CONTACTS 
0201 - Kaiser Permanente - Shadelands       925 906 2200
020101 - Walnut Creek, CA
020102 - Ms. Jeanne Bradley; Coordinator =925 906 2204
020103 - Jeanne.Bradley@ncal.kaiperm.org
020104 - Administration Department
0202 - Kaiser Foundation Health Plan, Inc.  510 ... ....
020201 - Mr. Tom Driscoll; Director of Operations =510 987 4921
020202 - tom.driscoll@kp.org
020203 - Call Center

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
Imploding Not Enough Time to Think
Click Links Objectionable, Takes Time
Overwhelmed Observe Complexity of Management Details
Medical Mistakes Require Review

2213 -
2213 -    ..
2214 - Summary/Objective
2215 -
221501 - Follow up ref SDS 36 0000, ref SDS 35 0000.
221502 -
221503 - Tom has reviewed the record, but is reluctant to respond in writing
221504 - for fear of becoming engaged in an effort to "sell" something.  He
221505 - suggests submitting a proposal on Com Metrics to him, and he will
221506 - attempt to accomplish good faith review.  He indicated Jeanne Bradley
221507 - can address pending doctor patient issues at Park Shadelands.
221508 - ref SDS 0 4914
221510 -  ..
221511 - Subitted ref DIT 1 0001 linked to this record with copy to Jeanne for
221512 - follow up per Tom.
221513 -
221514 -    [On 991217 called Jeanne Bradley about meeting. ref SDS 37 0001]
221515 -
221516 -    [On 991227 received letter from Tom, ref SDS 39 0001]
221518 -     ..
221519 -    [On 000118 Jeanne Bradely conducted telecon to address medical
221520 -    issues. ref SDS 44 3248]
221521 -
221522 -
221524 -  ..
2216 -
2217 -
2218 - Discussion
221901 -  ..
221902 - Tom Reviewed Record Feels Response at His Level is Not Required
221903 -
221904 - Tom initially said he has not had time to read the letter we discussed
221905 - last week, ref DIP 13 0001, on 991210. ref SDS 35 3072  He will be out
221906 - of the office until next Thursday?  This conflicts with understandings
221907 - on 991210 where Tom planned to respond Tuesday or at least by
221908 - Wednesday. ref SDS 36 0001
221910 -  ..
221911 - I asked Tom to send an email response when time permits.
221912 - ..
221913 - Tom asked about the objective of the letter on 991210 to which a
221914 - response is requested?
221916 -  ..
221917 - We reviewed three specific issues in the letter, ref DIP 13 9152, that
221918 - flow from medical mistakes reported on 991008. ref SDS 14 9055
221920 -  ..
221921 - Tom said he does not want to address following questions...
221922 -
221923 -   1.  Who is responsible for developing procedures to accomplish
221924 -       Kaiser's doctor/patient communication policies?
221925 -
221926 -   2.  Who is responsible for obtaining feedback from customers (here
221927 -       patients), on improving procedures to help doctors and patients
221928 -       become better partners?
221930 -        ..
221931 -   3.  Who is responsible for developing procedures for improving the
221932 -       quality of Team Care called out in Pearl's letter on October 15?
221934 -  ..
221935 - We considered that these are legitimate doctor/patient issues under
221936 - Kaiser's Team Care partnering goals.  If Kaiser management is
221937 - unwilling to support patient inquiry, then published guidelines are
221938 - merely empty rhetoric, TQM glitter without substance.
221939 -
221940 -   [On 991221 report on study showing doctor communication with patient
221941 -   is inadequate, ref SDS 38 0001; requires education and support
221942 -   processes. ref SDS 38 2288]
221943 - ..
221944 - Tom noted his understanding from discussion with Mark Mangrai
221945 - that the only issue was that Doctor Naqvi would not support web mail.
221946 - Tom advised that his explanation on Monday, that Kaiser is
221947 - experimenting with expanding use of the Internet, but availability of
221948 - web mail, if it comes, will occur in the future, addresses all pending
221949 - issues in the record.
221951 -  ..
221952 - This is an erroneous perception, i.e., another mistake.  The letters
221953 - to Kaiser consistently cite issues listed on 991008. ref SDS 14 9055
221954 - These issues were expressly discussed with Tom on 991206. ref SDS 33
221955 - 0330 The inability to remember objectives and align daily conduct with
221956 - the record is main cause of mistakes, which Com Metrics solves.
221957 -
221958 -   [On 991221 report on study showing doctor communication with patient
221959 -   is inadequate. ref SDS 38 0001]
221961 -    ..
221962 -   [On 991227 Tom Driscoll repeats mistake. ref SDS 39 9844]
221964 -    ..
221965 -   [On 000113 Tom Connolly makes same mistake. ref SDS 42 8268]
221967 -    ..
221968 -   [On 000114 sent letter to Jeanne pointing out possible cause of
221969 -   misperception. ref SDS 43 0001]
221971 -    ..
221972 -   [On 000118 telecon meeting with Jeanne on medical mistakes.
221973 -   ref SDS 44 3248]
221975 -    ..
221976 -   [On 000121 Jeanne submits response to medical issues. ref SDS 45
221977 -   0863]
221978 - ..
221979 - Tom said he read the letter on medical mistakes, ref DIP 2 0001,
221980 - and printed it.  Tom characterized the letter as interesting opinion.
221981 - He did not follow the links.  We did not discuss today that printing
221982 - the letter is a mistake, since it cuts the reader off from related
221983 - "intelligence," that supports the letter with research and independent
221984 - experts, plus the weight of chronology from related events.
221986 -  ..
221987 - He feels links in the SDS record are overwhelming.
221988 -
221989 - We did not discuss using "judicious review" to minimize the burden of
221990 - using "intelligence," explained on 990419, ref SDS 7 2601, and which
221991 - is part of the proposal to the National Science Foundation for
221992 - research in Com Metrics. ref OF 7 0877
221993 -
221994 -     [On 000115 Jeanne Bradley reported that links are overwhelming and
221995 -     prevent understanding of action items. ref SDS 44 3128]
221997 -  ..
221998 - Tom seemed to agree that "meaning drift" contributes to mistakes in
221999 - medical and other management arenas.  Perhaps this indicates Tom
222000 - reviewed the record on 991101 explaining "meaning drift." ref SDS 19
222001 - 2800  Tom indicated his experience with technology the past few years
222002 - shows information overload is a growing problem.  He cited more
222003 - patients at Kaiser, email, and cell phones contribute to the problem.
222005 -  ..
222006 - He seemed to observe that technology cannot improve upon the human
222007 - mind in avoiding error caused by the complexity of information
222008 - overload.  This belief hampers review of Com Metrics to solve the
222009 - complexity problem reviewed with Morris at Intel on 991014.
222010 - ref SDS 15 5600  It also conflicts with 3,000 years of experience
222011 - using alphabet technology to improve human memory by rendering complex
222012 - internal thoughts into external objects called words, sentences and
222013 - stories, as reviewed on 991108, ref SDS 22 0300, which cognitive
222014 - science maintains is the core competency of the human mind, reported
222015 - on 900303. ref SDS 1 5443
222016 -
222017 -
222018 -
222019 -
2221 -

SUBJECTS
Arrogant Com Metrics Not Needed to Solve Meaning Drift
Conventional Methods Can Accomplish SDS
Black Box Shocking Incredible Savings

2705 -
270601 -  ..
270602 - Helping People use Com Metrics to Avoid Meaning Drift is Arrogant
270603 -
270604 - Tom maintained that adding "intelligence" to management using Com
270605 - Metrics cannot reduce meaning drift better than other methods Kaiser
270606 - is using or trying to implement.  He did not cite any other method
270607 - that reduces meaning drift.  Tom feels Welch suffers hubris and
270608 - exaggerated sense of accomplishment, i.e., arrogance, in believing Com
270609 - Metrics improves management better than other methods available to
270610 - Kaiser. He suggested contacting venture capitalists about Com Metrics.
270611 -
270612 -     [On 000106 Morris feels offering Com Metrics to help Intel avoid
270613 -     continual bumbling is arrogant. ref SDS 41 8712]
270614 -
270616 -  ..
270617 - Communication Metrics Methodology Can be Evaluated on the Internet
270618 -
270619 - The implication of Tom's concern is that Com Metrics is quackery,
270620 - empty rhetoric looking for an easy dollar, preying on unfortunate
270621 - circumstances of escalating medical mistakes, which Kaiser is solving
270622 - by other means.  This reflects the record of the carbon blanket cancer
270623 - cure my niece, Patty, wanted me to investigate for her father.  On
270624 - 991108 I investigated and requested information from the vendor.
270625 - ref SDS 23 0001  The information was not supplied and so I refused to
270626 - call the vendor on the assumption that the proposed method was not
270627 - effective.  I have a clear sense that the carbon blanket cure would
270628 - not have been effective, based on lack of evidence.
270630 -  ..
270631 - Com Metrics is not a "carbon blanket" cure for medical mistakes.
270633 -  ..
270634 - Information, explanations, demonstrations are readily provided, and
270635 - there is no charge for discovering how to add intelligence to
270636 - management.  This record is a deliverable which Tom can use to refresh
270637 - his memory again and again, about his thoughts and how they align with
270638 - Kaiser's goals and the national agenda to reduce medical mistakes.
270640 -  ..
270641 - Tom expressed worry about spending hours meeting with Welch chasing
270642 - "blind alleys."
270644 -  ..
270645 - This worry is not justified by the record.  The letter to Tom on
270646 - 991210 merely requests information. ref DIP 13 9152  A meeting of 30 -
270647 - 60 minutes could formulate useful planning for a proposal that would
270648 - correlate with Kaiser's present practice and ongoing evolution of new
270649 - methods, based on Tom's experience and the agenda from experience
270650 - working with Kaiser, reported on 991008. ref SDS 14 9055
270652 -  ..
270653 - Until Kaiser addresses "meaning drift," explained in the letter on
270654 - 990924, ref DIP 2 1680, everything else Kaiser is doing is a "blind
270655 - alley."  The meetings, calls, email and "systems" under development
270656 - will most likely increase mistakes, rather than reduce them.
270658 -  ..
270659 - We considered briefly government reports finding Com Metrics saves
270660 - time and money by reducing rework to fix mistakes. ref DRP 5 0001
270662 -  ..
270663 - The letter on 990924 sets out specific solutions for medical
270664 - mistakes...
270665 -
270666 -    1.  Develop patient advocate role. ref DIP 2 2955
270667 -
270668 -    2.  Doctor/patient education on communication. ref DIP 2 2601
270670 -    ..
270671 -   [On 991221 report on study showing doctor communication with patient
270672 -   is inadequate calls for education and new processes. ref SDS 38
270673 -   2288]
270675 -  ..
270676 - Tom's direct experience with the SDS record on the Internet shows
270677 - stronger application of traceability to original sources, i.e.,
270678 - alignment (see definition from record on 991101, ref SDS 19 1448),
270679 - than is available with any other method.  In the discussion today, Tom
270680 - did not cite any method Kaiser is using or considering that meets the
270681 - need for building and maintaining alignment of daily communication.
270682 - Since communication is the dominate activity of daily work, no other
270683 - technology can help reduce medical mistakes more than adding
270684 - "intelligence" to management, as evidenced by the discussion today.
270686 -  ..
270687 - Tom can call Max Blodgett at the U.S. Army Corps of Engineers in San
270688 - Francisco and others to ascertain this method not only works, the
270689 - government has in fact published a scope of services. ref DRP 4 4929
270691 -  ..
270692 - Max's number at USACE is...
270693 -
270694 -                     415 977 8444
270695 -                     mblodgett@smtp.spd.usace.army.mil
270697 -  ..
270698 - Another person to call is Jim Lovo at HQUSACE in Washington D.C.
270699 -
270700 -                     202 761 4804
270701 -                     james.lovo@usace.army.mil
270702 -
270703 - ...or Wayne Wetzel, Deputy Director, DNRC
270704 -
270705 -                     406 444 6722
270706 -                     wwetzel@state.mt.us
270707 -
270708 - ...or Bill DeHart at PG&E
270710 -                      ..
270711 -                     415 973 1014
270712 -                     bdehart@home.com
270713 -
270715 -  ..
270716 - Tom indicated belief that alignment does not reduce mistakes in daily
270717 - management because it takes time to click on links, and managers,
270718 - doctors and patients do not have time.
270719 -
270720 -   [On 991221 report on study showing doctor communication with patient
270721 -   is inadequate, ref SDS 38 0001; requires education and support
270722 -   processes. ref SDS 38 2288]
270723 -
270724 -
270725 -
270726 -
2708 -

SUBJECTS
Atititude Makes Resistance to Communication Metrics Emotional
Culture Resists New Methods
Blinded by Common Sense

3005 -
300601 -  ..
300602 - Better Management to Reduce Medical Mistakes Requires Cultural Change
300603 -
300604 - Tom does not want to write a letter responding to Welch because it
300605 - takes time.  He feels Welch's effort to engage Kaiser management in
300606 - reviewing Com Metrics for reducing medical mistakes is a "backdoor
300607 - effort" to sell something, which should be presented directly.
300609 -  ..
300610 - We reviewed the challenge of presenting methods to improve management,
300611 - cited by Lynn Conway reviewed on 960606.
300613 -  ..
300614 - Tom concurred with Grove's point that successful executives have
300615 - difficulty admitting to themselves the magnitude of the problems they
300616 - face, and this denial causes bad faith, cursory review, cited on
300617 - 980307. ref SDS 5 2044  As a result, most management improvement
300618 - efforts occur indirectly as a result of someone gaining confidence in
300619 - the prospects of an idea, tool or method and championing an
300620 - effort to obtain good faith review.  Without a senior champion, there
300621 - is no chance a proposal to Kaiser would receive sufficient notice to
300622 - effect change.  Grove again notes that managers love to talk about
300623 - change, but in fact are loath to change their work practice,
300624 - ref SDS 6 1660, Therefore, leadership with a broader vision is
300625 - essential to make needed improvement, as explained in the NWO paper...
300626 - ref OF 6 5653
300628 -  ..
300629 - Tom suggested submitting a proposal to Kaiser, and he will try to get
300630 - it to the right people for review.
300632 -  ..
300633 - He feels Jeanne Bradley can facilitate changing the primary care
300634 - physician, and other matters planned for review with Tom, as set out
300635 - on 991008. ref SDS 14 9055
300636 -
300637 -     [On 991217 called Jeanne about this. ref SDS 37 0001]
300638 -
300639 -     [On 991227 Tom confirmed his idea to work on the personal care
300640 -     physician matter with the local facility. ref SDS 39 0001]
300642 -      ..
300643 -     [On 000104 requested meeting with Jeanne. ref SDS 40 0001]
300645 -      ..
300646 -     [On 000118 telecon meeting with Jeanne on medical mistakes.
300647 -     ref SDS 44 3248]
300649 -      ..
300650 -     [On 000121 Jeanne submits response to medical issues. ref SDS 45
300651 -     0863]
300652 -
300653 -
300654 -
300655 -
300656 -
300657 -
300658 -
300659 -
300660 -
300661 -