what happened at IHI for some who asked --long

[Guest guest]

IHI   Institute for HealthCAre Improvemnt  office practice symposium   held once a year in March   in 2010 it is in Washington DC i went to  Vancouver becasue I heard this conference  was energizing.  It is, however ridiculously expensive-- hence i put in a proposal to speak  so i would not have to pay:)

  So if it is useful to others  who did not go- here  are some notes

 I think I have the SPC ( not saving  primary care this time but spelling punctuation and  caps:)   )  all set all the handouts are at: http://www.ihi.org/IHI/Programs/ConferencesAndSeminars/10thAnnualOfficePracticeSummitMarch2009.htm?TabId=11   Anyone can look at them

 you could buy the tapes also .  Someone said she  would send  them  t o me so i may have some to share  in a  bit

Some people asked mewhat was the general feel? General feel was that  docs find themsleves hitting their heads against walls MOstly i talked to Canadian  docs and  US docs,( other s were there and many administrators  and managers were there)

no one has the time/ relationship/ payment/ delivery/system thing figured out- or well the y might --but policy does not allow it. Docs and patients   both feel put on by zillions of external forces making enemies  of each other. MAny sweet wonderful docs.  One suggested to me  we measure quality of Patient Centered Collaborative Care by seeing who gets the most cookies at christmas becasue she did not have anything better to measure with

  lots of non docs interested in initiatives and projects and implementation and measurement tools .Snooze . Well intentioned people doing well intentioned stuff but i have yet to figure out what to do about all the people and organizations that seem so wonderful but  what exaclty they have to do with me.  Maine Quality forum, and Quality Counts! a  best practices college, and MAine health Access, and franklin healht Access, and the Governors office on Health Policy, and Medical care Development ,and etc all just in my state  etc etc and while all docs can feel so isolated,well  that conflicts with all these programs-- that  think they will help us . Confusing and exhausting wasteful of  of dollars  Wholesale stuff not retail(That last may take clarification)

best part of  being there- talking to certain people Well maybe listenign  to  them  NOt enough of talking to others..

  i was also asked --what people were  thinking about PCMh  Well there may have been  some sessions where it was endorsed but i did not attend one . Every place i went it was shot  down as not getting at the real stuff  Now the conference was in Canada remember and many  more than half folks were  from Canada This was good for me to talk to them BAd i did not have enough time to talk to them There were folks s from Nigeria and Cameroon etc and i did not meet them .I did meet a very tall man from Scotland /a fellow at IHI/ and that was very interesting / so networking is more fun than many sessions.  There was a reception for faculty and they all know each other and hug and discuss their projects ,but i did get introduced  and met by myslef  also, some cool folks . Then i fled to my room

  i went to an all day session by Chuck Kilo and Doug Eby on something-- essential elements office practice design i think .I began to drift away after lunch because  though especially  Eby has done really  cool stuff taking the south Central Native Foundation hospital in Anchorage from complete garbage to apparent wonderfulness-- well  he had no tools I could get much  from-- EXCEPt for one analogy about financial advisers and walking with people where they were. I liked that    Financial advisors meet  you, he said, where you are  eg not knowing what to do w ith your money excpet  put it in themattress or up to the level of real diversitifctain etc .and they " walk along with you " to meet your goals. He was comparing  how docs can  be to this idea- good analogy

I understand he is very culturally sensitive good  but he will not take students becasue it is against the culture. That conflicted me up ,and i wandered next door to a  similar sized group taught by 6 people. I thought  that was  way cool . I guess they work together allt he time but 6 people team teaching  intrigued me.   Hard enough to  work with one or two as I have done.And the atmosphere in that room was soothingly quiet and tranquil  compared to my own session  Maybe it  was  boredom  or napping...it seemed like tranquil...    I know that  material  moslty but I was happier in there  The topic was    taught by this nice psychiatrist I met later Neil baker-I asked him how come he was not doing clincial work and he  said it did not suit him:) That is so interesting from a psychiatrist!   And when I can get people to tell me where they live and about their sweeties and whether they are going to  do a garden  it is always cool   ALso teaching there was Cory Sevin an NP  -WHO DOES NOT KILL PEOPLE- from clinica campesina in CO who is on this list serv hiding becasue we come  across as so brutal  some days:)   She has done alot of work with adolescents;    and Wasson, and Gordon, and Anne someone from the caresouth carolina place that has  done much work with low literacy patietns on  improving their health confidence,  and Tantau who i think is a nurse who has written about access i think  What a crowd huh?

.. There was a keynote by Cassel  MD  form   t he Internal medicine bd .I  did not think she said much.  Then I got two patietn calls and  had to sneak out to  do the IMP thing.and when I came back  it was over , so i dunno what she said. G said it was  geared to American not inclusive of Canadians and not so good(That is not exactly what he said but  we will stay there:)  )

The best session was well it may have  been me and gordon and except ..  i got nervous and fudged it up and there fore have chosen  t o forget it    I have had one email from someone who was there and she said ti was mind stretching which I  do take to be a good thing

The really best session was team taught by: a  family doc in canada who said she met the others by corresponding with them after reading their stuff -i would never do that!  what an idea! She  read her stuff ,and never smiled, but she  put up a diagram and said that she knows that no change can come about without a Venn diagram. 

-then she had us break up periodically with tasks at  our tables- we were instructed to sit with strangers-- and this was moderated by a guy from the dalai lama foundation . then Barbara Starfield spoke and  explained the stuff about how health care is better ,life span increased ,costs lower ,when goof quality primary care   is the foundation of the system T

hey introduced her as the high priestess of primary care. I di d  get to talk to her a bit. Then- and they built this session up /one speaker at a time/( as opposed to all 6 interweaving as the session  i described above) a Dee Mangin spoke from Christ church ,new  zealand, and she introduced a  concept of misusing evidence in discriminatory  ways " Areas of interest include... effective and discriminatory incorporation

of evidence into practice and  the harm of misleading pharmaceutical companies

' promotions to prescribers and   to  consumers "   She quoted- Berthold Brecht saying look science does  not exist to open the door to  infintie wisdom,its job is to protect against infinite error . And   a Turkish proverb- no matter how far you have gone down the wrong  road, turn back . Which resonates with me becasue i  begged the chick running the MAine PCMH  project to turn the ship before she  went further and be more inclusive  etc and she said " we have spent 6mo on this we cannot change. "

go look at Dee MAngin's  handouts - she relentlessly  built her case for discrimination between the hype cycle/ survving one disease by taking an expensive drug only to die at the same exact age  of something else -  see kevin egly's post recenlty  also -and have had less quality of life on the way. I do not  say it as well a s she does

 The n  Iona  Heath spoke a gp from Britain whose professional interests include " liberty and justice in health care , and the challenges posed by disease mongering,  the

care of the dying,  and violence within families " her disclosure  slide said Doubt

She said we need to build a furture different than the one we seem to be heading towards

This was a presetnaion that quoted  The little  prince(remember what it meant  to the fox for the  prince to tame him?)  Kant , issaac newton,  Margaret Wheatley ,ph Conrad, and she  showed us the  book that made her become a doctor  A Fortunate MAn by Berger  and told me later she wonders how she could have understood it when she was 19.

then a robert stoddard from Some candaian University spoke briefly perfeclty timed becasue it was a long morning, about system analysis  you can see his slides also

then they had us post some some stuff on sticky notes they could take home from anything we learned  They had   us  do  survey monkeys ahead of time  Think about it   i cannot collaborate with the cardiologist across the street to get a med list right and these guys from Canada ,NZ, Britain. the us and god knows where do 4 hrs together with  seamless brilliance. It was like to die for.

The   the iHI fellow  from SCotland  told me how cannot get med reconciliation to happen there  even  when every gp has an emr --but he hospitals  have none- i can say more about  tthat later He was fun to talk to.

The problems in having health care be safe are universally messed up but the ideas that each individual provider takes into the room with them are also universal.

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