CONTACTS 
0201 - Kaiser Permanente - Shadelands       925 906 2200
020101 - Walnut Creek, CA
020102 - Mr. Mark Mangrai; 925 906 2209
020103 - mark.Mangrai@tao.ncal.kp.org
020104 - Patient Assistance

SUBJECTS
Patient Assistant
Questions, Suggestions
Medical History, Xrays Not Submitted for Meeting
Medical Chart Missing Information
Policy Procedures on Communication
Team Care, Primary Care Physician
Patient Assistance Delays Action 2 Weeks
Prepared for Work
Information Entropy Rework Cost Saved by Comm Metrics
Prepare for Meetings Notes Linked to Common History
Remembering Avoid Mistakes, Rework
Mistakes Due to Haste, Avoid
Be Prepared SDS Provides 80% of Preparation Automatically
Problem Handling Expediting Bumbling Comedy of Errors,

2616 -    ..
2617 - Summary/Objective
2618 -
261801 - Follow up ref SDS 87 0000, ref SDS 86 0000.
261802 -
261803 - Received ref DRT 1 0001 from Mark responding to ref DIP 20 0001,
261804 - submitted on 991016 that confirms my earlier letter, ref DIP 19 0001,
261805 - on 991008, requesting a meeting with the supervisor of doctors or for
261806 - the Park Shadelands facility, to review three issues. ref SDS 84 9055
261807 -
261808 - Mark reports that Dr. Ross Armstrong, Chief of Internal Medicine, has
261809 - advised that Dr. Tim Corfman will investigate questions set out in the
261810 - letter, ref DIP 19 0001, submitted on 991008, ref SDS 84 5727, and
261811 - that either Dr. Corfman or Dr. Jonathan Shun, who is Dr. Naqvi's team
261812 - leader will respond. ref DRT 1 0001
261813 -
261814 - It is quite a coincidence that another "Ross Armstrong," who is an
261815 - exec with IBM, reported on 980808 that information overload is solved
261816 - by hard work to expedite "problem handling." ref SDS 30 3379
261817 -     ..
261818 -     Submitted ref DIT 1 0001 asking if Doctor Armstrong and
261819 -     others have reviewed the record?
261820 -
261821 -     Linked to letter on medical mistakes, ref DIP 2 0001, in the
261822 -     record on 990924. ref SDS 76 0001
261823 -
261824 -      [On 991024 Mark plans to submit the record after a doctor has
261825 -      been identified for responding. ref SDS 88 0001]
261826 -
261827 -      [On 991101 Mark has not received response, plans further
261828 -      proactive action. ref SDS 89 0001]
261829 -
261830 -      [On 991109 Mark expects Tom Driscol to respond. ref SDS 90 0001]
261831 - ..
261832 - Doctor Armstrong says it is unusual for doctors at Kaiser to
261833 - communicate with their patients by email, and that Dr. Naqvi's
261834 - preferred way of communicating is the norm within the Permanente
261835 - Medical Group. ref DRT 1 1444   This aligns with Doctor Naqvi's
261836 - comment on 990802, ref SDS 56 4293, and with feedback from Doctor
261837 - Boulris on 990910. ref SDS 67 9130
261838 -
261839 - Analysis of medical mistakes shows Kaiser's practice to avoid email is
261840 - correct, because communication using email is inaccurate, and so
261841 - compounds mistakes. ref DIP 2 2028 issued on 990927. ref SDS 76 5933
261842 - Doctors can appreciate this problem from work with viruses that spread
261843 - infection throughout an organism.  Accordingly, communication through
261844 - email should clearly be avoided.
261845 -
261846 - On 991011 Doctor Boulris responded to patient questions submitted via
261847 - web mail for clarifying Kaiser's medical report. ref DRP 19 0001  This
261848 - showed web mail can be effective in delivering timely information to
261849 - expedite patient care. ref SDS 85 0001
261850 -
261851 - On 990927 patient feedback showed Doctor Naqvi is talented and
261852 - dedicated to patient care. ref DIP 17 3570  Therefore, it may be
261853 - possible to provide support for clear, concise, complete communication
261854 - in order to apply talent and dedication, by Doctor Naqvi and others,
261855 - to greater advantage, under Kaiser's doctor/patient partnership goals
261856 - and procedures, reviewed on 990625. ref SDS 42 4185
261857 -
261858 -
261859 -  ..
261860 - Information Overload Causes Mistakes, Delay, Rework
261861 -
261862 - Mark says he delayed taking action for two weeks on the patient
261863 - request in the letter of 991008. ref DIP 19 0001  No reason for delay
261864 - is given.  Mark apologizes and says he will stay on this until a
261865 - response occurs. ref DRT 1 4872
261866 -
261867 - The record on 991019 indicates Mark issued timely notice, but that
261868 - doctors have not had time to respond for several weeks to requests
261869 - Mark submitted. ref SDS 87 0001
261870 -
261871 - Since Mark has demonstrated exceptional managerial skills and
261872 - commitment to support patient administration, the unusual delay in
261873 - this case may have been caused by...
261874 -
261875 -     1.  Backlog of issues due to a large patient load at the clinic --
261876 -         solution: help and cooperation from medical staff and
261877 -         patients, maybe another assistant.
261878 -
261879 -         Mark mentions in his letter that he did not disclose taking
261880 -         delayed action during the phone call on 991019 because a very
261881 -         impatient and irate member [patient??] was in his office and
261882 -         so presumably he did not want to provide grounds for further
261883 -         complaints.
261884 -
261885 -         Emotional encounters cause people to overlook things.
261886 -
261887 -         A heavy workload causes people to hurry, and this causes delay
261888 -         due to oversight and mistakes that require rework, as reported
261889 -         in the study on the cause of medical mistakes reviewed on
261890 -         990912. ref SDS 68 0285
261891 -
261892 -         Emotions are heightened by delay and mistakes -- so improving
261893 -         the work has a compounding effect on patients and staff alike.
261894 -
261895 -     2.  Tools and processes for tracking action items are inadequate
261896 -         -- solution:  better tools and processes may help.
261897 -
261898 -     3.  Information overload causes people to forget and to commingle
261899 -         unrelated issues, cited in the letter on medical mistakes,
261900 -         ref DIP 2 0001, -- solution: Communication Metrics maintains
261901 -         alignment and visibility of pending issues.
261902 -
261903 -
261904 -
261905 -
261906 -
261907 -
261908 -
261909 -