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. I am sharing everything I heard, grouped by themes, by the question that was asked, and by division--Primary Care, Consultative Specialty Services, or APPLE.

It’s all here—the good, the bad, and everything in between.

Several comments might feel pointed when you read them, but we need to remember that they reflect people's perceptions and experience.

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 had a long conversation with our Chief Medical Information Officer Dr. Gwen O’Keefe, about getting the most out of our technology, and she’s got more to say about our “love-hate” relationship with Epic this issue.

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.

Questions or comments? Respond to Open Mike

 

It’s National Nurses Week, and Group Health Physicians celebrates the many contributions nurses make to Group Health and our national health care system.

Now more than ever, nurses are playing leadership roles, providing primary care services to meet increased demand, implementing strategies to improve the quality of care, and playing a key role in innovative, patient-centered care delivery models. The nursing profession plays an essential role in improving patient outcomes, increasing access, coordinating care, and reducing health care costs.

The American Nursing Association’s theme this year is “Trusted to Care.” We talked to GHP clinicians and leaders about the many ways they appreciate the trust and teamwork that nurses build with their patients and in their care settings.

When you read these examples of the positive impact Group Health nurses make, think of the thousands of encounters in our system every single day. That’s a tremendous amount of trust and care. Thank you, Group Health nurses, for all that you do!

* * *

“I pass most days in our crowded Burien clinic sitting with our nursing staff. Spending so much time with this team, I have a new appreciation for how much they do for our patients. Our Family Practice RN, Sherrie Elmer, invests hours each day to help our patients manage chronic disease. She coaches and inspires with a mix of compassion, humor, and, when needed, a dose of tough love. Patients trust Sherrie with details of their lives that I could not begin to draw from them. Knowing what challenges they really deal with helps us to develop strategies that succeed where boilerplate instructions will fail. I can't imagine practicing medicine without Sherrie.”
- A. Wellesley Chapman, MD
Family Medicine, Burien Medical Center

“I worked with a wonderful group of pediatric nurses for years at Central and then at our former Eastside clinic in the pediatric ward. I could come up with hundreds of times that I relied on them; but one that I recall involved RN Norma Hurlocker. We had a little 4 or 5 month old baby with croup. I was checking in all the rooms and found Norma holding this little guy who didn't have a parent there at that time. She said to me, "He's going to stop breathing," and one look at him convinced me she was right. We quickly got him a breathing treatment of racemic epinephrine and got him stabilized enough to transport him to the ICU at Children's. He ultimately did great and I was always grateful for Norma's observation and quick "heads-up."
- Jill Allen, MD
GHP Board Member
Pediatrics, Capitol Hill Campus

“Nurses continually improve our patients’ health and help me in so many ways. I work with a wonderful team of nurses including complex case manager nurse, Carmen Suazo, who thankfully seems to follow half my patients. She is a joy and the patients love her. My teams nurse, Michelle Isbell, is a treasure. She appropriately triages our team's emails and phone calls. If I'm needed, she gets me involved and I trust her clinical judgment. Perhaps the best part of all: When I send her a patient to follow up, I never wonder if it will be done--it always is and I just close that encounter. She is efficient, responsible and experienced. It is rewarding to work with her, and I am lucky. Thank you Michelle and all the nurses at Downtown Group Health for your great work at Group Health!
- Charles Mayer MD, MPH
Family Medicine, Downtown Seattle Medical Center

“I have a patient with both congestive heart failure and sleep apnea. She’s on home oxygen and periodically has a lot of anxiety about her breathing. She came in to see me to address this, and the first thing she said was, ‘I am much better now. Just having had a chance to hear Lawana's voice on the phone calmed me down!’ I thought that was priceless. The close relationship with RN Lawana Shutt, a nurse who knows her personally, had a significant therapeutic effect.
- David O. Miller, MD
GHP Board Member
Family Medicine, Silverdale Medical Center

I want to give a shout-out to the Consulting Nurses and the nurses who support our Emergency Patient Resources and Options (EPRO) program. They have taken on lots of new work over the past several months to support the Emergency Department/Hospital Inpatient initiative (EDHI). Well done!
- Brenda Bruns, MD
Executive Medical Director, Health Plan Division

“There are daily examples of Group Health nurses helping patients, but I remember two times in particular when nurses were incredibly helpful to me as colleagues. Several years ago I had a delivery that was very stressful, with a mom and baby who did not do well initially. It was very hard emotionally on everyone. I worked hard to be a strong, competent doctor. The next day, Linda Anderson called to just check in and be sure I was okay. She reached out to care for me… talking to me about how hard it can be and if I needed anything. I cried after we finished, which I don't think I would have otherwise. I will never forget that phone call.

Second, a few years ago, I had a bad flu and was pushing to come back to work. I came in and tried mightily to see patients. After the second visit, my nurse Terri Ledray came up to me and kindly said that I would be going home now—that I was too sick to be here. We will take care of everything, she said, now go home and don't come back until you are well.

Nursing is a beautiful thing, and great nurses care for everyone they see and work with. I appreciate them professionally and personally every day.”
- Barbara Detering, MD
GHP Board Member
Family Medicine, Capitol Hill Campus

"I still remember the time in the late 1980's when one of my patients at the Bainbridge Island Group Health Clinic experienced anaphylaxis while waiting in our waiting room after an allergy shot. The receptionist quickly alerted RN Barb Middaugh, and within a minute Barb had an IV in place, full vital signs, and had my attention. Almost before the order for epinephrine left my lips, it seemed the injection was going in and had an immediate and positive impact. I was SO appreciative for the professional competence that Barb brought to that experience. Since then, I have had hundreds or thousands of wonderful experiences with our nursing staff in caring for our patients. They are a fabulous group and we appreciate them on a daily basis. THANKS to all our nurses!"
- Michael Soman, MD
President and Chief Medical Executive
Group Health Physicians

Questions or comments? Respond to Open Mike

 

Group Health Research Institute has selected Eric Chen, MD to receive the tenth annual “Birnbaum Award for Supporting Research that Benefits Group Health Members.”

The Birnbaum Award is given to an individual or team that has made extraordinary contributions to successful research at Group Health. Dr. Chen is being recognized for his support of the NCI-funded GHRI Oncology Nurse Navigator Study and his advocacy for clinical trial activities at Group Health.

From left: Oncology Nurse Navigator project manager Kathryn Horner, 2011 Birnbaum Award Winner Dr. Eric Chen, McColl Institute Founder and Senior Investigator Dr. Ed Wagner,  and Research Associate Evette Ludman.

The GHRI staff members who nominated Dr. Chen for this award wrote:

Dr. Chen has approached the Nurse Navigator project enthusiastically, providing feedback and support whenever asked. Dr. Chen’s participation provides clinical and operational expertise that improves our nurses’ ability to guide cancer care for patients. We all know the importance of leadership buy-in to implementing a new project; because of Eric’s ongoing participation, we have been able to provide a more “optimal” intervention.

 In addition to his critical support for our Navigator trial, Dr. Chen, in his role as Group Health Oncology Chief, has been a strong and consistent supporter of GHRI cancer research. His involvement goes way beyond providing letters of support. He has been a strong advocate for strengthening Group Health’s clinical trials activities. …He has provided timely and invaluable advice on any number of questions related to Cancer Research Network proposals and projects. His responses have significantly helped to assure that our cancer research is clinically relevant and feasible. In sum, GHRI's cancer research program has been substantially enhanced by Dr. Chen's wise and enthusiastic support and understanding of cancer research.

Congratulations, Dr. Chen! Thank you for your outstanding contribution to cancer research that will benefit our patients and the region, and your medical leadership of Group Health’s hematology and oncology clinicians.

Questions or comments? Respond to Open Mike 

by Gwen O’Keefe, MD, Chief Medical Information Officer

I still remember moving to EPIC from the world of large paper charts with pieces falling out—charts that weren’t available half the time because another clinic had checked them out. Things are still this way in much of the country, but it is changing rapidly. At Group Health, it’s hard to recall that paper world. Most of us would never go back, but that doesn’t mean we love everything about EPIC.

These days, the EMR has, in some ways, become as important in patient care as the stethoscope, or even the physical exam (!). Many new graduates from medical school and residency will not consider practicing in a place without an EMR, and the federal government’s Meaningful Use program is offering financial incentives to hospitals and practices to implement EMRs effectively.

There is nearly universal agreement across the industry that EPIC is by far the best EMR software out there, and we have many jealous colleagues who would love to have what we have. That said, we also realize that EPIC, and all other EMRs, have a long way to go before they are truly working with us, rather than frustrating us. One of the big responsibilities our department has is working with the people at EPIC headquarters in Wisconsin, advising and pushing them to improve their software product so it’s easier and more intuitive.

Because software design to support complex processes (such as taking care of patients) is so difficult, we know that training is critical to using it well and easily. I use the analogy of airline pilots, who also use highly complex technology to fly planes. If they don’t do it right, the consequences are immediate and disastrous. The airline industry knows this, and has all pilots spend significant time each year training on simulators until they know the tasks they need to do like the backs of their hands.

EPIC has focused recently on trying to reduce the amount of “clicks” it takes to do things, but in order to do that they do change the way it looks and feels. One of their goals was to provide a tool (Pulse) to give the user an idea of how well they use EPIC and point them to tips that will help them use it better. As we have heard from you, this tool did not necessarily meet that intent, so we are turning it off and will look at ways to better give you the information you’ll need to be effective Epic users.

We believe that using the power of an integrated EMR is the best thing for our patients, and will make us better physicians and providers in the long run. It’s a long road to get there and we are committed to making our system and users as strong as possible.

Questions or comments? Respond to Open Mike

 

By Barbara Detering, MD, GHP Board Member

The way we practice medicine today has made information technology feel as essential as electricity itself. Our office phones, medical records, the ability to accept payments at the pharmacy window--all depend on multiple systems. IT is central how we give care, and our GHP Board needs to be attentive to the robustness and reliability of our systems.

As a family doctor I never had the chance to learn what goes on behind the scenes to keep our IT systems up and running. But after last October when a power outage affected Epic and other systems, our GHP Board wanted a deeper understanding of how it all works.

L - R: Thurston Muskelly, Adam Burton, and Morgan Erwin running the IT Operations Control Center at AOC.

Board members Steve Duncan, David Miller and Paul Flugstad and I asked Group Health’s Chief Technology Officer Don Lewis if we could take a field trip to the IT operations center at Group Health’s Administration & Operations Campus in Tukwila.

Don and his staff gave us the full tour, showing us the control center (which looks like something out of Star Trek), and rooms with rows of servers humming away. We learned about the backup system for EPIC that is housed in Eastern Washington. Don’s team also explained how our system recovery capabilities are supported by an East Coast firm that holds all the codes and commands to bring us back online after a major outage.

When the lights go out: practicing the “old way”
During the October 2010 outage we struggled to return to the old way of practicing without computers. It was especially difficult and time consuming to catch up on all the ordering and documenting after the system came back on line.

The major point I took away from our field trip and the outage is that as clinicians we have as much personal responsibility for readiness as our highly functioning IT center does. In medical school we drilled and practiced “codes” for patients. With so many recent, tragic disasters—from tornadoes to Tsunamis—being ready with our “codes” to practice medicine under extreme conditions, without technology, is critical.

Eight years of Epic
It’s hard to believe that we’ve been using Epic since 2003. And in that time, there have only been two significant unplanned downtimes. That’s only two days out of more than 2,900! Our technology teams do a great job keeping things up and running, yet it’s important for our Board to participate in forming the “just in case” policies, procedures and drills that are so important to patient care.

As a Board we want to keep this discussion going, and we also want to remind you of the updated downtime procedures for Primary Care that Dr. Claire Trescott, circulated last fall.
Take a moment to read it and think about what you’ll do to be ready, just in case.

Questions or comments? Respond to Open Mike

 

To recognize and share the work of its Acclaim Award-winning medical group each year, the AMGA publishes a case study and a leadership article as a cover story in Group Practice Journal. This detailed coverage discusses Group Health’s innovations and delivery system transformations over the last several years, and highlights our renewed focus on people and culture. See and share our story—you have all contributed to this great honor with your dedication and hard work.