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Open Mike - 2012

Business problem? Diagnose it.
March 21, 2012

I’m about halfway through my 2012 clinical immersion. Again, it’s rejuvenating to get a closer look at clinic life around the state, and spending time with you always recharges me. So far, I’ve met with 127 GHP clinicians in 23 separate meetings of two to nine staff.

When I tried this last year it was new for all of us, and it felt right to start our conversations around values: what brought you here and why you stay. We talked about the things that help you live out your values at work, and things that get in your way.

This year I’m trying to build on that, digging a little deeper on the actions that you feel empowered (or not) to take to influence great care, no matter where you are in the organization:

  • What challenges do you believe you could make progress on through your own personal initiative and leadership, or in partnership with others?
  • What do you think I, and other formal leaders, can be doing in our roles to address the challenges of providing better care at lower costs? What ideas do you have?
  • Do you have any other advice for me?

Your feedback helps me focus my work for the rest of 2012. It’s giving me a read on the overall pulse of things, and just as last year, there many similarities in your answers. I’ll do a full recap when I’ve heard from all the sites I plan to visit.

Some things have come up that aren’t instantly “fixable,” but are easy to bring up with people who can clarify or help. For example, many of you have mentioned frustration with RAP sheets, while others want paperless information exchange with outside pharmacies through Epic. You’d also like to know the content of the “birthday letters” your patients are getting so you’re more ready to answer their questions about them. Another issue involves medications: new patients sometimes decline the pharmacy medication review during their on-boarding phone call. This means the work to capture medication lists moves downstream, affecting clinic time.

I’m routing these comments—and several other specifics that have come up—to people close to the work so they can start looking at what’s possible.

Back to the things you want to make progress on in your own work. Here’s what I think: if you want to have a positive impact and solve a business problem, invoke the model you learned in your medical training.

Think about how we get started with our patients. We take their history. Find out more about your problem: when did it start? What’s the chief complaint and how long has it been going on? What was happening in the environment at that time?

Take a look at symptoms: how is the problem making itself known? Could there be more than one root cause? Formulate your hypothesis.

On to exams and tests: get some data to test your hunches with. Communicate; ask questions. Get some people together and test your thinking. Challenge myths and find facts. Then diagnose and choose a course to follow.

Now for the treatment plan: given what you know, what strategies do you use to solve the problem? What are the potential benefits and risks of each choice? How will you know your plan is working? And (this is pretty critical) are you ready to adjust if things change?

Every day, you solve problems that I couldn’t even begin to try to work on. So have confidence in your knowledge. You don’t need a business degree to build great team function, communicate, and reach out to your colleagues to work through things together. Change happens one conversation at a time.

Once again I’m deeply appreciative of your thoughtfulness, and the time you are sharing with me. Thank you!

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.

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. 

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