Innovation in Collaboration: What 18F and Kaiser Permanente South Bay have in common

18F , where collaboration happens View on

I think I’ve mentioned a few times here that I’m guest lecturing in colleague Carol Cain’s (@ccain) summer course, Stanford BioInformatics (Stanford University Biomedical Informatics 207), aka “Digital Medicine: Designing IT Innovations that Improve Healthcare.”

Since I’m coming from Washington, DC, Carol asked me to include something about health policy, and what do I know about that, so I asked my very knowledgeable colleague Ann Kempski (our Director for Government Relations) for a few ideas. She gave me some, which I put into the double-rainbow machine for further processing, and the one of the examples that’s fresh in my mind are actually two examples, from two different places, in very large organizations, who are working to improve health for a lot of people.

That’s the actual URL -> and there’s a really simple twitter handle that goes with it (@18F). I heard about it from Adam Dole (@AdamDole) , most awesome (recently) Presidential Innovation Fellow, who went on a walk with me (which is where all discoveries happen) to a meeting hosted by the General Services Administration and asked me, “Is it affiliated with 18F?” To which I replied, “What’s 18F?”

Here’s 18F:

It’s in the middle of a very government-ish building on 18th and F streets (get it?) in an organization that’s not supposed to innovate. Except that they’ve discovered that you can innovate in a large organization (and I believe you can only innovate in one). It’s where the Presidential Innovation Fellows are housed, and where presentations are given including ones about hacking bureaucracy.

What’s special about 18F and health policy? Well… 18F is where a lot of fixing of happened, by a lot of talented people. I’m not going to tell that story here, instead I’d focus on the environment that allows innovation to flourish.

I was told that GSA is one of the few agencies that is using a web-based email and document collaboration platform (I’ll avoid using vendor names for the purpose of this post, since I don’t think it’s relevant). You know, the kind that allows you to not attach documents to messages and send them to people who don’t know what to do with them. This alone caught my extreme attention…more collaboration, less e-mail.

Notice the sign: “Get Excited and Make Things.” Innovation is ideas AND execution.

Kaiser Permanente, South Bay Medical Center

All the way across the country, in Harbor City, California (near Los Angeles), is a pretty large, technologically superb, clinically excellent medical center, Kaiser Permanente South Bay Medical Center  physician led and professionally managed, where I went with our Digital Workforce Team in late June, 2014, to learn about…collaboration.

They don’t have a “big room floor plan” like 18F (although they are constructing a brand new hospital which will open in 2015) because they’re actually preventing illness, saving lives, producing health. What they do have is a focus on connecting the people who are delivering high quality medical care.

They are also using one of those web-based social collaboration platforms with the specific intent of connecting people, supporting purpose….and reducing email. There are medical directors of physician wellness and the Area Medical Director, Barbara Carnes, MD, is supporting the use of this technology to connect all staff, including doctors, and nurses. This is a complement, of course, to the system that already connects members/patients to everyone, the world-class, now surpassing 4.5 million members online.

Orthopedic surgeon Abtin (“Abi”) Foroohar, MD, showed us how he’s using the platform to connect with his fellow physicians. As he pointed out to us, there’s an inherent increased collegiality and collaboration in a multispecialty group practice in an integrated system that is not matched in fee for service medicine. At the same time, working on staying connected brings huge gains in people’s perception of their purpose and mission.

Commonalities, Health, Policy

Why the focus? Isn’t it obvious that people should collaborate and therefore they will?

They should, but it turns out that in the era of Health Information Technology, and technology in general, sometimes they don’t. Physicians who used to have combined hospital/outpatient practices now have one or the other, which reduces their exposure to their colleagues. They chart on computers with fixed locations, they communicate via messages sent in text, test results, and digital progress notes.

Both of these teams are solving huge problems for people with great need. Electronic Health Record systems are not going to automate all communication and web sites aren’t going to build themselves, and not certainly using old methodologies, that’s definitely what I see in this post-EHR organization and at 18F. The policies that create the environment where more people can get health care that’s of a quality not previously imagined will also create the need to think differently to make this happen. With a combo of changing technology, changing behavior, changing minds. That’s what I saw at 18F and Kaiser Permanente South Bay Medical Center.

By the way, Kaiser Permanente also has an 18F-type floor in Oakland, called iThrive (don’t you love all the catchy names of these places). Come by and see it sometime 🙂

1 Comment

Ted Eytan, MD