported by La Mesa Medical Offices Physician in Charge, Martin (“Marty”) Bartolac, MD, who is also a practicing family physician. He is part of one of the largest (he says the largest, so the hedge is mine) primary care physician groups in the United States, in Kaiser Permanente, San Diego.

Marty told me that members of the staff will come to him with problems they would like solved, and he’ll advise them to do some analysis, propose solutions, and do a test of change. That’s where the folders come from. Imagine the opposite of this situation – a leader with a clean desk and no innovation projects going on, which would you prefer?

Our group continued our shadowing yesterday, switching between primary care and specialty care. The half of the group that was not in dermatology went there, under the guidance of Jeff Benabio, MD (@dermdoc) and the other half went to primary care, including me.

Here are some more images of what innovation looks like, plus a group shot of all of us, click to enlarge.

By the way, that’s Charles (Chuck) Miller, MD, sitting across from Jeff Benabio, MD, in the photo above. He’s the Chief of the Department, and is beyond ready to innovate not just in this department, but in the dermatology specialty itself.

I shadowed Vu Pham, MD, another family physician, member of the Southern California Permanente Medical Group for 4 and a half years. Like other physicians in his cohort, he has never practiced medicine at Kaiser Permanente in the absence of KP HealthConnect, the comprehensive electronic health record.

Because I can recognize these things 🙂 I can say it – he exudes the spirit of family medicine. He talked to us about how he really knows his patients, and he doesn’t just know his patients, he knows their families, and integrates the knowledge about their life journey into every visit. He knows them so well (and vice versa), he actually has trouble referring some of them to specialists for needed care, in a good way. The patients want to understand what a specialist knows about treating a condition that he doesn’t, and he explains it carefully – they see him as their steward through the health system.

Photographs of his family are posted on the wall of the exam room. At one point, Vu’s family comes to see him in person, because his son has just received well child care. We watch as the other doctors come to say hello and he hugs his children. Vu jokingly tells us that they really do work hard here. We’re not really hearing him because our hearts are melting all over the floor. This is the kind of hard work that technology supports – genuine social networking.

We’re are here, the Digital Workforce Capability team, to understand how a modern clinical workforce collaborates and communicates with each other in the process of clinical care and in leading the health system. In 2013, there is no shortage of modern social networking tools available to help people communicate in thousands of different ways. What we’re interested in is the right tools, deployed the right way, to support what physicians and nurses are doing well. We gained tons of insights about the how, what, and why that we never (never) would have understood without observing the care at the level of the patient.

I just have to show this photograph one more time. It’s the solar panel array that sits atop of La Mesa, generating 1 megawatt of electricity, supplying 75% of this medical office building’s power. Imagine practicing medicine or receiving care in the shadow of innovation like this, and what it does to encourage your drive to heal not just inside the building, but everywhere you live, work, learn, pray and play. And, La Mesa is not unique, not at Kaiser Permanente, maybe not in health care (well maybe a little unique in health care :)). Before you assume physicians, nurses, and patients don’t want to innovate, go shadow them.

Thanks again to the primary care, dermatology, pediatrics, departments at Kaiser Permanente La Mesa, as well as the members and their families, who took the time to give us the gift of their teaching. Also to our superstar host Jeff Benabio, MD (@dermdoc), and special shootout to Susan Russo (@Susan_Russo) , our culinary expert and food steward extraordinnaire who ensured that our shadowing was as healthy as the excellent care we observed.

1 Comment

Dang, how much I wish the Kaiser model was available in Jimbobwe, er, central Virginia. 
However, the all-in-one approach outside of non-profits like Kaiser is too often more about leveraging data for increased reimbursement. Patients wind up sharing the top spot with the billing codes they represent, and trying to get access to one’s own data from the EHRs of one’s various providers is a challenge. Holistic, head-to-toe care and engagement has to be managed almost entirely by the patient.
I guess I’ll have to continue to work toward moving home to San Diego one of these days!

Ted Eytan, MD