A Word on Service from the Medical Directors |
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In keeping with the service theme of this edition, we asked the
Permanente executive medical directors for their perspectives
on the importance of service.
Dr.
Ronald Copeland
Ohio Permanente Medical Group
Fundamentally, I believe, employees treat patients in the same
manner as they themselves are treated by Management. If high integrity,
fairness, and trust are valued and effectively modeled by leadership,
then there is a great opportunity to create a compelling work
environment that promotes and sustains high levels of service.
When we consistently demonstrate to our people that they are highly
valued, it is amazing how much they make our patients feel valued.
Although we clearly have to deal with the marketplace realities
as they pertain to our cost structure and level of service, the
manner in which we frame and execute our options for cost-structure
reduction dramatically informs our workforce about their true
value in the service improvement equation.
When we "institutionalize" our Programwide service
agenda to the same degree as we have done for quality and cost-effectiveness,
then I have no doubts about our capacity and ability to achieve
and maintain market-leading service performance.
Dr.
Oliver Goldsmith
Southern California Permanente Medical Group
I have seen PMG physicians recognize their need for service achievements
and their willingness to be graded. Our MAPPS survey with financial
incentives is an example. I believe our systems (phone, appointment)
and our large and sometimes disengaged ancillary staff can contribute
to the problem. Despite challenges, about 80% of our Region's
members feel that they have a primary physician. Our challenge
is to keep patient and physician close.
Dr.
Donald McGuirk
Kansas City Medical Group
I, as a PMG physician, have always been very proud of the quality
medicine that all the Permanente Medical Groups provide their
patients. Indeed, survey after survey demonstrates the ability
of our group model to coordinate care and accomplish high scores
in recognized measures of quality such as HEDIS. Most recently,
all Kaiser Permanente regions attained full NCQA accreditation,
a marvelous accomplishment.
What we, as PMG physicians, must address in the "real world"
reality of current medical practice is the definition our patients
and their employers give to quality. In most cases, this definition
does not include HEDIS scores or NCQA accreditation. Instead,
their definition equates to service. Quality is quality service.
As separate medical groups and as an organization, we must address
our shortfalls in this area. As opposed to the above measures,
service measures such as the STAR Survey show us significantly
behind our market competitors in this critical area. I challenge
my own Medical Group, as well as all PMGs to sincerely focus on
service and to appreciate the competitive edge this emphasis can
give us as we enter the 21st century.
Dr.
Robert Pearl
Northern California Permanente Medical Group
For the past 50 years, we used our integration as a Program to
keep our costs and rates below that of our competitors. However,
during that time, service was a competitive disadvantage for Kaiser
Permanente. Today, with our competition no longer fee-for-service,
the dynamics of the health care marketplace have changed dramatically.
The for-profit competition's primary goal is to generate equity
for its shareholders, and it achieves this by restricting care
through use of gatekeepers, clerks, and formularies. As a consequence,
the level of service and quality provided in the world around
us has deteriorated markedly. This now creates a potential strategic
opportunity for us to make service our competitive advantage.
For us to succeed, we must face the challenge of overcoming a
50-year culture of poor service. Addressing our service issues
will require strong partnership with Kaiser Foundation Hospitals
and Health Plan and with our labor unions. We must also differentiate
ourselves from the rest of the for-profit managed care world in
the eyes of both the media and government agencies. Ultimately,
our success will depend on whether members perceive that we deliver
better service, access, and quality; and whether purchasers are
willing to fund added health care costs. As an organization, we
will have to become more comfortable with increased autonomy,
authority, and accountability at the local medical center, department,
and functional unit levels. Moreover, we will have to learn to
innovate locally and learn both regionally and nationally while
understanding the variability in patient populations, facilities,
and people across the different parts of our Program. Our greatest
challenge will not be merely achieving this shift, but doing it
in a time frame of months and years instead of decades.
Dr.
Bruce Perry
The Southeast Permanente Medical Group
In Atlanta, TSPMG has maintained a sustained intense commitment
to improving our quality of service. Through this substantial
commitment, we have learned three important lessons.
First, service can be improved. In recent review of STAR Survey
results for 1991-1998, the Georgia Region had a 12% increase in
overall satisfaction; a 32% increase in satisfaction with phone
wait; a 15% increase in Care Index; and a 15% increase in seeing
their personal care practitioner. Multiple activities have led
to this increase: we have redesigned Primary Care into teams;
we have intense communication concerning service goals and our
progress for those goals; we hold managers accountable for reaching
those targets; and there are significant monetary incentives and
non-monetary awards for high-performing teams.
Second, a key success factor is accountability for service. Senior
managers are held accountable by the Board for service levels.
Senior managers in TSPMG hold Service Chiefs and Managing Physicians
of facilities accountable, and individual physicians are held
accountable for individual service levels. Patient satisfaction
with individual practitioners accounts heavily in both the appraisal
process and the annual service incentives. Through these mechanisms,
accountability for service is spread throughout the organization.
Third, service must be treated as a business survival issue.
Service can be distinguishing in the marketplace. In Georgia,
state employees are our largest group.
Through our intense work on service, we maintained a 10% advantage
over our nearest competitor and 20 points over the rest of our
competitors. We have found service to be a key distinguisher in
member retention, and we will continue the focus because member
retention is a business imperative.
The highest level of service can be provided even within budgetary
constraints. It is not a mantra; it is not a "can do or could
do." It must be a "given" because of the business
imperative that TSPMG faces.
Dr.
Allan Weiland,
Northwest Permanente Medical Group
As we continue to focus on how we create value and achieve the
"KP Promise," it becomes more apparent that our Achilles'
heel is service. In most markets, we trail major competitors on
most service dimensions. Not only is there a compelling business
case to improve service and member retention, but we all want
to belong to an organization that is recognized for excellence
in quality and service. It is a matter of pride!
Most of the regions are looking to improve the care experience,
and the program has recently started a Care Experience Council
to bring the same focus to service as we do to quality and finance.
At KP Northwest, we are changing our appointment scheduling practices
in primary care to increase the number of times members will see
their paneled practitioner. We have brought together a number
of local module teams and trained them in rapid-cycle change methodology
to test small interventions in service improvement and to learn
from them.
Despite a number of efforts, ingrained attitudes and systems
make us customer unfriendly. Many of our office buildings are
large and impersonal; our appointing systems are inflexible; our
staff are too busy to fix a service problem. It will take considerable
work to move toward a truly member-friendly organization. I think
it will be worth the work.
