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Saturday, May 25, 2002
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Pursuing Perfect Healht Care in Whatcom County, WA
This is a high level view of our project plan. Details will be forthcoming in various media and arenas. The project officially begins June 1 though much work has been going on at many levels in the participating organizations.
- Leadership Board Oversight
- Use of Simulation Model to advocate for reimbursement changes
- Complete Initial Staffing for Project
- Staff Training
- Creation of Curriculum and Documentation of Training provided all staff
- Measurement
- Information Technology Work on Infrastructure
- Medication Hand-offs Work
- Communication and Transparency (extraordinary openness) Infrastructure Complete
- Diabetes Pilot Work Plan
- Integrate Care Managers into the Clinics and Virtual Care Team
- Congestive Heart Failure Pilot Work Plan
- Hospital Related Changes to Support Chronic Care Model
- Living With Chronic Illness Program Expansion
- Idealized Design of Clinical Office Practice Completed for Pilots
- Develop Evidence Based Medicine strategy and approach
- Develop an approach for early adopters outside the grant
9:11:17 PM 
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Communication and Transparency Infrastructure
The Pursuing Perfection grant encourages, develops and requires Transparency. Extraordinary openness. In order to accomplish this level of openness we have the following project goals in front of us. Several are underway, even before the grant begins, June 1.
- Communication Plan Developed
- Establish Communication Team
- Identify current technology to support internal/external communication on Project Activities
- Test Technology with this Workplan
- Attempt to connect all sites participating across the country and in Europe with simple userfriendly web tools for communication. More later.
- Quarterly Community Forums Planned
- Extranet Web Site for Pursuing Perfection Started. More soon.
- Videos Developed
- Speakers Bureau Developed
- Experiment with RadioLand as long term communication solution
- Quarterly Community Forums
9:03:11 PM
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We will soon Complete the Initial Staffing for Project
For this project to truly be succefful, these typse of staff positions will need sustainable funding. A daunting thought for a cottege industry. It's a system. The only question is whether the stakeholders can create infrastructure to support a system.
- Recruitment and Hiring of Project Staff (Data Analyst, Project Manager, Project Coordinator)
- Hire Grant Writer
- Recruitment and Hiring of information technology staff (Web Content/patient Education; Programmers)
- Recruitment and Hiring of Team and Process Improvement Facilitator and Organizational Development (OD)
- Recruitment and Hiring of Care Managers
- Consultants and Contractors may be hired
8:55:35 PM
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We will use Simulation and System Models to understand and advocate for reimbursement alignment
Our task list includes the following:
- Engage the other grantees in system dynamics effort, sharing knowledge with them as it accumulates
- Follow up on HBOC Offer
- Develop a contract with System Dynamics folks
- Scoping Meeting in June.
- Identify community business participation
- Week long SYS Dynam meeting with the local Systems Team
- Conduct community data analysis and costing for diabetes and CHF
- Identification and contact with employers and community resources for support
- Identification and contact with payors, national representatives for support in change in reimbursement model
8:48:28 PM
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Pursing Perfection (PP) Leadership Board Oversight
- Recruitment of Additional Members
- We started with the leaders of the provider groups, added the leaders of the payer groups (Group Health and Regence. CHPW (Community Healht Plans of Washington) plans to join soon.
- We plan to invite WA State Medicare (DSHS) and Medicare (CMS) to join in the ldiscussions and modeling for alignment of payment with improved care processes. This work begins in July and shold conclude by January.
- Ongoing Measurement of Team work
- The Institute of Health Care Improvement is leading all of the grantees to find measures that are common between the participants across the nation. The goal is for us to benchmark ourselves and raise the bar on quality of healht care we deliver.
- Locally we have experience in measuing patient-centered satisfaction with healthcare, healthcare functional status outcomes, and "teamness", a proxy for cooperation. We will share that knowledge and experience with the others.
- Assessment of development needs
- We are hiring staff with skills in organizational development, education, and human relations. These folks will help us determine where we will want to increase our knowledge and skills, to make patient-centered care a reality by the end of this pilot project in less than two years.
- Develop Strategy to engage CMS and Medicaid
- As noted above, we have a plan and strategy to collaboratively develop a deep understanding of the local health care situation including the patients' and payers' concerns. We plan to get all the key skakeholders at the table late summer and fall to model ideal health care for thoses with diabetes and congestive heart failure in Whatcom County. We sincerely hope that a coherent demonstration project can be crafted between the providers, patients, and payers; especially Medicare--since much of the cost of chronic care is paid by Medicare.
- Initial Training of Board
- The existance of a board of professional leaders working together to create a system of care that supports the Institute of Medicine's (IOM) CHROSSING THE QUALITY CHASM report is exciting and represents a paradigm shift in focus and system building.
- We will try to support this group so that they are the most effective team with the best ideas and models to support such dramatic change in and amoung their organizations. More later.
- We have engaged Kristin Crosby to orient us to Medicare realities
- Kristen Crosby is the medical director of Olympic Healthcare, a division of Sterling Insurance. Olympic is the largest provider of Medicare supplemental insurance in the country. Kristen is helping us understand the workings and relationships needed for collaboration with Medicare.
- Development of strategic community-wide plan
- For this pilot to meet its aims, it must begin to engage the entire community and provide a sustainable vehicle for the full development of the Six Aims of the IOM report Crossing the Quality Chasm: safe, effective, patient-centered, efficient, timely, equitable care. This level and direction of change will require ongoing system building. This is one of the key responsibilities of this PP Board.
8:23:56 PM
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Sunday, May 19, 2002
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Site map?. We need something akin to a site map for Whatcom PP that show what and who a user can link to.
3:19:03 PM
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Searching strategies.
Searching appropriately,
Our next big challenge is to get a search engine in our implementation of Radio and Manilla so that it does what the customer would expect: search the current author's category, the current author's entire web site, the entire Whatcom Community’s category or all local Radio PP sites, and then the WWPP by the same aggregates.
One would also want to be able to search by any combination of organizations, categories, and authors.
This represents design perspective as well as a search strategy.
3:19:03 PM
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Medication System, measure related to quality.
Common Measures: Medication System
1. Adverse Drug Events (ADEs) per 1000 doses (safety)
2. Therapeutic Range (effectiveness) 3. Cycle time to medication for certain medication (timeliness)
3:19:03 PM
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We need something akin to a site map for Whatcom PP that show what and who a user can link to.
1:42:45 PM
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Searching appropriately,
Our next big challenge is to get a search engine in our implementation of Radio and Manilla so that it does what the customer would expect: search the current author's category, the current author's entire web site, the entire Whatcom Community’s category or all local Radio PP sites, and then the WWPP by the same aggregates.
One would also want to be able to search by any combination of organizations, categories, and authors.
This represents design perspective as well as a search strategy.
1:40:56 PM
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WA state medical reimbursement.
Rewriting WA State medical reimbursement to support new models of care..
From: Anderson, Nancy, Dr. (MAA) [mailto:ANDERNA@dshs.wa.gov]
Sent: Monday, May 13, 2002 10:49 AM
To: Kevin Little
Cc: 'James W. Stout'
Subject: RE: [asthma] FW: [btscollege] Re: Asthma group visits
Medical Assistance (the Washington State Medicaid Administration) is in the process of writing billing instructions for group clinical visits, led by an MD or ARNP, that are specific for diabetes and asthma.
We've written various drafts of the instructions, but all include:
1. review of records/labs/etc by the clinician prior to the visit;
2. Group discussion devoted to a clinical issue;
3. Some question/answer time;
4. Routine review for all (most can be done in a group setting) and short individual visits as necessary
We will allow four one hour modules per year, which can be grouped together and billed as more than one module at one time. We will not allow billing for another e/m code the same day for the same diagnosis. We will allow those clients who have both diabetes and asthma to get clinical visits for each diagnosis (ie 8 one-hour visits a year, 4 for each disease). I'm hoping that we'll begin reimbursement June 1 (but with various bureaucratic issues, probably wouldn't make a bet). We also have a separate pilot project for asthma education with one clinical site, which is an individual contract. These visits are let by an asthma educator and are modeled after the diabetes education that we already reimburse.
Nancy Anderson MD MPH
Medical Epidemiologist
PO Box 45506
Olympia WA 98504-5506
360-725-1567 (v) 360-664-3884
1:19:05 PM
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Cooperation and communication are related.
If we are to begin to cooperate/communicate with web logs we probably need some instruction in "reporting". I am thinking about getting a news paper reporter and some professor types from the university to help us learn to communicate in this style. I wonder if someone from the Weblogging community might not have some good ideas too.
12:19:02 PM
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Saturday, May 18, 2002
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Remote e-mail to your weblog (Radio site). I figured out how to send updates to my weblog from e-mail anywhere. That will come in handy. The only trick is that you need another dedicated e-mail account.
1:19:04 PM
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Stories or Weblogs. If our logs are to be navigable we either need to find a way to only present the top couple of lines and then link or expand OR use "stories" feature and link to those form a weblog.
12:19:02 PM
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Interactions the antidote for isolation. I am beginning to like this. The reason is that for a babble brain like myself it is an outlet in an otherwise isolated environment. I can see that the exchanges/interactions could become very rewarding in a purely selfish way. But, whatever rings your bell could result in music. [Bill Mahoney's Radio Weblog]
12:19:02 PM
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Medication Hand-offs from Hospital to Community.
From Mary Minniti, Project Manger of Pursuing Perfection and Carol Boston, Director of Clinical Quality for PeaceHealth:
Hi All:
As we move into implementation of our Pursuing Perfection Phase II effort, a number of work teams are being formed. We are blessed with a wonderful opportunity to focus some attention on the issue of medication safety and hand-offs now to get us started. Carol Boston will be leading a team to focus on improving the medication hand-offs between hospital and the community. The aim is to decrease medication list inaccuracy between venues for CHF patients. This project has been scoped and team members are being identified. Either Carol or myself will be contacting those potential members to confirm their ability to participate. As is the case with RWJ efforts, this team will launch quickly. Tentative first meeting is slated for May 9th from 7- 10 am and a follow-up the week of May 20th.
You are receiving this email as an FYI. We would appreciate your support in this effort and we will keep you informed of progress. Clearly, there are many things to do and unlike the work of the core team- to write a grant, transforming healthcare will take a much larger and expanded group. So core team members will not all be able to participate in all activities. However, by keeping communication lines open, we can ensure thoughts and ideas are shared. Stay tuned for details.
Feel free to share this with others as appropriate. Carol Boston is the lead and questions can be directed to her.
Thank You!
Mary Minniti, CPHQ, Project Manager
8:19:06 AM
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Patient ACTIVATION, the key to care planning and resource deployment.. From: Bill Mahoney [mailto:bilmah@telebyte.com]
Sent: Monday, May 06, 2002 9:49 AM
To: Minniti, Mary
Subject: Activated Patient
Hi Mary
As you know I have been working with Judy Hibbard's RWJ data trying to build a measure of how activated is a patient. I have a measure that makes good theoretical sense, is consistent with the research in this area and works quite well.
I just wanted to let you know what is available and what next steps I would suggest to complete this.
I will leave it at that and let you respond, but a few things:
- All of this stuff (activated patient, patient-centered care, team development, culture of patient-centeredness, leadership, outcomes) is integrated around the central concept of patient-centeredness. And all of this is integrated with readiness to change, how change occurs and selg-perception theory (I can give you the model if interested).
- The measurement of how much activation is the up front piece for every patient since this is what optimally serves as the information on which the care plan is built and the care team resources are allocated. Using this in this manner will result in the most effective use of resources and the most targeted care.
- Perhaps it would be useful to meet with the teams (CHF, Diabetes, ?) and discuss this and other needs they think they have. I suspect there are reasonable and unknown needs.
Just some thoughts. Let me know your needs.
Bill
8:19:05 AM
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Acute Care Hospital, measures related to quality.
Common Measures
1. Adverse Drug Events (ADEs) per 1000 doses (Safety)
2. Mortality rates (Effectiveness)
3. Readmissions (Effectiveness)
4. Time to treatment on presentation (Timeliness)
5. Functional status, Quality of Life (Patient centered)
6. Average cost per case (Efficiency)
7. Average length of stay (Efficiency)
8. Hours of diversion per month (Efficiency)
9. Patient satisfaction (Patient centered)
8:19:04 AM
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Access to Care, Measurements of. Common Measures
1. 3rd next available appointment (effectiveness)
2. Total time for a visit (efficiency)
3. # of patients on a wait list to be assigned a primary care physician (effectiveness)
4. Percent of patients “highly satisfied” with appointment scheduling (patient centered)
5. Percent “no show” (efficiency)
8:19:04 AM
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Boston U. Sch. of Health Poligy to evaluate Pursuing Perfections Sites..
From: Fiorillo, John (Robert Wood Johnson Foundation)
Sent: Wednesday, May 15, 2002 3:13 PM
To: Bitting, Nancy J.
Subject: Pursuing Perfection Evaluation
To Pursuing Perfection Phase II CEOs
During prior meetings of the Pursuing Perfection grantees we've briefed you on the Foundation's plans to evaluate this program. We're happy to tell you that, after an excellent competitive process, we've selected a team composed of several national experts in health services research from the Boston University schools of management and public health to conduct the evaluation of Pursuing Perfection.
The team will be led by Dr. Martin Charns who, in addition to his role in the School of Public Health, is Director of the Management Decision and Research Center at the Veteran's Administration. Another key member of the team is Dr. Alan Cohen, Professor of Health Policy and Management at the School of Management. Dr. Cohen is a former Vice President for Research and Evaluation of RWJF. It is important that this team begin working with each of you as early in your implementation efforts as possible, so we have asked that they conduct initial site visits during June. A member of the evaluation team will be contacting you shortly to arrange a visit during which they would like to conduct initial interviews with key staff members. We realize that scheduling for June may require some accommodations in scheduling, but it's important that the team have an understanding of what you're trying to accomplish right from the beginning.
The Boston University team will be present at the May 29th meeting to introduce themselves and answer your questions about the evaluation.
We know you understand how important this evaluation is to building an understanding of how others may follow your example in pursuing perfection in health care. We also believe this team brings expertise to the overall effort that will enhance your ability to achieve your ambitious goals.
Sincerely,
John Fiorillo Linda Bilheimer
Senior Consultant Senior Research and Evaluation Officer , RWJF RWJF
8:19:03 AM
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6 Aims and 10 Simple Rules for more perfect heathcare, Institute of Medicine. The key ideas behind this entire Institute of Medicine approach includes six goals:
1. Safe, 2. Effective (evidence based), 3. Patient-centered, 4. Timely, 5. Efficient, and 6. Equitable; and ten simple rules:
1. Continuous healing relationships
2. Customization
3. Patient control
4. Shared information
5. Evidence-based decision-making
6. Safety as a system property
7. Transparency
8. Anticipation of needs
9. Continuous decrease in waste
10. Cooperation among clinicians
8:19:03 AM
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Patient Centered care, the relationship between measruement and care team behavior.. Bill Mahoney begins the open dialogue on Patient Centered care when he posts:
Activated patientness is not a trait but a state. The state is created by the care team (in whatever form) providing patient-centered care. The only importance of patient traits is that they (e,g, locus of control, self-esteem, soci-economic status, location in the social structure) specify the probability of x level/type of patient-centered care activity resulting in y level of activation. The biggest barrier (if the focus groups done 2 years ago tell us anything) is not the patient, but the provider. Building patient-centered care (CCM's productive interactions) is identical to building team development (it is team development.....patient as full partner in the care team). The absolutely essential foundation of patient-centered care is the creation of team cohesiveness (see team measure) and this will require that providers redefine their role, the patient's role and the nature of the patient-provider relationship. My hypothesis is that few will be willing to go there and we may easily revert to blaming it on those noncompliant patients...an animal that does not exist. [Bill Mahoney's Radio Weblog]
8:19:03 AM
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Cooperation and communication are related.
If we are to begin to cooperate/communicate with web logs we probably need some instruction in "reporting". I am thinking about getting a news paper reporter and some professor types from the university to help us learn to communicate in this style. I wonder if someone from the Weblogging community might not have some good ideas too.
8:19:01 AM
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Friday, May 17, 2002
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Patient-Centered Care and Hello History. I had some interesting interactions with clinicians earlier this week that I think gave me a little insight into a key factor in the process of change to patient-centered care. In PeaceHealth our model states that you cannot give what you do not have. This means that we must heal ourselves before we can be effective in providing healing and compassionate care to patients. In these interactions with clinicians I realized that a big part of this healing ourselves is to right past wrongs. I was asking these clinicians to go where they had not gone before (patient-centered outcomes assessment). While their openess to and understanding of measuring health status from the patient's point of view would rise to the conversational surface every once in a while the bulk of the talk was about what they saw as past refusal to supply them with the most elementary of outcomes data. As we talked it became clear to me that their healing of the past would be required if they were to go forward. The conclusion: We may have to champion the implementation of things for clinicians that are not especially germain to patient-centered care in order to heal ourselves so we can heal others. As we move forward I suspect we are going to come face to face with whatever history we have left behind us on the trail and we are--like it or not--have to clean up some of our litter to get where we want to go.
9:19:20 PM
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Just thinking. Radio may have too many features for the needed PP functionality. If communication is the key may want to think about the Yahoo (do not name). It is an email, but not sure I see anything special about web site at this point. Perhaps later I will. Still anything that can be communication via a web site can be communicated via yahoo.
Will need to have a clean setup. I am now forced to use 1024 x 698 res for all web access and the size is very hard to see. Not sure this kind of thing will be welcomed by many.
9:19:20 PM
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Learning From Pursuing Perfection: Science or only Stories?. From: Bill Mahoney [mailto:bilmah@telebyte.com]
Sent: Thursday, May 16, 2002 9:39 AM
To: Minniti, Mary; Donelson, Sarah
Cc: Stock, Ron (MD); Pierson, Marc; Scott, Jim (MD); Meyer, Summer
Subject: Re: Clinic Teams
Mary and all
I have a difficult time seeing how the team measure can be used to measure cooperation. It is certainly true that part of the role of a team member is "being cooperative" within the context of the team, the team measure does not directly assess cooperation. At best, you might be able to make some empirically unfounded extrapolations from the level of team development to assuming cooperation, but this would largely be a leap of faith.
In the context of the larger patient-centered care model I have been working with/developing there are several key variables (patient-centered cultural context, patient-centered leadership, team development, activated patient, etc.) that are closely related, but conceptually distinct. At the level of (necessary) detail that this model involves it is extremely important to make clear and maintain well-defined and empirically verified distinctions between these different constructs. Not doing so will, at best, result in confusion and, more certainly, the inability in the end to understand (from the empirical evidence) how much impact each of these key pieces has on the different outcomes.
If we think cooperation is a key concept that need to be made explicit, the concept needs to be defined and how the concept fits in the larger model needs to be explicitly stated (hypothesized). What I suspect at this point is that cooperation is a notion that is really just an independent variable that we think might impact one or more of the key components. For example, if the key players on the leadership team do not cooperate, the leadership team will not be a team. This will then lead to certain predictable (non)events. Right now, however, I just do not see this boring, but necessary conceptualization and so I am at somewhat of a loss as to the importance of whatever cooperation is.
For whatever it is worth (and at the risk of unintentionally offending by not saying it very well) let me tell you all my biases. In the end our part of P2 will be judged by our ability to understand and demonstrate what happened with hard scientific evidence. To a significant degree, 2 years from now there will be the need to call upon the research findings component of this project. Those research findings cannot magically appear. They will only come from irritatingly careful conceptualization, design and measurement that is put in place as soon after July 1 as possible. I know that this is my typical position that all of you have heard too many times. But we have the opportunity here to, in the end, be the stellar project of all of the P2 sites and I want us do everything we need to do to make that a reality. PeaceHealth is unique in that because of the wonderful people mix we have at all levels of the organization we are way out front of the rest of health care in many ways, including the whole conceptualization and understanding of patient-centerness. So you may have to rein Sarah and I in, but I think I speak for Sarah when I say that we will be bulldogs on having this project include rigorous standards of scientific research design and execution.
None of this is to say that this is not everyone's intention, but quite honestly, the research component seems to me at this point to be a little ambiguous. And this kind of ambiguity makes a researcher very, very nervous.
Bill
9:19:11 PM
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Radio for P2 Category added. Read Marc's post and have added this category to my weblog. Still not sure how this is visible, perhaps in the news listing.
9:19:03 PM
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Regarding Bill & Marc's discussion on Radio as 'the tool' for Pursuing Perfection. I certainly believe side by side comparison of a other products is in order. I can see how the configuration of Radio could be passed around to other participants, but a product is still needed. I am beginning to appreciate the array of functionality that Radio offers, however and find it hard to imagine another product having all of the pieces.
That said, we may want to continue experimenting with this, while we use other means for our current live project and communications.
I've just checked the 'categories' Cooperation & Communication in Health Care and Information Flow in Health Care not sure what the effect will be, but suspect that will allow us to collect communications 'somewhere' that have these things associated with them.
9:19:03 PM
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Testing post of others' news. So now I am seeing whether or not I can duplicate your action Marc. Thanks for describing the new functionality as you find it. Although I have not used a lot of web forums in the past, I can see the value of this to link folks together and share information.
So, one could use the titles of the categories below to capture and group content related items.
Adding hyperlinks in the post's title.
There is a little work to be done in Radio Prefs if you want your posts to have hyper links to URLs in the Title. One might expect just selecting to add Title and Link to your posts would take care of this but it doesn't. Read the following http://radio.userland.com/titleLinkRadioRss. It it the ITEM PAGE template to which you will be adding <%itemTitle%> . Good luck. It makes a big difference to your readers.
This whole notion of mine may be incorrect. My site requried this. Lori Nichols site requires this; however Bill Mahoney's site worked as I suggest it should with out this intervention by the owner. Perhaps the Radio Code was enhanced since Lori and I installed it last week. Let's just see how it works as we add people. If the links don't appear on your news feeds then you will need to take the above referenced steps. Good luck. [Marc's Pursuing Perfection Weblog]
9:19:03 PM
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Trial title link to HInet website. Here's my trial of title and link functionality. I hadn't been putting a title on my postings. I will consider myself reformed.
I did successfully put a link in my Outline update earlier today as well as nav links to Marc's & Bill's sites. Let me know as others in our healthcare community connect and I'll add them as well.
I am getting more comfortable with the application. Kind of a friendly way to get me comfortable with html/xml.
9:19:02 PM
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G'day,
I updated my Outline today with link to internal draft Pursuing Perfection project document management template. Marc, Bill, let me know if you can open and see it. It isn't ready for primetime, but Outline talks about desired functionality. Let me know what else you think should be on there.
9:19:02 PM
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Matching categories added. Have SMTP server info for both Marc and Lori.
9:19:02 PM
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Used the outliner tool for some meeting preparation around the grant communications issues. Pretty slick, it even put the little list I created in my calendar into the outline format.
However I had some extra lines in my original text. The outliner seems a little funky, how do you delete a line that you don't need? Backspace?
9:19:02 PM
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Thursday, May 16, 2002
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Wednesday, May 15, 2002
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Acute Care Hospital, measures related to quality.
Common Measures
1. Adverse Drug Events (ADEs) per 1000 doses (Safety)
2. Mortality rates (Effectiveness)
3. Readmissions (Effectiveness)
4. Time to treatment on presentation (Timeliness)
5. Functional status, Quality of Life (Patient centered)
6. Average cost per case (Efficiency)
7. Average length of stay (Efficiency)
8. Hours of diversion per month (Efficiency)
9. Patient satisfaction (Patient centered)
8:19:05 PM
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Access to Care, Measurements of. Common Measures
1. 3rd next available appointment (effectiveness)
2. Total time for a visit (efficiency)
3. # of patients on a wait list to be assigned a primary care physician (effectiveness)
4. Percent of patients “highly satisfied” with appointment scheduling (patient centered)
5. Percent “no show” (efficiency)
8:19:04 PM
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6 Aims and 10 Simple Rules for more perfect heathcare, Institute of Medicine. The key ideas behind this entire Institute of Medicine approach includes six goals:
1. Safe, 2. Effective (evidence based), 3. Patient-centered, 4. Timely, 5. Efficient, and 6. Equitable; and ten simple rules:
1. Continuous healing relationships
2. Customization
3. Patient control
4. Shared information
5. Evidence-based decision-making
6. Safety as a system property
7. Transparency
8. Anticipation of needs
9. Continuous decrease in waste
10. Cooperation among clinicians
7:46:04 PM
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Cooperation and communication are related.
If we are to begin to cooperate/communicate with web logs we probably need some instruction in "reporting". I am thinking about getting a news paper reporter and some professor types from the university to help us learn to communicate in this style. I wonder if someone from the Weblogging community might not have some good ideas too.
7:46:03 PM
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Tuesday, May 14, 2002
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Complex Adaptive Systems, a definition.
Health care is a complex apaptive system. The outcome of CASs is shaped by the simple rules that the agents follow. The simple rules are the most important feature of any complex system.
Here is a nice definition of CAS.
9:19:02 PM
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Sunday, May 12, 2002
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Instant messaging for P2. Great potential..
My first AIM exchange with Jack Mancilla.
The fact that the conversation is documented and shareable is important for Communities of Learning. One just publishes it on a weblog or elsewhere if it proves to be productive and of use to others. This post is an example. It may not fit the stated criteria.
We need to research the network security issues around using instant messaging tools. WWPP (world wide pursuing perfection group) needs to get the IT leaders together to decide upon collaborative communication stragegies and goals for the community.
8:19:04 PM
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Cooperation and communication are related.
If we are to begin to cooperate/communicate with web logs we probably need some instruction in "reporting". I am thinking about getting a news paper reporter and some professor types from the university to help us learn to communicate in this style. I wonder if someone from the Weblogging community might not have some good ideas too.
11:19:01 AM
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I wonder if Userland could manage a "shared care plan". The key idea is that several (3-7) people need to be informed and in communication about a specific "data set".
I believe that Nicholas Riley had done this previously with Frontier Manilla or Radio.
11:19:01 AM
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Saturday, May 11, 2002
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The key ideas behind this entire Institute of Medicine approach includes six goals:
1. Safe, 2. Effective (evidence based), 3. Patient-centered, 4. Timely, 5. Efficient, and 6. Equitable; and ten simple rules:
1. Continuous healing relationships
2. Customization
3. Patient control
4. Shared information
5. Evidence-based decision-making
6. Safety as a system property
7. Transparency
8. Anticipation of needs
9. Continuous decrease in waste
10. Cooperation among clinicians
4:08:03 PM
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Bill Mahoney begins the open dialogue on Patient Centered care when he posts:
Activated patientness is not a trait but a state. The state is created by the care team (in whatever form) providing patient-centered care. The only importance of patient traits is that they (e,g, locus of control, self-esteem, soci-economic status, location in the social structure) specify the probability of x level/type of patient-centered care activity resulting in y level of activation. The biggest barrier (if the focus groups done 2 years ago tell us anything) is not the patient, but the provider. Building patient-centered care (CCM's productive interactions) is identical to building team development (it is team development.....patient as full partner in the care team). The absolutely essential foundation of patient-centered care is the creation of team cohesiveness (see team measure) and this will require that providers redefine their role, the patient's role and the nature of the patient-provider relationship. My hypothesis is that few will be willing to go there and we may easily revert to blaming it on those noncompliant patients...an animal that does not exist. [Bill Mahoney's Radio Weblog]
11:11:22 AM
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Sunday, May 05, 2002
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Too often the culture and organizational inertia brings innovation to a halt before it can germinate.
3:45:41 PM
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Saturday, May 04, 2002
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Please read this.
11:45:23 PM
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Friday, May 03, 2002
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Cooperation and communication are related.
If we are to begin to cooperate/communicate with web logs we probably need some instruction in "reporting". I am thinking about getting a news paper reporter and some professor types from the university to help us learn to communicate in this style. I wonder if someone from the Weblogging community might not have some good ideas too.
9:14:49 AM
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© Copyright 2002 Marcus Pierson, MD.
Last update: 5/25/2002; 9:11:30 PM.
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