DailyKaizen

Hi everyone, I’m still around, admiring the great work of Lee and colleagues at Group Health, and also applying my knowledge at a different level, working with the California Healthcare Foundation, based in Oakland, California. What I’m experiencing in this work is a very different view of health and health care - a societal one, as opposed to one that is based at the level of a health plan / delivery system.

The specific medical issue we’re looking at is the control of blood pressure, which has been really interesting to look at from a societal perspective. Why? Because the health system sees a slice of the impact - expenditures on drugs, office visits, and eventually the devastating outcomes of cardiovascular disease. It does not see the other impacts, on patients’ time, their costs, or the time and costs of their employers and families, which frames how a society might look at managing this condition (which right now is done poorly, with only 35 % of Americans with adequate control, and a third unaware that they are at risk).

This is very tied into LEAN for me, because it’s taught me to look at every problem as one impacting society, whether I am seeing it in an exam room or a board room. I am also using everything I’ve learned to date to help make an impact with this organization and its partners. This includes visibility - I asked if it would be okay for me to publish the plan “in the making” on the public Internet, and the answer was “yes.” I have never done that before.

With that in mind, feel free, if you’re curious, to take a look on my other blog and offer myself, and Californians, some advice on improving a plan that will make a difference for patients managing chronic conditions.

Also feel free to answer this question - why doesn’t every health care organization post its A3’s in progress for community comment? Should patients and their families be part of the nemawashi process? Should we create a forum where that happens?

(I’ve been spending a lot of time studying patient and family involvement in the care system, also thanks to LEAN..)

Finally, something to energize us about all that we have left to do:

A guest in my home who is from Germany told me today, “Ted, I saw that book (“Overtreated,” by Shannon Brownlee) on your table, and it brought a smile to my face that you were reading it. Why is health care here all about money? When I compare health care to Europe to health care in America, it’s like first class compared to tenth class.” I told her I was doing my best along with others to make a difference, but I felt as disappointed as I ever have at what we’re accomplishing with the $2 trillion we spend each year.

The title of my post is a corollary to Lee’s previous post, which I loved, because besides talking about the issue of going to see things, it also alludes to the idea that LEAN creates leaders who are able to reflect on to themselves what they reflect onto others.

My little add is to always go see as part of what I do. Now that I’ve been working this way for 3 years now (and I can’t believe that it’s been 3 years), I realize that I am more and more uncomfortable hearing about anything in the absence of seeing.

This has really hit home in the last two weeks, actually, as I wind down some of my sabbatical work, and schedules have gotten a little tighter. I found myself about 3 weeks ago having a conversation with a great group of physicians about their launch of a patient portal….in the conference room of their headquarters. It just wasn’t the same for me, and at some level I felt I was being disrespectful by offering any advice at all in the absence of seeing the care that these physicians provide.

Last week, I spent time in California, and I was able to get close to the work, but I didn’t actually shadow the patient process of care, and that still felt a little uncomfortable. Same feeling - what do I have to offer someone who experiences a set of facts that I did not see? At the same time, I saw more than I did in the experience above, and it was very important and meaningful, judging by the fact that my blog posts on them were much richer with information.

Fortunately, no communication is ever over in life, and I asked for the chance to go back and shadow the first set of providers. They said sure, and I really want to do this.

If there is anything from this experience that I could impart, it would be that your approach to where you do your work will change with LEAN. You will feel more natural being close to the patient, and more unnatural being farther from the patient. What used to seem like the easiest, most comfortable thing, going to the same conference room watching Powerpoint slides, connected to your iPhoneBerry, will begin to seem like the hardest, least comfortable thing. And you’ll love what you do more than you ever have.