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Open Mike - 2011

The good, the bad and everything in between
May 11, 2011

As many of you know, I went all over the state in March, talking with small groups of GHP physicians and other clinicians about critical issues. I connected with about 175 of you in 29 one-hour meetings over a five week period.

When I reached the halfway point in this clinical immersion, I wrote about some of the early themes I was hearing in Open Mike.

My questions were:

  • 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?

Why did I do this?
There are two major reasons I did this immersion (and yes, I do plan to do it again in the future). First of all, I wanted to be influenced by you. Without your influence, I cannot drive change in a direction that will help you help your patients. So that was important for all of us.

Second, I wanted to feel better connected with you—for your sake and for mine. I spent 17 years as a family doctor seeing patients every day. I have plenty of regular dialogue with lots of people in my current job. But I don’t get many chances for this kind of intensive dialogue with front line clinicians. Getting connected with you fills my tank and inspires me both personally and professionally.

What did I learn?
I went in without preconceived notions, yet I knew I would hear some things that were hard.

I organized the thousands of individual comments that I collected into “buckets” with similar themes. Then I shared everything I heard, grouped by themes, by the question that was asked, and by division with all of you—the good, the bad and everything in between. 

One thing I’m really proud of: your answers to “Why I stay.” Dozens of you literally sat taller in your chairs—you changed physically when you answered that question. Your hope for our future, and your depth of caring about your medical practices is amazing. You love that that you are surrounded by colleagues who want to do the right thing. You are proud to work for a values-based organization, you love your patients, and despite valid concerns about growth and space and equipment, many of you say you would never want to practice anywhere else.

What’s changing?
There were two operational things that I wanted to take action on right away. It’s probably no surprise that Epic came up often in your comments: I love it and can’t live without it! I hate it and it drives me crazy! I also found out that the “Pulse” feature is not popular. Turns out, it’s also pretty easy to turn off, so it will be going away.  

I’ve also spoken with Executive VP and Chief Financial & Administrative Officer Ric Magnuson about the Dedicated Appointing Group (DAG). We’re working on solutions for your appointment setting concerns in Bellevue.

I appreciate the openness and willingness of both of these leaders to listen and respond to your frustrations and concerns.

Where do we go from here?
In general, you say you’re pleased that executive leaders are able to make decisions, but that the decisions and implementation feel too top-down. We’ve got to figure out the bottom-up part of change around here. Respect for people means taking local impacts into account before we do things, not after. While there’s excitement about Front Line Improvement (FLI), and some teams have been taking part, it’s not moving fast enough for some of you.

Investments in Group Practice facilities, equipment and staff came up repeatedly. The most pressing regional space issues are in Tacoma, Bellevue and Seattle, and this will only intensify with the enrollment growth we expect in the next five years.

Group Health’s 2015 Strategic Plan calls for $750 million in expenditures to increase capacity, improve facilities, and build new medical centers over the next five years. In the short term, Group Practice leadership just approved $20 million in new hires. We know that we can deliver the highest quality care at the best cost, with the best outcomes in our Group Practice, and we’re committed to supporting your work in the heart of our business.

I want to thank all of you for your honest dialog with me and for the commitment you have to do the right things for our patients.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.
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.

Why are we here?  3/23/2011
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.

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
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
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”
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.

Other GHP Leadership Publications