Each Permanente Medical Group grew locally through the
personal character of the physicians and providers of that region. However,
their medical practice philosophy of a health maintenance organization
unified them nationally. Each day, in the hospitals and clinics, they
worked out what we recognize as "Permanente practice." On
some of those days they mused about a greater connection with those
across the country. It was a yearning to share their experience, to
learn from others, to improve the care they delivered to the people
they served. This "Voice of Permanente" can be heard in the
comments of physicians and providers applying for the Review Board of
a new national journal, and in the physician focus groups across the
country. The editorial team sought their advice about a new venture
in a time of unprecedented change. In this foreword I would like you
to hear your Permanente voice as I describe the evolution, the purpose,
the value, and the aspirations of your Permanente Journal.
The Permanente Journal has grown into a national publication
from roots in newsletters produced by many clinicians. Three years ago
in the Northwest we consolidated several newsletters, including Permanente
Practice, into the NWP Journal of Clinical Practice.
Our clinician readers found more than their favorite newsletter within
the Journal. As they read across the pages into different disciplines,
they found value in other people's ideas, experiences and practices.
We took this learning to the Regional Medical Directors in the form
of a proposal for a national journal. If sharing "Permanente practice"
was valuable regionally, then this conversational process interregionally
could create superior value to enhance learning, accelerate progress,
and reduce practice variation. "I am delighted the PMGs are
putting together a journal to allow us to share our ideas." "Permanente
talent will create a readership beyond our walls."
The process of selecting Review Board editors revealed to me, in the
impassioned words people wrote, the enormous value of Permanente physicians
and providers. "Permanente is a group with tremendous resourcefulness,
creativity, and care-full-ness in meeting the challenges ahead, but
we need to share amongst ourselves much more effectively and efficiently."
"Permanente has unique practices, skills, and knowledge to share."
The daunting task of narrowing the field of reviewers became inspirational
for me as I recognized how so many people felt so strongly about the
need for a national journal. "A multidisciplinary journal is
exciting and creative, and a unique experience." "I am keenly
interested in the success of this journal." "This journal
can showcase our best work and practices, strengthen the connection
among groups, and influence the direction and nature of change in the
practice and business of healthcare." Along with these thoughts
came a resolve to make it work. "I am extremely interested in
the quality of medicine and dedicated to Kaiser Permanente." "I
have a long-term commitment to the highest individual, department, and
group standards for Kaiser Permanente." "Practicing clinical
physicians have a responsibility to contribute." "I want to
make a real contribution."
These and other like statements are directly aligned with achieving
Kaiser Permanente Program goals of improved quality and service and
reduced cost. Foremost was the recognition and importance of the patients
we serve. "The Journal must promote and support the goal of
bringing increased value to our members and communities." "I
have an interest in influencing healthy choices for patients."
"I have a strong interest in patient satisfaction and well-being."
To achieve this end, a journal, its contributors, and its content has
to meet certain high standards. "Encourage critical thinking
in day-to-day clinical practice, and encourage the description of clinical
experience in a managed care setting." "KP has an obligation
to promote research into clinical practices and set the standards and
communicate through an organ such as the Journal." "The Journal
can promote our organization's place in research excellence." Several
people spoke of its direct value for clinicians. "To encourage
and promote scholarship in Kaiser Permanente." "Remain on
top of advances 'on the horizon'." "Keeping current is vital
to improve quality and service to improve patient outcomes."
To quote Senge's Fifth Discipline Fieldbook, "Buckminster Fuller
used to say if you want to teach people a new way of thinking, give
them a tool, the use of which will lead to new ways of thinking."
The Permanente Journal is that tool. In the focus groups, physicians
spoke about what this Journal could and should be like. "We
don't want another New England Journal of Medicine, and we don't
want a 'throwaway' journal. We want something 'midway'." As
they struggled to give that concept definition, they continually used
the words "practical," "usable," "readable,"
and "concise." They wanted something different yet were troubled
with the idea of a journal "in the middle"that it might be
insubstantial. To me, a middle ground of significant substance and consequence
is a journal that is "practice-based," "evidence-based,"
"experience-focused," and "innovation-driven." That
is Permanente practice. "A description of clinical experience
in a managed care setting."
As much as clinicians need and seek information they can use today in
their practice, they desperately want a forum and a vehicle to connect
them with each other. And through a journal, people can converse. Associated
with their yearning for a national connectedness and community is a
realization that "Permanente practice" is a larger concept
that meaningfully describes the future of managed health care. "Kaiser
Permanente is developing systems of health care for the future."
From a seemingly peripheral group in traditional, mainstream medicine,
Permanente has become a centerpiece, an experienced core, and now a
large national group with a growing voice of great inherent strength
and presence.
One physician prompted another perspective. "I want to serve
because of my interest in the well-being of Kaiser Permanente."
This suggests an organization as a living entity, a viable organism.
It is this biological "systems thinking" viewa holistic perspective
that is necessary to explore and grow the interrelatedness and interdependency
of the parts of Kaiser Permanente. Our relationships, as partners with
our patients, as partners with Health Plan, and as interregional Permanente
physicians and providers, will create for us "a whole" that
is one of our sustainable competitive advantages.
The organizational image we create matters for ourselves, for our members,
and for our competitors in the marketplace. The Permanente Journal
has the power to unify and bring to a larger level what people feel
in their local regions. Communicating with a national voice, now essential,
is possible. Members of the Advisory Board, Review Board, and Editorial
Team have a responsibility to carry forward the energy, enthusiasm,
commitment, dedication, long-standing effort and work, aspirations,
and dreams of all physicians, providers, and Health Plan experts so
invested in Kaiser Permanente.
Clinical Contributions
Clinical articles on the practice of medicine within The Permanente
Medical Groups and their affiliates. Article topics may include reviews
of successful practices, programs and policies, and analyses of new
techniques.
Phillip
M. Brenes, MD, Editor
As Executive Editor for the former Northwest Permanente Journal
of Clinical Practice, the model for this publication, it has
been my pleasure to participate in the design and formulation of this
Journal and to act as the Associate Editor for this, the Clinical
Contributions Section for the inaugural issue. Starting with the next
issue, however, Dr. Arthur Klatsky from The Permanente Medical Group
(Northern California) will take over as the Associate Editor for this
section.
The Clinical Contributions Section of this Journal will feature
articles that apply directly to the actual clinical practice of medicine
in Kaiser Permanente. Articles in this section may include reviews,
applications of new technologies to clinical practice, clinical observations
and anecdotes, case presentations, experiences with successful practices,
and other discussions relating to seeing and caring for patients. Because
our collective clinical experience, interests, and expertise are immense,
we want to provide a variety of clinical articles that will give you
the opportunity to examine, evaluate, compare, explore, review, and/or
ponder.
Given the enthusiastic response from so many of our clinicians wanting
to contribute and participate in this enterprise, there should be great
opportunity for all of us to share and learn from each other.
Original Research
This section features Kaiser Permanente's research contributions
through original, empirically based research in areas of great clinical
importance. This includes outcomes research, studies that use Kaiser
Permanente databases, and rigorous evaluations of best practices and
innovations in clinical care.
Mary
Durham, PhD, Editor
There has been a great deal of discussion about whether to have an original
research section for The Permanente Journal. Some people have
told us that good research will always go to one of the major research
journals. I have been a voice for having a Research Section because
I believe The Permanente Journal is a place where clinicians
and researchers can publish important articles which inform us about
clinical practice within Kaiser Permanente. It is certainly true that
such articles will also be published elsewhere. However, I hope the
Research Section inspires clinicians to analyze their practices in a
rigorous fashion and to share their findings with their colleagues.
I hope you'll send us articles for consideration and that you'll let
us know about the important research you are doingregardless of where
it is eventually published
Health Systems
Management
This section features articles from a "systems" perspective,
recognizing that medicine is practiced in the larger context of health
care, involving ambulatory care delivery, hospital strategy, program
expansion, and network development; and supported by information technology
and the Internet. Growth in this system occurs through the leadership,
education, and development of clinicians.
Lee
Jacobs, MD, Editor
In the spirit of this inaugural issue of The Permanente
Journal, I am very pleased to introduce this section of the Journal
titled, Health Systems Management.
It was clear to me in reviewing the early work of the founders of this
publication that they had a very good understanding of the value of
the Permanente community. They understood that Kaiser Permanente's real
competitive advantage, the Program's major asset, if you will, is the
quality of the Permanente clinical care supported by a unique physician-led
practice environment. The Health Systems Management Section will focus
on the latter, our practice environment in which physician leadership
plays the crucial role.
Specific areas of focus of this section will include leadership development,
educational programs, ambulatory care delivery, Program expansion, network
development, and information technology. While our challenges in these
areas may be similar, our approaches and experiences may be quite different.
The transferring of this knowledge is our objective. In essence, this
section will provide an opportunity for the Permanente community to
have a literary dialogue, so important if we are to learn and grow as
Medical Groups.
At times, while reading this section, you will be somewhat consoled
in learning that we are all encountering the same barriers as we refine
our practices. You will also be excited about the learnings that you
can derive as other Permanente groups share their experiences. Most
of all, I believe that you will read with pride the steps that Permanente
groups are taking to meet the everyday challenges that they encounter.
Quality Permanente people sharing amazing innovations, that is what
the Health Systems Management section will be all about.
External Affairs
This section features nonclinical articles on external issues
related to the practice and perception of Permanente medicine. These
may include articles by customers and consumer groups, as well as internally
generated articles on health policy, the media, the marketplace, and
our social mission.
Scott
Rasgon, MD, Editor
It is with great pleasure that I introduce the External Affairs Section
of The Permanente Journal. The articles in this section range
from an article by David Pratt of General Electric Power Systems, "The
Health Care Dynamic from a Physician-Purchaser Perspective,"
to an article by Jim Gersbach of Kaiser Permanente Northwest Division,
"Media Training for Physicians."
I invite everyone inside and outside the Medical Groups with a perspective
on how our health care program is viewed from the outside or how we
from the inside mirror this perspective to contribute to the External
Affairs Section. Our health care program viewed from the outside and
how we shape this view are what this section is about.
Abstracts
This section features abstracts from articles published in other
journals, preferentially featuring the works of Permanente physicians,
and abstracts of books written by Permanente physicians. Some abstracts
may be coupled with a critical commentary.
Mary
Durham, PhD, Editor
Kaiser Permanente is fortunate to have hundreds of gifted researchers
who routinely contribute to the medical literature. We plan to reprint
abstracts which represent a broad range of topics, from a variety of
geographic locations, by a diverse group of authors. It is clear from
just our first edition that we will have to make some tough choices
in order to cut across a wide range of interests and expertise.
We are now in the process of creating a method to identify published
research through electronic and other means. Please send us articles
that have been published so that the abstract can be considered for
republication. Abstracts of books written by Permanente physicians which
are related to health care will also be printed. Authors are urged to
alert us to publication of their work.
A Moment in Time
A look back at milestones in the history of the Permanente Medical
Groups.
Ek
Ursin, MD, Emeritus Editor
The mandate of our column A Moment in Time, is to look back at milestones
of the Permanente Medical Groups. Later in this issue the inaugural
article by Dr. Greenlick gives us an overview of how we, the erstwhile
pariah of health providers, became the envied and most copied model
of American health care. The paper ends with a propitious outlook on
the future, if we remain true to our social mission and accept the present-day
challenges with an "if not us, then who?" attitude.
What we will print in the future will to a significant extent depend
on you, your critique, and occasionally your praise. If you'd like to
contribute, send us an outline (preferably on disk) of a story that
will tie our past to Kaiser Permanente's present and future.
