Tuesday, August 25, 2009

What does a Public Option look like?

"The work goes on, the cause endures, the hope still lives and the dreams shall never die." -Edward M. Kennedy

Remembering Senator Edward M. Kennedy for his tireless efforts and dedication to guarantee the basic right to health care for all Americans.

I've been following the social media coverage from other parts of the world covering the debate here in the Unites States regarding the pros and cons of a "public option" as part of health care reform. Some people in other countries have found it amusing and some have expressed feeling that their system has been misunderstood. Social media campaigns such as the WeLovetheNHS campaign have sprung up on twitter. Even Gordon Brown has found his way to Twitter to make a 140 character (or less) public proclamation of pride in Britain's National Health Service.

It prompted me to think about our system (CCHS). We too are a fully integrated health system based on primary care and prevention. I'll admit, I was feeling a little misunderstood as well. When I asked, I found others shared my feelings. I realized that like those who "lovetheNHS", I love our public system, CCHS. I am proud to be a public servant and proud to be a part of what has been since 1880, our community's public option.

So today I decided to take to heart Paul Levy's recent comments in his blog ecouraging us to "stand on a soapbox" and be "seen." He reminds us that "people have given their lives to allow us to have freedom of speech."

I realize and accept the debate about the public option appears to be dominated at the present time by debate about insurance/coverage/money, which is a critical discussion. I would, however, like to offer a moment of pause to remind those of you in our system (and others who may find it worthwhile) that the public option as we realize it through fulfillment of our mission is so much more. It's about safe, efficient, effective, timely, patient-centered and equitable care for everyone. It goes beyond coverage (but yes, it does include it). It's about health.

One of the things I have learned through my exposure to Lean Methodology is how important it is to go and see for yourself (Genchi Genbutsu / 現地現物) to thoroughly understand the situation. I would ask that we all take the time to understand and to "Go and see" , for ourselves what a public option is.

Earlier this month in his Directors Report Dr. William Walker said that "Above all, we should encourage people to get information from objective sources and not rush to judgment."

You can find Dr. Walker's podcast (available at http://cchealth.org/topics/podcast/) about this topic with others and let them know they can get more information at these sites:


Although you won't find any speeches or soap boxes, in the spirit of being "seen" and participation, I thought I would offer a friendly hello from a publicly owned and operated, fully integrated health system here in America.


Saturday, August 22, 2009

Into a new world

"and we shall learn" -W. Edwards Deming

In response to our session on variation I thought you may like the video below. W. Edwards Deming uses powerful descriptions such as being in prison. Sound familiar to what some of those who played the game said?

What Deming says is needed is "transformation, which will come from movement into a new world."
Movement into a new world? What does that mean? Does it feel like we are, or should sustain our system as is? If we were to change, how should we change? Where is the new world? Are there any signs leading us?

For those of you who attended the session this week I'm curious to hear what you think of this video and if you have any thoughts about this concept of movement into a new world?

Thanks to everyone for coming and learning together. We'll try and post the video from our session here and on iSite in the next few days.


Please join us for our next session:
Variation Happens
Thursday September 27th at 9:00am at CCRMC Building One Conference Room One.

Here is a very brief clip of Deming- Enjoy!

Tuesday, August 18, 2009

Uninsured in California: Interactive Map from the Sac Bee

Here is an interactive map of those under 65 without health insurance in each county in California. When you compare, bear in mind the actual numbers and the size of our system (whole system capacity) including the number of medical center beds compared to other counties.

What you all do every day is truly spectacular.


Monday, August 17, 2009

"The Good, the Bad and the Ugly?" I'll agree with two of those!

See the PBS Online NewsHour feature of Contra Costa County and the California Budget Process. Bravo Supervisor Gioia and Dr. Walker! I share your frustration.

I'm sure this was a difficult process for all. I do agree with Governor Schwarzenegger that this budget is bad and it is ugly, but I'm having a hard time finding the good.

Sunday, August 16, 2009

"It's about people, not products"

There is no question, and I make no attempt to hide the fact that I am heavily influenced by the teachings of W. Edwards Deming and The Deming System of Profound Knowledge.

Here is Part 1 of a short series that can be found on YouTube about W. Edwards Deming. Enjoy!

To learn more, you can go to the The W. Edwards Deming Institute® website.

Friday, August 14, 2009

The Justin Micalizzi Memorial IHI Scholarship for 2009

Opportunity from MITSS-Medically Induced Trauma Support Services Clinicians and the IHI.

From the MITSS blog:

Justin’s Hope Project & IHI are pleased to announce the Justin Micalizzi Memorial IHI Scholarship for health caregivers who are committed to serving vulnerable, underprivileged and underserved pediatric populations. The Scholarship covers the cost of Forum General Conference fees and includes a stipend for travel, lodging, or other conference costs.

http://www.ihi.org/IHI/Programs/ConferencesAndSeminars/21stAnnualNationalForumonQualityImprovementinHealthCare.htm?TabId=10 for more information.

Reality Check on Health Care Reform: Message from the Director and Health Officer of Contra Costa Health Services

Below is an All Staff Message from Dr. Walker:

Over the last few years, I’ve devoted a number of my messages in the monthly Director’s Report to the issue of health reform. I’ve been alternately optimistic and pessimistic about the chances of success for a variety of state and federal proposals.

For those of us working in an organized health system like ours, it isn’t hard to see how the United States’ broken health care non-system affects us all - most recently people losing their jobs and their health coverage. As the Health Officer for Contra Costa County, I know how critical it is that Congress agrees on a solution to the health care crisis. What we have now is a non-system that leaves millions without adequate quality care,increases the stress on safety net providers like Contra Costa Health Services and impacts on the health of all residents.

The safety net that each of us supports is ripping more each day.

It is understandable that people are worried about what the solution will be. Health reform is a complicated issue with many moving parts. I spend a number of hours each week on phone conferences with my colleagues across the country discussing strategies and solutions and realize that rational and civil debate is critical to identifying the best strategy for the years ahead.

It worries me to see so much misinformation about options being considered. From my discussions with health leaders around the country, I know many of the “facts” being used to frighten people are false.

I think it is important for those of us who work in a public health system providing high quality service through a myriad of programs speak up and describe how our system works. It is also important that the voices of those benefiting from government-run health programs are heard so others can learn from their experiences. And those being harmed now, who have lost their jobs and their health coverage, should also be encouraged to tell their stories.

Above all, we should encourage people to get information from objective sources and not rush to judgment. Please share my podcast (available at http://cchealth.org/topics/podcast/) about this topic with others and let
them know they can get more information at these sites:


I know this is a very complex and confusing discussion at the present time. Let’s all do our best to keep informed and help others to stay informed. And I will do my best to keep you up to speed with current information.

William B. Walker, M.D.
Director and Health Officer, Contra Costa Health Services

Wednesday, August 12, 2009

Contra Costa County "must shed more than $50 million, atop the $150 million cut from the county budget since December."

Read Dr. Walkers comments in The Contra Costa Times about the budget.

For those who think Health Care Reform isn't necessary, please think again.
The current state is unsustainable. The time for change is now.

Monday, August 10, 2009

Interrupting Harm

Here you can find The San Francisco Chronicle's "Dead by Mistake", a series dedicated to exploring the profound effects of harm caused by medical error. On the site they highlight the Institute for Healthcare Improvement's (IHI) Global Trigger Tool- a tool used for measuring adverse events. You can read more about the GTT here.

Remember, to count is only part of our work. We must find harm, understand where our defects are, make predictions, test our theories/changes, and ultimately interrupt the cycle of harm before it ever occurs. We must use design science to eliminate needless death, pain and human suffering, unwanted waiting, helplessness and waste, and we must do it in a way that no one is left behind (IHI.org).

Many of you have asked to learn more about measurement. As promised, I will begin a series of weekly learning sessions with an aim to demystify quality improvement.

Please join me for next week's session: Understanding Variation on Thursday August 20th at 9:00 AM at CCRMC in Building One, Conference Room One.

Be well,