440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700

December 10, 1999

03 00050 61 99121001

Mr. Tom Driscoll
Director of Operations
Call Center
Kaiser Foundation Health Plan, Inc.
1950 Franklin Street
Oakland, CA 94612

Subject:   Meeting on Team Care

Dear Tom,

Thanks for timely response in your voice mail today. Kaiser is investing to improve management and cut mistakes, as shown by the pilot test underway in Santa Clara. However, spending money does not ensure success. Com Metrics provides a path for adding intelligence to management, which is essential to reduce mistakes, as explained in the letter on September 24, cited recently on December 7 in my letter to you.

As you point out, your assignment with the Call Center is somewhat off the mark with respect to reducing medical mistakes, improving Team Care and lowering costs. The idea of meeting with you was to find people at Kaiser to assess this opportunity, based on your knowledge of operations, and medical history that emerged from operations and show specific problems, which we discussed on Monday. This idea arose from difficulty Patient Assistance encountered attempting a solution at the local level.

Robert Pearl's letter on October 15 sets out Kaiser's goal to improve the quality of Team Care. Adding metrics to communication is the foundation of quality for all enterprise because before physical work occurs (e.g., an operation, swallowing a pill, etc.), there is communication for diagnosis and planning, except in emergencies, as set out in the letter on September 24. For example, Covey notes that before we prescribe, we must first understand, i.e., diagnosis, which largely comes from communication. Drucker argues, as well, that analysis is a critical ingredient of management; yet most managers and medical practitioners feel they do not have time to think. This causes mistakes.

Thinking is a cognitive function. Recently Drucker recommended focusing technology on enhancing cognitive science to improve management. This idea, combined with Kaiser's policy for doctor/patient partnership through communication, provides a nexus between Kaiser's goals to improve quality, the national initiative to reduce medical mistakes, and Communication Metrics, which uses technology to support cognition that avoids meaning drift. The letter on September 24 makes the case that solving meaning drift is the only meaningful way to to reduce mistakes, since it offers a cognitive solution to a problem of cognition.

Based on this record, can you help with the following....

  1. Who is responsible for developing procedures to accomplish Kaiser's doctor/patient communication policies?

  2. Who is responsible for obtaining feedback from customers (here patients), on improving procedures to help doctors and patients become better partners?

  3. Who is responsible for developing procedures for improving the quality of Team Care called out in Pearl's letter on October 15?

This information can focus Kaiser's talents and resources toward productive use of people, leadership and technology.

Kaiser is commended for the work of Jeanne Bradley and Mark Mangrai at Park Shadelands, who have been helpful and innovative supporting patient communication to facilitate care. Failure to bring closure on pending problems reflects a systemic challenge that requires senior leadership under the President's call for the nation to rally our energy and resolve to improve health care.

Your interest and help are greatly appreciated.



Rod Welch