As may be apparent from our past commentaries, those of us at The Permanente Journal are not bashful when it comes to acknowledging the cutting-edge work of Kaiser Permanente (KP) people across the country. The response of the KP Mid-Atlantic States (KPMA) Region to the recent anthrax bioterrorist attack is no exception. You need to hear their story and share the pride we all have in their work. Although some national news media did have very favorable remarks on the quality response of KP, there is much more to their journey, and so I want to tell you the rest of the story.

After witnessing firsthand the KPMA response to the anthrax-contaminated letters while I was in the DC area, I can reassure our readers that, in the final analysis, the standard of care for response to such disasters was established by Kaiser Foundation Health Plan administrators and Permanente physicians and associate providers. I was reminded yet again that confronting major challenges does not create high-quality leadership rather it is during such situations that the quality of leadership is revealed. Such was the case recently in the Mid-Atlantic, where Kaiser Permanente's leadership was apparent to all observers.

In the early phase of the bioterrorism attack, the region leveraged national KP resources and convened a command center modeled after an earthquake center in the Northwest Region. This center focused on the need for timely and reliable information, not always readily available in first-time disasters. The room was replete with several computer stations providing access to pertinent Web sites. This permitted clinical anthrax guidelines to be revised and distributed to frontline clinicians rapidly as new information was received. CNN was continuously projected on one wall as the major source of information as various health and criminal agencies scrambled to understand both the extent of the problem and their role in responding. Briefings took place at the large conference table in the middle of the command center as key people received and provided updates in person or through conference calls with leaders of all the peripheral medical facilities. I found it interesting

how having to deal with so many unknowns in the disaster response necessitated collaboration among members of the team. Not just coordination or communication, but rather true collaboration--ie, you have some knowledge in this area, and I have some knowledge, and together, regardless of our disciplines or hierarchal job ranking, we are going to solve the problem. Dealing with the unknown--fertile ground for teamwork--is a Kaiser Permanente competency that was so well demonstrated in the anthrax attack.

Throughout the ordeal, all aspects of the care experience system in the KPMA were impacted with both the administrative and clinical people responding. While administrative people focused on the call center and appointment capacity to provide access for worried members, the frontline clinicians appropriately adjusted their clinical approach to these patients. The infectious disease specialists dealt with the diagnostic and therapeutic aspects of this rare disease along with the stressful public relations interactions while at the same time doing their regular jobs. (Just further proof that infectious disease is the cornerstone of medicine!)

To supplement their staff during the high demand period, the MAPMG further leveraged the resources of the Permanente family and brought in several physicians from other Permanente Medical Groups. To be able to rapidly deploy these physicians out to the medical offices, they fast-tracked licensure, computer encounter training, and other necessary preparation so the physicians could expeditiously be equipped to see patients. When the demands of the crisis subsided, the Medical Director, Dr Adrian Long sent personal letters of appreciation to those from other Permanente Groups who provided assistance, acknowledging in his comments that this level of support and caring is what makes a Permanente physician.

In summary, there is no doubt in my mind that, during this disaster, the members of KP could not have been in better hands. I do hope that health care organizations across the country will learn from the Mid-Atlantic's experience.

So, to the entire KP family in the Mid-Atlantic states from all of us across the program--Thank you!

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