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THE PARALLEL PROCESS OF EDUCATIONAL AND PRACTICE TRANSFORMATION

THE PARALLEL PROCESS OF EDUCATIONAL AND PRACTICE TRANSFORMATION. JIMMY H. HARA, MD, FAAFP FAMILY MEDICINE RESIDENCY DIRECTOR EMERITUS KAISER PERMANENTE LOS ANGELES PROFESSOR OF CLINICAL FAMILY MEDICINE DAVID GEFFEN SCHOOL OF MEDICINE AT UCLA AT-LARGE DIRECTOR, BOARD OF DIRECTORS

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THE PARALLEL PROCESS OF EDUCATIONAL AND PRACTICE TRANSFORMATION

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  1. THE PARALLEL PROCESS OF EDUCATIONAL AND PRACTICE TRANSFORMATION JIMMY H. HARA, MD, FAAFP FAMILY MEDICINE RESIDENCY DIRECTOR EMERITUS KAISER PERMANENTE LOS ANGELES PROFESSOR OF CLINICAL FAMILY MEDICINE DAVID GEFFEN SCHOOL OF MEDICINE AT UCLA AT-LARGE DIRECTOR, BOARD OF DIRECTORS AMERICAN BOARD OF FAMILY MEDICINE

  2. THE LEGACY OF KAISERPERMANENTE, THEN…

  3. THE LEGACY OF KAISER PERMANENTE, NOW…

  4. LEADING THE TRANSFORMATION… Benjamin Chu, MD President, KFH/HP Former Assoc Dean NYU/Cornell Former Director NY Public Hospitals Member of Bell Commission

  5. EXTENDING CARE TO THE COMMUNITY… • HEAL INITIATIVE • ALL/PHASE INITIATIVE • TRAINING COMMUNITY HEALTH PROMOTERS (PROMOTORAS) • SPECIALTY CARE INITIATIVE • OPERATION SPLASH

  6. THE FOURTH AIM… • IMPROVE THE HEALTH OF THE POPULATION • REDUCE, OR AT LEAST CONTROL, THE PER CAPITA COST OF CARE (BY AVOIDING UNNECESSARY TESTS AND TREATMENT) • ENHANCE THE PATIENT EXPERIENCE OF CARE (INCLUDING ACCESS, QUALITY, AND RELIABILITY) • THE FOURTH AIM OF ED WAGNER, MD, MPH, MACP: “RE-ESTABLISH PRIMARY CARE AS THE FOUNDATION OF U.S. HEALTH CARE DELIVERY IN THE CONTEXT OF THE PATIENT CENTERED MEDICAL HOME”

  7. BECOMING A PCMH REQUIRES TRANSFORMATION… • CHANGE IS HARD; TRANSFORMATION TO A PCMH REQUIRES EPIC WHOLE-PRACTICE REIMAGINATION AND REDESIGN, WITH A “CORE STRUCTURE” • SOUND FINANCIAL SYSTEMS • STABLE STAFF AND LEADERSHIP • STABLE INFORMATION TECHNOLOGY • KEY FACTORS FOR SUCCESS = “ADAPTIVE RESERVE” • STRONG RELATIONSHIPS WITHIN PRACTICE • FACILITATIVE LEADERSHIP • PROTECTED GROUP REFLECTION TIME • ATTENTION TO LOCAL ENVIRONMENT • A LEARNING ENVIRONMENT

  8. HEALTH EQUITY AND CULTURALLY RESPONSIVE CARE • KP FUNDED UCLA CEHD • UCLA KP CENTER FOR HEALTH EQUITY • RECOGNIZES NEED FOR CULTURALLY SENSITIVE AND RESPONSIVE CARE TO OPTIMIZE QUALITY OF CARE AND CARE EXPERIENCE • HEALTH EQUITY AND SOCIAL JUSTICE INCLUDES ATTENTION TO GENDER, ETHNICITY, LANGUAGE, AGE, INCOME LEVEL, HEALTH LITERACY, ETC…

  9. CULTURALLY RESPONSIVE CARE

  10. CULTURALLY RESPONSIVE CARE

  11. LANGUAGE LINE

  12. COMMITTED TO HEALTH EQUITY IN GME • SIX FAMILY MEDICINE RESIDENCY PROGRAMS IN SOUTHERN CALIFORNIA, TWO IN NORTHERN CALIFORNIA • FULLY INTEGRATED ELECTRONIC HEALTH RECORD • FELLOWSHIPS IN SPORTS MEDICINE, GERIATRIC MEDICINE, AND PALLIATIVE CARE • COMMITMENT TO COMMUNITY (COMMUNITY HEALTH CENTERS AND HEALTH FAIRS)

  13. ROLE OF PALLIATIVE CARE • PALLIATIVE CARE TEAM: SPIRITUAL CONSULTANT, PHYSICAL AND OCCUPATIONAL THERAPISTS, NURSE, SPECIALTY CONSULTANTS, PRIMARY CARE PHYSICIANS, FAMILY MEMBERS, FRIENDS, AND PATIENT • DETERMINE GOALS OF CARE • REDUCE UNNECESSARY DIAGNOSTIC AND THERAPEUTIC MISADVENTURES

  14. PALLIATIVE CARE AND GERIATRIC MEDICINE • TWO FELLOWSHIPS WORK HAND IN GLOVE • FAMILY MEDICINE RESIDENTS WORK WITH FELLOWS AND FACULTY MONTHLY IN LOCAL SKILLED NURSING FACILITY • MAKE HOME HOSPICE VISITS • ALL ADVANTAGES OF INTEGRATED SYSTEM AMBULATORY CARE AND HOSPITAL CARE ARE CONTINUED INTO THE COMMUNITY

  15. OTHER NECESSARY EDUCATIONAL TRANSFORMATIONS • MILESTONES PROJECT • RESIDENCY COMPETENCY METRICS • INTER-PROFESSIONAL COALITION • IMPLICATIONS FOR WORKFORCE • LCME CURRICULAR MANDATES

  16. More to come… Kaiser Permanente.thrive.

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