CONTACTS 
0201 - Kaiser Permanente - Shadelands                                                                                                                                     O-00000718 0403
020101 - Walnut Creek, CA                                                                                                                                                 O-00000718 0403
020102 - Ms. Jeanne Bradley; Coordinator
020104 - Administration Department                                                                                                                                        O-00000718 0403
0202 - Kaiser Permanente - Shadelands                                                                                                                                     O-00000718 0103
020201 - Walnut Creek                                                                                                                                                     O-00000718 0103
020202 - Dr. Thomas E. Connolly; Physician Leader
020204 - Physician in Chief

SUBJECTS
Medical Practice Requires Records
Team Care in Medical Practice
Kaiser Medical Group
Kaiser Computers Can't Open Links in Email
Executive Cannot Follow Points in Letter
Overwhelmed by Details of Daily Management, SDS Format
Medical Mistakes Require Review
Bumbling Knowledge Repository Needs Redundancy
Communication Biggest Risk in Enterprise, Dilemma
Talking Improved by SDS Balances Literacy Orality
Complexity Thinking Shocking when 1st Encountered in SDS Record
Knowledge Management Dilemma Balancing Summary and Complex Details

2714 -
2714 -    ..
2715 - Summary/Objective
2716 -
271601 - Follow up ref SDS 63 0000, ref SDS 62 0000.
271602 -
271603 - Jeanne feels Welch method of communication is not effective, it is too
271604 - complex.  We reviewed the record of pending medical mistakes. Jeanne
271605 - will investiage and take action.
271606 -
271607 -     [On 000120 follow up on task #5 scheduled. ref SDS 65 0001]
271609 -      ..
271610 -     [On 000120 follow up on task #6 scheduled. ref SDS 64 0001]
271612 -      ..
271613 -     [On 000125 Eric Armstrong expects that a connected environment to
271614 -     improve management will "boggle the mind." ref SDS 67 3975
271615 -
271616 -
271618 -  ..
2717 -
2718 -
2719 - Discussion
2720 -
272001 - Asked for a telephone number for Tom Connolly, MD, to follow up my
272002 - letter, ref DIP 2 0001, on 000113. ref SDS 62 0001
272004 -  ..
272005 - Advised Jeanne that when "1" was pressed using Kaiser's phone system
272006 - to leave a message for Tom, there was a message saying it is a
272007 - non-working number.
272009 -  ..
272010 - Jeanne will investigate the Kaiser phone system.
272012 -  ..
272013 - Jeanne said Tom is not in the Park Shadelands facility today.
272015 -  ..
272016 - Jeanne asked for an explanation of medical mistakes cited in the
272017 - letter to Tom. ref DIP 2 5810  This reflects the letter to Jeanne,
272018 - ref DIP 3 0001, on 000114, pointing out that Kaiser has not addressed
272019 - medical mistakes. ref SDS 63 0001
272021 -  ..
272022 - Jeanne advised that the Welch environment is overwhelming, echoing Tom
272023 - Driscoll's concern on 991216. ref SDS 53 3808
272024 -
272025 -    This clarifies initial favorable review on 990802. ref SDS 18 5328
272026 -
272027 -     [On 000125 Eric Armstrong expects that a connected environment to
272028 -     improve management will "boggle the mind." ref SDS 67 3975
272030 -      ..
272031 -     [On 000824 Eric objects again, review objections and support for
272032 -     connected environment. ref SDS 68 7O9I
272034 -  ..
272035 - Jeanne said she was not aware of specific medical mistakes because she
272036 - has been lost in the links.  She feels Mark was also not aware of the
272037 - list of mistakes, because he was lost in the links.  As a result,
272038 - Jeanne has not reviewed the record of medical mistakes on 991008.
272039 - ref SDS 25 9055
272041 -  ..
272042 - One way to work through a complex record is to get support from the
272043 - people who do the work to sort out the record.  This help provides
272044 - orientation that aids understanding to expedite action.
272046 -  ..
272047 - The purpose of requesting a meeting was to help Kaiser staff deal with
272048 - the record in a careful and thorough manner that avoids further
272049 - mistakes.  Since the meeting has not taken place, understanding has
272050 - been deferred.  Delay compounds the record and increases complexity.
272052 -  ..
272053 - Jeanne suggested we can make a first order review today during this
272054 - call, as recommended by Tom Driscoll on 991227, ref SDS 58 0001, and
272055 - set out in my letter to Jeanne, ref DIP 1 0001, on 000104, and cited
272056 - again in the letter to Tom Connolly on 000113. ref DIP 2 4464
272058 -  ..
272059 - Jeanne feels the Welch system is too complex.  She suggested that I
272060 - provide a simple list of the medical mistakes for which review is
272061 - requested, and she asked that this be done verbally in order to save
272062 - time.
272064 -  ..
272065 - This is a good explanation of the knowledge management dilemma that
272066 - occurs when trying to understand complexity with summary, and to
272067 - balance limited time with the need to find relevant details in time
272068 - for taking effective action.  Com Metrics tries to solve this problem
272069 - by connecting summary to details, as explained in POIMS. ref OF 5 8774
272071 -  ..
272072 - The problem was discussed at Intel on 970116. ref SDS 7 9539
272074 -  ..
272075 - We considered the risk of overlooking or stating issues incorrectly
272076 - from reliance on memory and conversation, based on weaknesses in oral
272077 - communication, which literacy was developed to solve, beginning about
272078 - 700 BC, as reported on 991108. ref SDS 35 7426
272079 -
272080 -     The big challenge this presents is finding the right balance
272081 -     between orality and literacy, explained on 991108. ref SDS 35 0866
272082 -     Under the Welch system this includes balancing clear, concise,
272083 -     complete communication, developed on 960620. ref SDS 6 1643
272085 -      ..
272086 -     Busy people want a simple list of action items, as Jeanne
272087 -     requests today.
272089 -      ..
272090 -     However, performing the actions effectively requires access to
272091 -     relevant background, also called "context," which often is a large
272092 -     record, especially when action has been delayed.  If only clear
272093 -     and concise information is provided, cursory understanding leads
272094 -     to erroneous conclusions to "just do thus and so."  When that
272095 -     fails, because it conflicts with the larger record, people get mad
272096 -     and accuse others of telling a "big story" rather than telling the
272097 -     "truth," i.e., they did not get an accurate story, as reported on
272098 -     950412. ref SDS 5 3920
272100 -      ..
272101 -     Com Metrics solves this by providing access to the complete story
272102 -     at the touch of a key, but this is overwhelming.  The problem was
272103 -     cited on 990419 by Dave Bouncristiani, ref SDS 11 2601, that led to
272104 -     the idea of judicious review. ref SDS 11 3240
272106 -      ..
272107 -     When the record becomes complex, as in this case, we need a
272108 -     meeting to provide orientation in knowledge space.
272110 -  ..
272111 - Jeanne opened the letter to Tom Connolly, ref DIP 2 0001, and clicked
272112 - on the link for medical mistakes, which opened the record for 991008.
272113 - ref SDS 25 9055  This took 10 seconds.
272115 -  ..
272116 - Jeanne suggested we review medical mistakes, requested previously on
272117 - 991217, ref SDS 54 0001, later on 000104, ref SDS 61 0001, and again
272118 - on 000114. ref SDS 63 0001
272120 -  ..
272121 - We decided to review today only medical mistakes and to set aside
272122 - issues to enhance Kaiser's communciation capabilities.  Jeanne noted
272123 - that the latter issues present conflicts because there is a concern
272124 - Welch is trying to sell Kaiser something.
272125 -
272126 -     [On 000120 follow up on task #5 scheduled. ref SDS 65 0001]
272128 -      ..
272129 -     [On 000120 follow up on task #6 scheduled. ref SDS 64 0001]
272131 -  ..
272132 - As a result, we discussed only issues 1 - 6 on medical mistakes listed
272133 - in the record on 991008, ref SDS 25 9055, and did not review today
272134 - issues 7 - 9 which relate to communication process improvement issues.
272136 -  ..
272137 - We reviewed background of issues 1 - 6. Jeanne clicked on the links
272138 - and we read together letters sent to Kaiser and received from Kaiser
272139 - that explain background, objectives and problems that occurred on each
272140 - issue.
272142 -  ..
272143 - Jeanne indicated these matters require investigation.
272144 - ..
272145 - She will investigate and submit a letter on action taken, and
272146 - any need for additional information.
272148 -  ..
272149 - Jeanne will ask Tom Connolly if he will take up the Primary Care
272150 - Physician role, and, if not, she will try to find someone who is
272151 - willing to work with the patient to apply Com Metrics on the web.
272152 -
272153 -     [On 000121 Jeanne reports Tom will not take up this opportunity.
272154 -     due to a heavy administrative schedule. ref SDS 66 6424]
272156 -  ..
272157 - She will initially respond to the letter to Tom Connolly, ref DIP 2
272158 - 0001, setting out the 6 action items she will address, confirming our
272159 - telecon today.  Jeanne will advise Tom that we have accomplished today
272160 - the meeting requested in the letter to Tom. ref DIP 2 4424
272161 -
272162 -     [On 000121 Jeanne responds to medical mistakes. ref SDS 66 0863]
272163 -
272164 -
272165 -
272167 -  ..
2722 -
2723 -
2724 - 1623 called Jeanne back
2725 -
272501 - She feels the Welch system is not the answer.
272502 -
272503 - She asked how it improves upon Kaiser's existing system for fixing
272504 - mistakes?
272506 -  ..
272507 - I related the idea of introducing a better balance between literacy
272508 - and conversation, and the tension between clear, concise, complete
272509 - communication.
272511 -  ..
272512 - She feels Com Metrics is too complicated.  She feels burned out
272513 - thinking about it.
272514 -
272515 -
272516 -
272517 -
272518 -
2726 -