How are you working together?

M. Erikson: What’s great is that Dr. Soman and I already have history together so I know a lot about him: what drives him from a values perspective, and how he views the world. It’s great that I don’t have to guess, ‘I wonder what he meant by that?’ We are also both driven to succeed and this means we want Group Health to thrive and we want our group practice to be the best place to work and to get care—definitively and without exception.

M. Soman: We’ve been working together since 2005, and during that time we’ve done a lot together. Michael is really capable and he’s drinking from the fire hose right now, trying to absorb all of the intensity of shifting his role. One thing I really appreciate about him is his commitment to do what he says he’s going to do. He follows through, which makes for a really good partnership.

What’s top of mind in your first weeks of partnership?

M. Erikson: We’re both very concerned that many of our care teams are feeling they don’t have enough space to take care of their patients effectively. We have very quickly agreed that we need to respond. We’ve worked with our respective Executive Leadership Team colleagues to get to some solutions more quickly. The other thing that Dr. Soman and I agree on and are absolutely committed to is extending the presence of our group practice into new communities, and expanding it in places where we already have a presence.

M. Soman: The Group Practice has seen an influx of 51,000 enrollees since the end of 2006 and 33,000 have come in since the end of 2009—that’s a sign of very successful growth. But Michael and I are very aware that we also need to make sense of the fact that we’re closing our group practice presence in the Coeur d’Alene community at the same time that overall enrollment is growing.

M. Erikson: I do want to acknowledge that our push to expand and extend the group practice presence probably feels disconnected from what 40 of our people in Coeur d’Alene are experiencing. I was with them last week, and it wasn’t the first time we had talked about the possibility of closure. We reaffirmed that Group Health hasn’t been successful with our group practice model in Coeur d’Alene. This is not because of anything the staff has done. They have been great; their patient experience surveys and clinical quality performance scores really tell that story. The market there is just not seeking what we have to offer, and over the last five years we’ve been steadily losing our ability to keep going.

How do you think we can sustain growth?

M. Soman: After we announced the closure I got an e-mail from a doctor asking when we were going to open a new medical center in a new neighborhood, which is a good question. We haven’t had a new medical center that wasn’t a replacement building for about 22 years. Sustainable growth means figuring out ways to more quickly move into communities where we are in high demand and can maintain our performance on cost, quality and access.

We have to make sure we’re staffed up for growth and have space to give good care and not burn out people. We need space not just in exam rooms, but in operating rooms and all the other places patients need to be seen. So we’re going to have to figure out ways to enter a community with smaller, maybe leased spaces that aren’t $15-$20 million boxes that take three to four years to build. And we’re going to have to grow within the multispecialty sites, where we need more scale to have a thriving, sustainable delivery system.

M. Erikson: There are really two major themes in my first two weeks. And they’ll continue defining our work together. On one hand, we’re in a really operational mode planning for the practical realities and challenges of growth like equipment, space, and having enough people. On the other hand, we flip over to the really focused strategy of how to grow. What do our consultative specialty services business planning and studies from Milliman and other business consultancies teach us about what the group practice can and will become?

M. Soman: Ultimately 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.

What makes you excited to come to work every day?

M. Soman: We have phenomenal people who work here. There’s a foundation of values in their work, along with passion and level of intent to do right thing that I’ve honestly not seen anywhere else. And we are doing things, in fact, that nobody else can do. It’s very exciting and it keeps evolving. We don’t give ourselves enough credit for what we really are doing that’s innovative right now. The combination of our people, their values and our business model helps us do things that are more like a model for the country than 99 percent of other places in healthcare.

M. Erikson: I think about 1997 when my first meeting of my very first day at work was about layoffs in Central Washington. And within a couple of weeks I learned about some areas of huge financial losses. Here I am this new guy from a behavioral health background and I started thinking what have I done? But I hung in there. We as a company find our way out of hard things and into finding really important things to do. This is a place where creative and great people come to solve significant human problems and make a difference in peoples’ lives. It evokes a level of passion and commitment and intelligence to be working in a community focused on making a real and measurable difference in peoples’ lives.

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Last month appointment staff began asking members about their race, ethnic background, and language preference (REL) when they call for an appointment or check in at Group Health Medical Centers. Patient response is voluntary.

Nationwide some racial and ethnic groups report higher rates of illness and disease-related death. These differences—known as health disparities—show that people from specific population groups frequently have poorer health outcomes than Caucasians.

Our Quality Improvement and Informatics Department has long wanted to collect data about our own patients. The data can help us learn:

• What language services are needed in our medical centers
• Where we have opportunities to reduce disparities in care

Today 8 out of 10 hospitals collect data about their patients’ race and ethnicity. Group Health began asking about ethnicity through health risk assessments in 2006, and the Group Health Research Institute has done some early research. This push, however, will build a critical mass of data for analysis.

Promoting equitable health care

“There is plenty of evidence that shows that some populations do worse in conditions like hypertension, diabetes and cancer. We’re committed to providing the best care to all of our patients,” said Matt Handley, MD, medical director for Quality Improvement and Health Informatics in a videoconference on meaningful use.

Because the Pacific Northwest’s demographics differ from the rest of the nation, “It is important we have demographic data that reflects the unique diversity of our patient population,” says Bri Dinoso, quality improvement specialist.

By mid-July, all check-in staff will be asking three questions as standard work. The plan is to begin analyzing the data this fall. “Using REL data, we hope to design strategies to reduce disparities in our patient population, ultimately improving equity in health care,” says Dinoso.

Helping Group Health achieve “meaningful use”

Group Health is also acting now because of incentives offered by the 2008 federal stimulus package. The government will pay hospitals and clinicians that provide high-quality care to their patients through the “meaningful use” of electronic medical records. Reducing disparities is one of the government’s six priorities. “We’re just getting started because we haven’t had the data,” says Handley.

Appointment staff get more comfortable talking race

Asking personal questions about race and ethnicity doesn’t come easily to many and at first the staff from Patient Access and Business Operations were nervous. The planners spent a lot of time researching approaches that make patients and frontline staff most comfortable discussing the questions. More than 500 people will be trained.

A pilot held at Olympia Medical Center in May went smoothly. Planners observed and measured the patients’ and staff’s reaction to the questions. In the first week, 98 percent of staff reported that the interactions were successful.

“Because we did it the right way and trained staff, did focus groups, and notified patients ahead of time, it’s gone well,” says project manager Jennifer Haury.

Handley acknowledged the staff’s initial anxiety about asking such emotionally-charged questions: “After all, 20 years ago doctors were uncomfortable asking patients if they smoked. But today the question is routine and we recognize the value it brings to the clinical relationship.”

To learn more about the initiative and its rollout, visit the Meaningful Use Initiative area on Incontext (link only available via Group Health's intranet site).

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Beginning in late June, Group Health will begin automatically releasing written radiology results through MyGroupHealth. Patients will receive a summary portion of the written report: the radiologist’s impression.

The project’s first phase is to release routine plain films, mammograms and bone density studies after a two-day delay. The ultimate goal, at a later date, is to release written results for all radiology studies including MRI, CT, and ultrasounds. These “special” study results will have a seven-day delay before release.

“While these reports have always been available by in-person request, our patients have long been asking for them online,” says Dr. John Kaschko, internist at Group Health Redmond Medical Center at Riverpark. “Other groups across the country have been releasing the same types of reports for years, and they have been very well received by patients.”

The Group Health team studied the impact of radiology report releases at Palo Alto Medical Foundation, Beth Israel Deaconess, Vanderbilt University, Intermountain Health Care and Partners Healthcare, which includes physicians at Mass General, Brigham and Women's, and Dana Farber.

At these organizations doctors were understandably hesitant about having patients see their results without screening because of potential misunderstandings of variations slightly above or below normal ranges. Over time, providers found that it supports both patient satisfaction and safety to increase access to this valuable information. At Intermountain Health Care, patient surveys show that access to personal radiology information is the top reason patients sign up for access to their patient portal.

Radiology Service Line Chief Dr. Robert Karl says it's a great opportunity for our patients and doctors to be more actively involved as partners in care. “I'm looking forward to the day when all imaging studies are released to our patients,” he adds.

Our medical director for patient safety maintains it's an advance in patient safety, too. “Enabling patient access to more of their records improves the safety of their care,” says Richard Hert, MD. “It may take some explaining to the patient, but if patients can bring items in the reports to their doctor’s attention and avoid delays in diagnosis, it's a good thing.”

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Take a look at these recent thank-you letters about our work with hospital partners. Each of us can impact our co-workers, patients and partners every day. You make Group Health proud!

Group Health pediatricians Kathy Bloomer, MD and Jill Allen, MD receive high praise from care partners at Seattle Children’s Hospital.

Jill and Kathy

I wanted to thank you for your “unofficial” mentoring you have provided to our hospitalists.

I am in the process of doing the annual reviews for some of our clinical faculty, many of whom are in the Division of Hospital Medicine.

Some of them have commented how one of the advantages to the common office area for the hospitalists that include Group Health providers is that there are ample opportunities for discussions about cases. You were both mentioned as being approachable and spontaneously joining in the discussions. This is very much appreciated by our young hospitalists.

Thanks again.

Mark Del Beccaro, MD
Professor, Vice Chair for Clinical Affairs
Pediatrician in Chief
Department of Pediatrics
Seattle Children's

A longtime member recently wrote to CEO Scott Armstrong, expressing appreciation for quick diagnosis with his Group Health Physicians doctors, and successful surgery at Virginia Mason.

Gentlemen,

I have been a customer of Group Health for over 30 years, and the one time that I needed them the most, Group Health and initially Dr. Megan Melo saved my life. Dr. Melo's read on my past history, along with Dr. Travis Abbott's assessments was above and beyond what most would have assessed of this situation.

I had none of the typical indications of heart problems, however, Dr. Melo persevered and put me in Virginia Mason for a angiogram with Dr. Green the next day. Dr. Green also assessed the situation and said that I needed a quadruple by-pass by Dr. Hill the next day. Everything went as planned on Thursday, March 17, and I was discharged on March 21, no heart damage, and a great prognosis for the future.

Again, my thanks to Dr. Melo, Dr. Green, Dr. Hill of VM and all of the Group Health professionals for aiding me in my time of need.

Sincerely,

James Allen

Sometimes medical staff have to care for each other unexpectedly. A registered nurse at St. Joseph Hospital in Tacoma thanks Dr. Bruce A. Wilson for his calm, caring professionalism.

I am writing to you to let you know about Dr. Wilson and how much we appreciate him!! Dr. Wilson was present on the 9th floor when a CNA collapsed (rapid response). He ran over and assessed the CNA and directed the floor staff.

Last Thursday, another staff member was having chest pain, unable to breathe or speak. Dr. Wilson was again present, assessed the nurse, gave us direction and just really put the nurse and staff at ease.

It is so different when it is a team member who is having difficulties compared to a patient. The staff really just freeze up and are thinking on a personal level compared to clinical. Dr. Wilson is able to compassionately but efficiently get us thinking and moving again. I just wanted to let you know how much he means to our staff and that we really hold him in the highest regard!! The ‘caught in the act’ or candy bar award seemed so insignificant to the care that he provided us.

Thank you,
From all of the 8th and 9th floor staff.

Elaine Roedell RN BSN
9th Floor Resource

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Whether it’s willingness to help with difficult cases, a great sense of humor, or clinical knowledge, Group Health Physicians medical staff value each other for many great qualities.

We’re pleased to share more about the recent winners of GHP’s new Regional Awards for Clinical Excellence. This is a peer-nominated recognition program to honor medical staff from all over our delivery system.

Medical staff nominated their colleagues for
• quality of care and customer service
• demonstrated teamwork with support staff and colleagues
• representing Group Health well.

Congratulations!

Mark Snyder, PA-C Urgent Care Capitol Hill Campus His peers said: Mark has been providing excellent care for Group Health patients for 30 years. He is a fantastic provider and a selfless team member with a long history of contributions to Group Health. Mark is insightful and complete in his evaluation and care of patients. He is always respectful and kind when consulting. A great provider and a great guy!

John Gayman, MD Family Medicine Capitol Hill Campus His peers said: Dr. Gayman is always ready to go the extra mile for his patients!

	Nathan Green, MD Cardiovascular Disease Capitol Hill Campus His peers said: I always enjoy consulting with Dr. Green. He is kind and compassionate, approachable and knowledgeable. He is a great clinician and always open to my many questions and staff messages. Dr. Green has gone above and beyond with several patients to help advance their care.

Ian Becke, MD Internal Medicine, Hospitalist Bremerton Medical Center His peers said: Ian Becke is the definition of a thoughtful, skilled internist who delivers excellent care, often to the most challenging patients in our area. He is a team player and always helpful to colleagues. He is thorough, supportive, compassionate, always accessible and always helpful.

Dave Miller, MD Family Medicine Silverdale Medical Center His peers said: Saying enough about Dr. Miller could take all day: his commitment to excellence, service to GHC/GHP. He is kind and nearly unflappable. Patients love him and he is supportive of colleagues. He walks the walk and cares for the complete patient.

George Lamb, MD Internal Medicine, Hospitalist Olympia Medical Center His peers said: Dr. Lamb thinks through cases thoroughly and has an extensive knowledge base, which he applies in a practical down-to-earth manner. A true 'workhorse' year-in and year-out, along with several other of his long-time IM colleagues. He’s a good big picture guy who keeps it all in perspective.
Mike Rogoza, MD Urgent Care Olympia Medical Center His peers said: Dr. Rogoza is UNFAILINGLY patient-centered, humane and as kind as he is thorough. You never hear anything less from patients that see him. He is always professional, caring, thoughtful, helpful and compassionate.

	Janet Ball, MD Family Medicine Olympia Medical Center Her peers said: Jan is wise, compassionate and has a great sense of humor.
	Seth Scott, MD Family Medicine Olympia Medical Center His peers said: He's in great company with this group. I have always appreciated his clinical skills, and great temperament.

Carl Myers, MD Otolaryngology Olympia Medical Center His peers said: Dr Myers has been so helpful to primary care. He readily gives great clinical advice and is so generous with his time. He is always a gracious consultant and is well liked by his patients. He is kind and caring, with a good bedside manner, and makes himself available to see patients on short notice.

	John Vandergrift, MD Emergency Medicine Tacoma Medical Center His peers said: Dr. Vandergrift is a great teacher and physician who is truly dedicated to our patients. He has been very helpful in a very large project.

Sarah Nyland, MD Family Medicine Tacoma Medical Center Her peers said: Dr. Nyland is the reason I work at Group Health. She was my physician for a couple of years--now I am lucky enough to work for her. She is as competent and caring with us as she is with her patients. Sarah has the empathy and compassion to go with her superior clinical skills, making her a great all around primary care doctor.

Mark Arrant, PA-C Orthopedic Surgery Tacoma Medical Center His peers said: An outstanding Physician Assistant with great insights in clinical and administrative areas. He is a strong leader. Mark is enthusiastic and positive, with a single minded focus on patient service.

Robin Moore, PA-C Emergency Medicine Bellevue Medical Center Her peers said: Robin is a star. She is dynamic and engaged in her work. She has amazing technical skills and an astounding fund of knowledge, especially in orthopedics. Robin is an Awesome PA, always helpful, with great pride in her work. You can always count on her.
Melissa Szocik, PA-C Family Medicine Bellevue Medical Center Her peers said: Melissa is an extremely capable, well-rounded provider. She is down to earth, incredibly knowledgeable, and very personable. She has a very well balanced approach to caring for patients as well as leading a team. She has a strong knowledge base and is always ready to help and learn.

	Jason Kettler, MD Infectious Disease Bellevue Medical Center His peers said: Dr. Kettler is an excellent physician: compassionate, diligent and tireless in his care of patients! A pleasure to work with, and smart too! Helpful, supportive, incredibly bright. Always answers your question in a way that makes you glad you asked rather than sorry you did. Dr. Kettler is a joy to work with, always elevating others’ spirits, and he is a great consultant: respectful, available, listens well, teaches well.
	John Graham, MD Internal Medicine, Hospitalist Sacred Heart Medical Center, Spokane His peers said: Dr. Graham has done a great job leading the hospitalists in Spokane. He is a thoughtful, kind-hearted person, and an excellent clinician. He has great leadership skills and is a forward thinker. I always look forward to patients receiving care under Dr. Graham. Phenomenal job overseeing what is arguably the best hospitalist service in Spokane.

Tim Whiteley, MD Family Medicine Everett Medical Center His peers said: Tim has a consistent approach to always putting his patient's interest first. His kindness and work ethic are superb. Tim is the epitome of dedication and kindness. He is a superb family physician and a great representative of Group Health.
Al Fine, MD Internal Medicine Capitol Hill Campus His peers said: He is a seasoned general internist who is a "doctor's doctor". Excellent physician, incredible knowledge base, deeply committed to evidence based practice.	Artist's rendering of Dr. Al Fine. Artist: A.Fine

Questions or comments? Respond to Open Mike