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Open Mike - 2011

Why are we here?
March 23, 2011


As I mentioned in the last Open Mike, I’ve spent most of March in clinical immersion. I’ve been all over the state, getting together with our medical staff in small groups. These are really intimate settings, usually with about four to eight clinicians in any given meeting.

First, let me say that it’s been very personally and professionally energizing to get out into your workplaces and see you in person.

Lots of folks are curious about these talks, and what I’m learning. I’ve met with nearly a hundred of you so far, and I’ll be talking with another hundred or more of you through early April. Now that I’m roughly at the halfway point in these meetings, I want to share some early themes.

We spend about an hour together in each of the meetings, and I ask just three questions:

  • Why did you come to Group Health, and why do you stay?
  • What’s working and feels right to you?
  • What’s not working, doesn’t feel right, or feels like it needs to change?

So far, I have notes on hundreds of your comments, and I’m starting to organize them. For a diverse group, you’ve actually got a lot in common. Where it comes through most obviously is when we’re talking about why each of us came to Group Health, and what keeps us here.

Why are we here?
Easily eight out of ten of you mention that our philosophy of medicine—the way we practice—drew you here. And paired with the people and relationships in your workplaces, it’s a major thing that keeps you here. You’re telling me that you’re feeling really integrated with the colleagues on your teams, and that you love working in an evidence-based environment. I am also hearing that you like working with other clinicians who want to do the right thing, and keep improving how we do it.

This impressed me so much that I mentioned it last week when I was presenting Group Health’s work at the Northern California Permanente Medical Group’s Board meeting. They invited me to talk to their 43-member board of directors and executive medical director Dr. Robert Pearl about you and your work. I mentioned specifically, and confidently, that the values you bring to work are so powerful that they’re clearly related to our many successes over recent years.

What’s working?
When we talk about what’s working and feels right, I’m hearing that you feel people here are really committed to their work. The doctors I have talked with say they notice that people around them are starting to listen more, to hear more. I’m hearing that Epic is, for the most part, great (though there are many areas where you feel it might improve). And in our multispecialty groups, you’re generally feeling supported in doing the right things.

What’s not working?
Because I’m going to so many locations, I'm hearing lots of specific things about your clinic environments. This ranges from use of space in Tacoma to concerns about off-site specialty appointing in Bellevue.

Operational issues come up, like the extra work it causes when a feature changes in Epic. And some of you aren’t satisfied with what you call “filler” that appears in charts, obscuring the patient’s real story in the midst of all the extra information. You also need more time and support for your virtual medicine workload.

Another common, big-picture theme is that it’s time to change from top-down management emphasis. You all want to see more front-line-initiated improvement.

What happens next?
I’m looking forward to my next meetings with you, because I know I’ll learn something unique each time I sit down and pose those three questions.

I intend to keep sorting the comments into themes. I’ll use them to influence our direction, especially in areas that are most broadly felt to need improvement, or especially critical local issues. I’ll be working with my operational colleagues to push toward improvement based on what you’re telling me. Obviously, we won’t be able to take on everything at once, but we’ll address the things you’re telling us are most important.

My takeaway from this experience, so far, is my deep appreciation for you as a medical group. Where you have problems and want to fix things it’s not coming from a place of anger or victimization. You voice your concerns and fears and complaints because you care.

And let me be the first to wish you a Happy Doctor’s Day. March 30 marks the date that ether anesthetic was first administered in surgery in 1842. People began celebrating this day in 1933, honoring doctors past and present for their work. We have the best medical group in the United States, and I am deeply appreciative of what you do every day. Thank you for doing what you do so well, and with such commitment.Print

Open Mike Articles
  • 2012  
  • |  2011  
  • |  2010  
The Path To The Best Care At Lower Cost   12/01/2012
The US spends $2.7 trillion on health care every year. If our collective wallets feel lighter, that’s because $304 billion comes out of our own pockets. How can these kinds of costs be brought under control, without sacrificing quality of care?

Certainty   09/04/2012
Sustaining momentum in uncertain times can be hard, but one way to keep it up is to celebrate progress. I’m really proud to call your attention to a study published in Health Affairs today.

Affordable Care Act ruling brings stronger imperative to transform health care  07/11/2012
As important as the Supreme Court Ruling is for the future of health care, it’s really just one step in a process that started before the Affordable Care Act passed and will continue for a long time to come.

Only connect 05/16/2012
This spring I spent five weeks in clinical immersion all over our system. I had 34 small-group discussions with 172 different clinicians. In March, I shared some early insights at the half-way point. Now I want to wrap up everything I heard.

What if? 04/11/2012
What if the “new normal” doesn’t feel normal at all, for many years? I try to remind myself and others that the current turmoil in health care is driven by market forces—not politics—and can only be solved by directly addressing the market. Our “new normal” is all about reaching across silos to work with partners in new ways.

Business problem? Diagnose it.
03/21/2012
I’m about halfway through my 2012 clinical immersion. When I tried this last year it was new for all of us, and it felt right to start our conversations around values. This year I'm trying to dig a little deeper.

What will your legacy be?  02/24/2012
What a night! It felt terrific to see over 700 clinicians and special guests at the GHP Annual Meeting on February 15. “A Legacy of Leadership” was our theme for the evening, touching on our shared past, present, and future.

Performance matters  10/19/2011
Only nine Medicare Advantage plans in the country earned 5 stars overall, and Group Health Cooperative’s Medicare Advantage plan is one of them!

Looking back, and ahead: reflections on my first three years  9/17/2011
The last three years have passed quickly, largely because I’ve had such an amazing group of people to work with. What you’re capable of no longer surprises me. It inspires me.

Our people are our culture, and we’re constantly evolving  8/17/2011
One thing I’ve noticed since my last Q&A on Group Health culture with Scott Armstrong is that conversations like ours are spreading.

More than elbow room  7/6/2011
Growth is a good problem to have in turbulent economic times. But as I’ve heard in medical staff business meetings and conversations, growth is hard on daily life at work.

Erikson and Soman on partnership and growth  6/15/2011
Sustaining growth isn’t about Michael and I being leaders; it’s about teams of seasoned, excellent colleagues and leaders and clinical teams. We both have tremendous confidence in them.

The good, the bad and everything in between  5/11/2011
I went all over the state in March, talking with small groups of GHP physicians and other clinicians about critical issues. 

Culture at Group Health: 7 questions for Scott & Michael  3/9/2011
Scott and I kicked off some fresh thinking about culture and respect for people at our Leadership Conference about five weeks ago. Recently, we sat down to check in with each other about it.

Put some passion in your workplace 2/17/2011
What satisfies you, motivates you, or makes you want to tell your friends and family about your day? Do you know how your co-workers would answer these questions? Talk to each other to learn from each other.

Sometimes growth don't feel like it should  1/28/2011
We know that taking on new patients—and engaging them in their own good health—takes time. But it’s what’s unique and important about our kind of medicine.

What will it take? You.  12/1/2010
About 350 leaders from the Group Practice and throughout Group Health gathered for the Group Practice Annual Fall Forum on November 12.

Demystifying clinical integration
11/3/2010
Clinical integration is the key, so let’s define what that phrase means.

Step back and take it all in. You’re making great things happen.  10/21/2010
In the last issue of Open Mike we had just learned that we had won the 2010 Acclaim Award from the American Medical Group Association.

Group Health sees a big jump in NCQA private plan rankings  9/22/2010
Group Health is one of the highest rated health plans and among the top 50 in the nation, according to the National Committee for Quality Assurance (NCQA).

Innovation is where we shine  9/8/2010
I am very excited to share that the American Medical Group Association (AMGA) has honored our work with its 2010 Acclaim Award.

Notes from the Colorado Health Symposium  8/11/2010
During the last week of July I traveled to the Colorado Health Foundation’s annual symposium in Keystone, CO.

Measuring up  7/28/2010
Quality. Ask a hundred people to define it, and you’ll get a hundred answers.

The risk and opportunity of Accountable Care Organizations
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Shared values, physician-led care models, and aligned incentives can bridge the distance between organizations in the world of accountable care.

Let’s start a conversation about our workplace  4/4/2010
People are our most important resource, our “secret sauce.”

Decreasing “unwarranted” variation in clinical care  3/24/2010
As you read this, we are in the midst of unprecedented reform to our national health care system.

Making the transition from “I” to “we”
2/10/2010
Last night the Group Health Permanente Annual Meeting left me feeling inspired and confident.

Looking ahead to 2010  1/13/2010
First, for 2010, our goal is as follows: We will lead the top delivery system in the state.

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