2003 Vohs and Lawrence Awards
& A Focus on New Products:
••Spring 2004/Vol. 8, No. 2

Editorial Comments

Arthur L Klatsky, MD Associate Editor Clinical Contributions

The James A Vohs Award for Quality--The Permanente Journal Sixth Annual Special Issue | to pdf >>

Considering the difficulties and inevitable discomfort associated with change, we who practice Permanente Medicine can feel proud of our acceptance of perpetual evolution in our medical practice. Many organizations have foundered for failure to deal with this need. We are fortunate that emphasis upon continual improvements has always been a primary concern of the leaders of the Kaiser Permanente (KP) Medical Care Program. Adaptation to new knowledge and technologies improves the quality of our patients' care and ensures our survival in the competitive health care marketplace. Perhaps our flexibility is partially a result of the fact that our system was started by pioneers who made a huge revolutionary change in the established medical system. In any case, our acknowledged long-term success is a tribute to the adoption of the philosophy that we need to constantly evaluate and improve what we do.

James A Vohs was a creative champion of innovation and improvement in Permanente Medicine. Upon his retirement from 17 years as President, CEO, and Chairman of the Boards of Kaiser Foundation Health Plan, Inc, and of Kaiser Foundation Hospitals, Inc, the James A Vohs Award for Quality was established. The intent was to recognize and honor projects that advance the quality of care, showcase innovative techniques, produce transferable knowledge, and underscore the value of multidisciplinary teamwork. Annually, each KP Division is invited to nominate one or two projects, either new ones or major improvements in existing ones. The award is presented for the project best representing an established effort to improve quality through objectively documented and institutionalized changes in direct patient care. The selection criteria include demonstration of measurable improvement in care and potential for transfer to other locations as a "successful practice." Thus, the benefits ultimately extend to large numbers of KP members nationally and to the general community and the entire health care industry.

We present in this issue the 2004 Vohs Award winner from the KP Colorado Region entitled "Mammography Interpretation Improvement Initiative." Started in 1996 by the radiology leadership team composed of Kaiser Foundation Health Plan and Permanente Medical Group personnel, the objective was to minimize variability and inaccurate interpretation of mammograms. Reasons for variation in interpretation, the potential for improvement, and innovations to affect improvement were thoroughly and systematically assessed. The five-year results are impressive, including substantial improvements in sensitivity of diagnosis to levels not achieved elsewhere and increased detection of Stage 0 or Stage 1 lesions. The American Cancer Society statement in the June 28, 2002 New York Times sums it up: "Every mammography program in the country should be doing something like this."

Publication of the Vohs winners perfectly fits the stated mission of The Permanente Journal "to promote the delivery of superior health care through the principles and benefits of Permanente Medicine." This year's winner represents a triumph of Permanente Medicine. We have now published 16 Vohs projects over a six-year period, representing many Kaiser Permanente Regions and most major medical specialties. The topics preponderantly involve: 1) preventive practices (pediatric practice, immunizations, breast cancer), 2) management of chronic illness (asthma, diabetes, heart disease, cancer, COPD, sickle cell disease), 3) computerization of medical data and 4) drug utilization. A number have already rapidly spread to use by other regions.

We remind the reader that, while the process for nomination has some local variation, each KP Division has contact liaisons easily located through its regional quality representative. Nominations need approval by that KP Division's President and Medical Director, and applications are due September 1st each year. There is no monetary gift with the James A Vohs Quality Improvement Award, but there is much recognition. The winning KP Division receives an engraved award, and project team members receive awards. Winners and runners-up are invited to present their projects at a reception hosted by the KP National Boards of Directors, Division Presidents, and other Program Officers. The awardees also receive publicity through the Quality Notes newsletter and through local, state, and national press releases. Of course, the "real" award is the knowledge of having done good work which made a real difference in people's lives.

A Vohs Award Selection Committee includes KP National Board of Directors members, a Vohs family member, Chairman Bob Crane, Program Office quality representatives, a Permanente Federation representative, and two nonvoting Program Office quality representatives. This Committee announces its selection at the December Board of Directors meeting and team members are contacted by phone within the next day or two. The recognition ceremony takes place at the March Board of Directors meeting.

The possibilities for projects are limited only by the imaginations of our health professionals. Undoubtedly, many qualifying programs have not been submitted. Part of our purpose in publishing these projects is the hope that they will serve as models to motivate others to present projects for consideration. The process is an opportunity to share with 11,000 KP physicians and the general health care community your ideas about improving care of illness and providing health information.

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