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

SUBJECTS
Medical Practice Requires Records
Risk Communication Main Factor of Management Success
Risk Management Communication Main Task of Managers, Largest Risk
Telephone Game Shows Meaning Drift, Need to Maintain Shared
Common Administration
Team Care in Medical Practice
Kaiser Medical Group
Accuracy, SDS Records Inaccurate
Feedback Provides Metric
Psychologically Demanding Com Manager
Communication Biggest Risk Enterprise Alignment Complements Accountan
Communication Feedback Medical Management Correct Understandings betw

2414 -
2414 -    ..
2415 - Summary/Objective
2416 -
241601 - Follow up ref SDS 38 0000, ref SDS 33 0000.
241602 -
241603 - Jeanne submitted a letter with corrections to the record on 990802,
241604 - and noted the challenge of communication and limited time.  A second
241605 - letter indicates further corrections are pending.  I called and
241606 - clarified a few issues.  Jeanne followed up with Tom Driscoll again
241607 - today.  Entered corrections to record on 990802, and developed
241608 - analysis on the role of feedback for effective communication.
241610 -  ..
241611 - Submitted a confirmation to Jeanne, ref DIT 1 0001 linked to this
241612 - record for clarification, and suggesting agenda issue for meeting
241613 - with Tom.
241614 -
241615 -     [On 991206 reviewed letter with Jeanne. ref SDS 40 0001]
241616 -
241617 -
241618 -
241619 -
241621 -  ..
2417 -
2418 -
2419 - Progress
242001 -  ..
242002 - Feedback on the Record on 990802
242003 -
242004 - Received ref DRT 1 0001 from Jeanne responding to ref DIP 7 0001
242005 - submitted on 991103. ref SDS 32 0001  Jeanne says...
242006 -
242007 -      The statements that I disagree with or are just not true are
242008 -      below in red. My comments are in blue. ref DRT 1 3264
242009 -
242010 - ...unfortunately, in Jeanne's email the red and blue colors did not
242011 - show up.
242013 -  ..
242014 - A second letter indicates further corrections and additions will
242015 - submitted later in the week. ref DRT 2 0001
242016 - ..
242017 - Following issues are cited in Jeanne's first letter....
242018 -
242019 -    171904 - The summary. ref SDS 14 0001
242020 -
242021 -       There is no specific error cited nor correction submitted.
242022 -       ref DRT 1 3942
242023 -
242024 -       I modified the summary to avoid evaluating Kaiser systems.
242025 -
242027 -     ..
242028 -    172704 - The Message Center system. ref SDS 14 9360
242029 -
242030 -       She says this is... Another example of misinterpretation, No one
242031 -       calling the hospital is connected to call center.  This is for
242032 -       outpatient clinics only. ref DRT 1 6177
242033 -       ..
242034 -       When I called below, Jeanne points out that the Call
242035 -       Center is used for clinics, like Park Shadelands, not for the
242036 -       hospital.
242038 -        ..
242039 -       I made this correction.
242041 -  ..
242042 -    172710 - ...these messages typically comprise a note to the doctor
242043 -    to call the patient, without any material content of a message.  In
242044 -    other words, the record of the discussion is not captured and
242045 -    entered in the chart. ref SDS 14 4189
242046 -
242047 -       She says... I wouldn't have said this...It's not true.
242048 -       ref DRT 1 2576
242050 -        ..
242051 -       When I called below, Jeanne points out that Call Center
242052 -       attendants can fill out a symptoms data base that helps the
242053 -       doctor.
242055 -        ..
242056 -       I made this correction.
242057 -
242058 -         [On 991206 Tom Driscoll clarified this. ref SDS 40 5112]
242060 -     ..
242061 -    172719 - Transcribing verbal expressions accurately is very
242062 -    difficult and time consuming for everyone, the doctor, the voice
242063 -    mail clerk, and the customer, the patient.  This presents liability
242064 -    issues which restrain transcription, and invite duplication that
242065 -    wastes time. ref SDS 14 0899
242066 -       ..
242067 -       She says... Very True!! ref DRT 1 3294
242068 -
242069 -    ..
242070 -    172753 - information is readily available by clicking on
242071 -    links. Jeanne said this saves a lot of time, storage space, and
242072 -    frustration dealing with documents that get mixed up and misplaced,
242073 -    which is a big problem at Kaiser. ref SDS 14 5328
242074 -
242075 -       She says... This implies that I said, "Kaiser has a big problem
242076 -       with documents getting mixed up or misplaced."  Which is simply
242077 -       not true. ref DRT 1 4975
242079 -         ..
242080 -        [On 000116 Jeanne reported links in SDS records on the Internet
242081 -        are overwhelming. ref SDS 41 3128]
242083 -     ..
242084 -    A correction might be to eliminate the string...
242085 -
242086 -       ...which is a big problem at Kaiser.
242087 -
242088 -    ...or we could generalize it and say...
242089 -
242090 -       ...which is a big problem in business due to "Information
242091 -       Overload," as evidence by movements toward...
242092 -           ..
242093 -           Business Intelligence reviewed on 980226. ref SDS 9
242094 -           0001
242096 -            ..
242097 -           Knowledge Management reviewed on 990213. ref SDS 10 0788
242099 -            ..
242100 -           Enterprise Management reviewed on 990427. ref SDS 11 7503
242102 -        ..
242103 -       I made this correction.
242104 -
242106 -  ..
242107 - Psychological Demands and Limited Time Restrain Feedback
242108 - Feedback is Key Business Metric of Communication to Avoid Mistakes
242109 -
242110 - Feedback is part of "intelligence" defined in POIMS. ref OF 6 0582
242111 -
242112 - The New World Order... paper explains differences in understanding are
242113 - inherent in verbal communication. ref OF 7 1122  Alphabet technology
242114 - reviewed on 991108, ref SDS 34 5628, was developed about 700 BC to
242115 - solve weaknesses in verbal communication. ref SDS 34 4505
242117 -  ..
242118 - Writing makes it possible to provide feedback showing understandings
242119 - and alignment with requirements and objectives.  This builds shared
242120 - meaning, which enables people to cooperate in taking effective future
242121 - action, as reviewed on 991108. ref SDS 34 3339
242122 - ..
242123 - Jeanne notes that feedback to correct the record takes time, and
242124 - says...
242125 -
242126 -                     time is a very "Hot Commodity."
242127 -                     ref DRT 1 0530
242128 -
242130 -  ..
242131 - Feedback not only takes time, but is also emotionally demanding, as
242132 - explained in the New World Order... ref OF 7 2670
242133 -
242134 -        [On 000116 Jeanne reported links in SDS records on the Internet
242135 -        are overwhelming. ref SDS 41 3128]
242137 -  ..
242138 - It is frustrating when meetings are reported incorrectly, or at least
242139 - differently from what we recall, and intended.  We are disappointed
242140 - when forced to invest time correcting the record, especially when time
242141 - is limited, because future savings in time and cost seem too remote
242142 - compared to immediate concerns.
242143 - ..
242144 - Time is not the only factor that restrains feedback....
242145 -
242146 -  •  Ignorance about the need for accurate understandings aligned with
242147 -     objectives and requirements, and ignorance of meaning drift that
242148 -     causes inaccurate understandings, reviewed on 991101, ref SDS 31
242149 -     2800, are strong forces that restrain feedback.  Ignorance can be
242150 -     blissfull, or willful.  But it always leads to an unhappy end,
242151 -     under Aristotle's rule. ref OF 7 6056
242152 -
242153 -  •  Fear about alienating people, angering a boss, or causing hurt
242154 -     feelings block feedback under the Prometheus rule, on 991108.
242155 -     ref SDS 34 5810  Pointed corrections and angry reprisals cause
242156 -     future reporting to be watered down with less context and
242157 -     analysis, in order to avoid controversy, which then reduces the
242158 -     value of the record.  This makes reporting on communication a
242159 -     psychologically demanding task, that is not a popular assignment,
242160 -     as noted by Amy this past Saturday. ref SDS 39 1584
242161 -
242162 -  •  <BH35 Ignorance and fear lead to denial that feedback is needed,
242163 -     and that tools, roles and processes are needed to overcome
242164 -     inherent restraints to good management.  The report on rework
242165 -     shows limited time can only be solved by reducing mistakes that
242166 -     take time to fix, ref DRP 2 4680, and are endemic to the sprial of
242167 -     crisis explained in the letter on the high cost of medical
242168 -     mistakes. ref DIP 2 2028  Otherwise, limited time in the near
242169 -     term, becomes a self-fulfilling prophecy that blocks improvement.
242171 -  ..
242172 - Thus, strong social dynamics and meaning drift that hides mistakes by
242173 - deferring impact to the future and transferring accountability to
242174 - others, makes....
242175 -
242176 -
242177 -            Communication the biggest risk in enterprise
242178 -
242179 -
242180 - ...explained in the letter on Medical Mistakes, ref DIP 2 1680,
242181 - discussed on 991101. ref SDS 31 2800
242182 - ..
242183 - Jeanne notes this challenge in her letter today. ref DRT 1 3294
242185 -  ..
242186 - One result is to give up and eliminate feedback under the guise of
242187 - saving time.  Peter Drucker notes the tendency to give up on improving
242188 - communication, reviewed on 931130. ref SDS 4 3851
242189 - ..
242190 - Kaiser's policy expressly calls for "ping pong" communication,
242191 - ref SDS 13 3960, where people comment on written notes of verbal
242192 - communication, as essential feedback for effective doctor/patient
242193 - partnership under Kaiser's Team Care policy.
242195 -  ..
242196 - Kaiser's CEO sent a letter to members supporting the Team Care policy,
242197 - reviewed on 991028. ref SDS 29 0800
242199 -  ..
242200 - Doctor Sylvia Connolly advised on 990625 that doctors do not have time
242201 - to implement Kaiser's policy. ref SDS 13 1978
242202 - ..
242203 - Reports the past two days on the high cost of medical mistakes
242204 - broadcast on CNN and MSNBC specifically cite the doctor/patient
242205 - partnership model as critical to reducing mistakes. Partnership hinges
242206 - on improving communication, so we have to search for ways to surmount
242207 - obstacles to effective feedback.
242208 -
242209 -     [On 991206 high costs are more visible at hospitals than at
242210 -     clinics. ref SDS 40 0899]
242212 -  ..
242213 - If there is not enough time to perform an essential function to reduce
242214 - time and cost of the work, then tools and people must be provided to
242215 - support that function.
242216 - ..
242217 - In addition, cultural change called for in the CNN and MSNBC
242218 - broadcasts, requires training that supports implementing Kaiser
242219 - guidelines on patient communication, discussed with Jeanne on 991101.
242220 - ref SDS 31 1718
242222 -  ..
242223 - This is the purpose of the meeting with Tom Driscoll.
242224 -
242226 -  ..
2423 -
2424 -
2425 - 1348 called Jeanne
2426 -
242601 - Left message that the color code in her email did not show up, and
242602 - asked to discuss clarifications to complete correcting the record.
242603 -
242605 -  ..
2427 -
2428 -
2429 - 1607 called Jeanne back
2430 -   ..
243001 - Jeanne advised that that while she has differences with the
243002 - record on 990802, per above, ref SDS 0 3180, she does not feel they
243003 - require correction, and mentioned debating whether to send the letter,
243004 - then and clicked "Send," before fully deciding what to do.  Jeanne's
243005 - second letter, makes this same point.
243007 -  ..
243008 - I thanked her for investing time to submit feedback, and noted that no
243009 - apology is needed for providing corrections to the record, since that
243010 - is an essential metric of communication, per above. ref SDS 0 2703
243012 -  ..
243013 - Our discussion today indicated that I entered more of what I wanted to
243014 - hear on 980802 than Jeanne recalled.
243016 -  ..
243017 - While that particular record is not very important, we took a few
243018 - moments to verify corrections, per above, ref SDS 0 3180, which
243019 -
243021 -  ..
243022 - Jeanne will Attend Meeting with Tom Driscoll
243023 -
243024 - Jeanne sent a follow up letter to To Driscoll today, asking if he has
243025 - contacted me yet.  She also spoke to Mark, and he related having left
243026 - a voice mail for Tom asking about progress contacting me.
243027 -
243028 - I thanked Jeanne for this help.
243030 -  ..
243031 - We discussed the idea of Jeanne participating in the meeting with Tom,
243032 - when we get it scheduled.  This will provide continuity between Tom's
243033 - world of Kaiser procedures, which Jeanne knows well, and the new
243034 - concepts of Communication Metrics, which Jeanne has experienced the
243035 - past few months.
243036 - ..
243037 - Jeanne agreed to this.
243039 -  ..
243040 - The letter to Jeanne asks about focusing the discussion with Tom on
243041 - how to implement Kaiser's policy for feedback. ref DIT 1 0952, per
243042 - above. ref SDS 0 4088
243043 -
243044 -
243045 -
243046 -
243047 -
2431 -