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
0203 - Thelen, Reid & Priest LLP            415 371 1200
020301 - Mr. David Buoncristiani, Esq.
020302 - dbuoncristiani@thelenreid.com

SUBJECTS
Medical Practice Requires Records
Team Care in Medical Practice
Kaiser Medical Group
Overwhelmed by Details Outside Span of Attention
Willfully Blind, Fear and Denial
Emotional Resistance to Com Metrics
Knowledge Avoided Ignorance Avoids Accountability
Email Improved by SDS Links
Kaiser Computers Can't Open Links in Email
Executive Cannot Follow Points in Letter
Team Care No Process Address Medical Mistakes

1913 -    ..
1914 - Summary/Objective
1915 -
191501 - Follow up ref SDS 50 0000, ref SDS 49 0000.
191502 -
191503 - Received ref DRT 1 0001 from Tom responding to my letter on 991216.
191504 - ref DIP 5 0001,
191505 -
191506 - Tom confirms his suggestion to discuss the personal care physician
191507 - issue with the local facility, ref DRT 1 4864, cited in my letter,
191508 - ref DIP 5 5520, and discussed in telecon on 991216. ref SDS 49 4914
191509 -
191510 - While Tom fails to address the scope of pending issues on 991008,
191511 - ref SDS 23 9055, the implication is that he suggests the local staff
191512 - work on the agenda before review at a higher level.  This ignores the
191513 - record on 991109 where Mark reported local management did not have
191514 - time to perform the work, and as a consequence he contacted Tom.
191515 - ref SDS 34 0001
191516 -
191517 -      [On 000103 submitted letter to Jeanne. ref SDS 56 0001]
191518 -
191519 -      [On 020221 Vickie Travis requests permission to list this record
191520 -      on The Kaiser Papers; that record applauds Vickie's courage to
191521 -      speak out for better medical management, and comments Kaiser for
191522 -      good people and good procedures, while recognizing that
191523 -      improvement is needed, as evidenced by this record. ref SDS 58
191524 -      0001
191525 -
191526 -
191527 -  ..
191528 - Clear, concise, complete communication.
191529 -
191530 - Tom re-stated Kaiser's efforts to develop Internet communcation, which
191531 - he mentioned on 991216, ref SDS 49 5846, and indicates it will be...
191532 -
191533 -
191534 -                     concise and to the point
191535 -
191536 -
191537 - ...which seems to repeat the error on 991216, ref SDS 49 5846, that
191538 - the focus of the inquiry is email. ref DRT 1 0001   This supports the
191539 - report on 991221 by ABC News about the problem of communication
191540 - errors. ref SDS 51 0001
191541 -
191542 -    [On 000113 Doctor Tom Connolly at Park Shadelands makes same
191543 -    mistake. ref SDS 57 8268]
191544 - ..
191545 - Tom says "I received your letter [on 991216, ref DIP 5 0001] and
191546 - tried to follow the points that you made but was unable." ref DRT 1
191547 - 0001  He does not say which points he could not follow.
191548 -
191549 -    [On 991229 reviewed "grand ideas." ref SDS 54 5320]
191550 -
191551 - Tom's point is unclear...
191552 -
191553 -    1.  The letter on 991216 simply says I will contact the local
191554 -        facility, per Tom's suggestion.  It does not seem likely he was
191555 -        unable to follow this point, since he re-states it, indicating
191556 -        it was within his span of attention.  The letter on 991216 also
191557 -        asks Tom to call if he has any questions on Com Metrics, which
191558 -        does not leave a lot of room for error.
191559 -
191560 -    2.  Assuming he is referring to the record of our discussion on
191561 -        991216, or to the explanation of "meaning drift" on 991101,
191562 -        both of which are cited in the letter on 991216, he does not
191563 -        state that fact.
191564 -        ..
191565 -    3.  Tom does not state that he could not access links, or
191566 -        that he could not follow the reasoning in links that support
191567 -        particular points he was trying to follow.
191568 -
191569 -    4.  Assuming he is referring to points in a referenced source, Tom
191570 -        does not state what points he was unable to follow.  Was it
191571 -        one, two, all of them?
191572 -
191573 - These four (4) mistakes illustrate problems in medical communication
191574 - found in the study reported on 991221 where key information is omitted
191575 - 90% of the time. ref SDS 51 0001
191576 -
191577 - Why should doctors be better communicators than top executives?
191578 -
191579 -     [On 991230 another example of errors in email. ref SDS 55 7840]
191580 - ..
191581 - Tom's letter reflects the quality of work cited on 991028 from
191582 - Doctor Craig Boulris, who omitted critical information that led to
191583 - proposing communication training and support, ref SDS 26 8499, listed
191584 - as an agenda item for discussion with Kaiser on 991008. ref SDS 23
191585 - 0899
191586 -
191587 - This example of poor communication supports analysis on 991108 showing
191588 - literacy declines due to the pressure of limited time in daily work,
191589 - ref SDS 31 7380, that causes over reliance on verbal communication
191590 - that is highly error prone. ref SDS 31 4505
191591 -
191592 - Email inherently causes mistakes as explained in the letter on 990924,
191593 - ref DIP 2 1045, citing the example of the space orbiter crashing on
191594 - Mars, reported on 991001. ref SDS 21 3077
191595 -
191596 - If Tom could not access links, or if Internet traffic was heavy when
191597 - he tried to open links, which slowed and discouraged access, these are
191598 - technology issues.  On 990706 there was a report that Kaiser's
191599 - computers could not open tertiary links. ref SDS 12 7410  This may be
191600 - the referent Tom was trying to convey.  But he did not do that.
191601 -    ..
191602 -    A few days later, I called and left message for Tom asking
191603 -    him to clarify the scope of the problem he encountered "following
191604 -    the points" in my letter on 991216.
191605 -
191606 - Limited time causes cursory, incomplete communications that cause
191607 - mistakes, also, cited in the letter on 990924. ref DIP 2 2028  An
191608 - example is the record on 990718. ref SDS 15 6120
191609 -
191610 - Limited span of attention leads to desire for concise to the point
191611 - communication that omits context hoping to save time.
191612 -
191613 - If Tom does not want to follow links to discover "understanding," that
191614 - is a responsibility avoidance problem, similar to discussion at Intel
191615 - on 990712, ref SDS 13 5837, and with NSF on 990715. ref SDS 14 0001
191616 - On 991014 the problem of avoiding responsiblity was reviewed again.
191617 - ref SDS 24 3066
191618 - ..
191619 - On 990802 links in communication were found useful. ref SDS 16
191620 - 5328
191621 -
191622 - Willfully blind makes communication the biggest risk in enterprise
191623 - because "experience" comes from connecting chronologies of cause and
191624 - effect, also called "context," and is the underlying source of all
191625 - human knowledge, cited, for example, by Einstein, reported on 991124,
191626 - ref SDS 39 3066, who today was credited as the man of the century by
191627 - Time magazine. ref SDS 53 0001
191628 -
191629 - The desire for communication to be "concise and to the point," is
191630 - typical advice from lawyers, reported on 960620, ref SDS 5 1643, that
191631 - reflects fear of accountability and limited time which limits span of
191632 - attention and constrains understanding due to lack of context, the
191633 - environment that makes management a process of continual bumbling.
191634 - Cursory understanding that avoids responsibility for knowledge in
191635 - order to avoid accountability is crisis management explained in the
191636 - letter on 990924. ref DIP 2 2904 This is a big part of the "psyche"
191637 - problem cited by Fortune as the reason executives refuse to execute
191638 - sound management practice, reviewed on 990625. ref SDS 11 4914
191639 - ..
191640 - Executives who demand cursory communication, later complain they
191641 - were not told the truth when lack of understanding leads to disaster,
191642 - reported on 950412. ref SDS 4 3920
191643 -
191644 - Kaiser's doctor/patient guidelines require feedback loops, called
191645 - "ping pong," to ensure understanding in communication, as reported on
191646 - 990625. ref SDS 10 3960
191647 -
191648 -
191649 -
191650 -
191651 -
191652 -  ..
1917 -
1918 -
1919 - 1410 called Dave Buoncristiani at Thelen, Reid, Priest
1920 -
192001 - Dave is out today.  Clair said he is expected back tomorrow.
192002 -
192003 - I asked if TRP is having continuing problems accessing information on
192004 - the Internet?
192005 -
192006 - Clair advised the problems have been solved.  She will let Dave know
192007 - I called.
192008 -
192009 -    [On 991228 called and talked to Dave. ref SDS 54 0001]
192010 -
192011 -
192012 -
192013 -
192014 -
1921 -