Our history as a medical group dates to 1947. Since then we’ve sustained our values—such as innovation and scientific discipline—and have pursued medical management principles that both heal and foster a lifetime of well-being for our patients.

GHP is now one of the region’s largest and best medical groups. Over time, our size and market position have deepened our ability to deliver on four key elements: cost, quality, service, and access. Our ability to perform depends on our alignment, our focus, and our collective engagement in our work.

Pushing forward is hard, often messy, and takes courage. That’s why the GHP Board and leadership are committed to creating forums for medical staff to weigh in on where we’re going, what’s working, and what needs more attention.

 A time to check in and listen 

Twice a year the GHP Board hosts business meetings for medical staff in seven locations across our service area. We use this time to check in with the GHP medical staff— our shareholders. We review GHP’s financial performance, enrollment numbers, industry trends, strategic direction, and local medical center issues.

We invite frank and honest feedback on all of these issues. Then we provide time to hear each others’ questions and concerns, and to learn from one another.

I participated in the meetings at Capitol Hill Medical Center, Tacoma Medical Center, Silverdale Medical Center, and Bellevue Medical Center. Hundreds of clinicians took part. It was exciting to see how passionately our staff dives into the business environment and the work at hand.

 What did we talk about? 

First, our theory for success: because we manage the health care dollar from insurance to care, and we have a medical group steeped in evidence-based medicine rather than the fee-for-service paradigm, we should be better than competitors at delivering innovation. In turn, our innovation should lead to enhanced quality, efficiency, enrollment growth, profitability, and reputation.

At our meetings, we looked at our performance in terms of enrollment, quality, and profitability. Then we talked about what healthcare reform will require of our system. How will we serve our share of a half-million newly insured people? What will or role be as an accountable care organization working with partners in the medical community?

We also talked about our market. Falling revenues across the health care industry are causing consolidation and new partnerships. Even though we’re doing well, we’re going to have to keep changing. Physician groups are partnering with hospitals and leaving their traditional domains. Hospitals are buying physician practices. What will we need to do to stay strong in this environment?

 The heart of the matter: getting together

These meetings are among our best tools to get medical staff input on enterprise business strategies. By the time we’ve finished each series of meetings, we have hundreds of ideas flowing our way. We’re also clearer on medical center issues that affect daily work.

The real magic of these evenings is spending time together in the same room. People are speaking up, owning issues, and solving problems together.

My sincere thanks go out to my colleagues from around Group Health who provided their perspectives on why they take part. Here’s what a few of them took away from the spring meetings. 

"I really like to hear the perspectives of the other physicians who come out to these meetings. It’s good to remember we don’t work in a black box. I also like having the opportunity to offer feedback, especially in areas that affect my service line."
-Thomas Stoll, MD, Chief of Orthopedic Surgery, Bellevue Medical Center 

"Everyone in the room wants to know the straight scoop from leadership about how we’re doing, and what’s coming next. As board members, we get to hear directly from the front line doctors about what is most pressing and important to them. In turn, we get a chance to thank them for what they do to keep us going."
-Robert Karl, MD, Chief of Radiology, Tacoma Medial Center and GHP Board Vice-Chair

"I attended the meeting in Bellevue, which involved providers from many practices—some in their first year, others with decades of tenure. I was impressed by the honest discussion of concerns, successes, and new opportunities. The comments focused on identifying issues and asking questions in a way meant to solve problems. People seemed engaged and deeply committed to our success. I was very proud to be associated with this group."
- Scott Armstrong, Chief Executive Officer, Group Health Cooperative

"Getting the big picture is always good for me. We have experienced lots of changes in recent years. But when I have the business context for it, and can help my department understand that context too, it makes it easier to handle rapid change."
-Sheila Brown, MD, Chief of Pediatrics, Olympia Medical Center

 "I was struck by the structured, disciplined approach GHP is taking to these meetings, with the complimentary purposes of sharing information in multiple directions. This is the kind of discussion needed throughout the Group Health enterprise, regardless of the organizational unit in question. I was impressed by the genuine listening and questions asked for the purpose of learning, rather than making a point."
-Rick Woods,  Executive Vice President and General Counsel, Group Health Cooperative

In recent Open Mike issues we've looked at various aspects of EHDI: Group Health's Emergency Department / Hospital Inpatient initiative. It's a big project, involving many provider roles. In short, EDHI systems and training make care transitions smoother, especially for patients with complex conditions.

Here, Leslie Cohn ARNP, Nurse Practitioner and Judy Hill, ARNP, Nurse Practitioner, explain how EDHI supports transitions into and out of Skilled Nursing Facilities (SNFs). These patients are typically fragile older adults who have complex medical conditions. The stakes are high, so new processes cover safe transitions and ways the patients can take action if they start to worsen after discharge.

What do you wish people knew about your work?
Leslie: Our comprehensive transitional management is key for patients' safe and seamless discharge to their next level of care. Due to the teamwork brought about by EDHI, and the systems in place for transitional management, we are able to provide patients and their families with a plan of action for safe care after they leave the SNF.

Judy: The nurse practitioners in Group Health's contracted SNFs are managing patients with complex medical problems, day in and day out. We begin transitional management at the time of admission and continue through the patient's discharge. Because we're physically removed from Group Health facilities it's a largely unseen role, but one of the most medically demanding. Most of our skilled nursing patients are admitted for 12 to 14-day stays. After our physician partner performs a comprehensive visit and sets up a treatment plan, we take over the ongoing medical care and coordinate the discharge home.

How does your work fit into the overall EDHI picture?
Leslie: Our team participated in the EDHI process improvement work on transitional management. This encompasses the medical care of patients who move from an ER, urgent care clinic, or hospital into one of our contracted SNFs, and continues until transfer to the next level of care. It's different from the standard work, visual systems, and discharge planning that hospital-based care teams have worked on. They focused on tighter in-hospital coordination and discharge processes.

Judy: With transitional management, nurse practitioners have a central role. Our efforts are focused on providing a safe discharge plan and in preventing an ER visit or hospital readmission.

Leslie: We're very rigorous in the ways we work with patients to make sure their medication plans can be understood and followed. We make sure their next care setting is going to be the safest based on their functional status and their medical condition. This is a very vulnerable group; their situation can worsen quickly and dramatically.

What are some specific things that you have implemented?
Leslie: There are five major tasks that we worked on: the comprehensive medical assessment, the sick day plan, the discharge plan, updating or securing POLST (Physician’s Orders for Life Saving Treatments) forms, and the follow-up plan.

Judy: I think the sick day plan is the most empowering new task for our patients. It sets them and their caregivers up for quick action. It spells out exactly what steps to take if something doesn't feel right—if they're having a sick day. It's very specific about warning signs, such as when to call the consulting nurse or their doctor, and includes the different numbers they might need. If they have pain or develop an infection, they know what to do. They don’t have to wait for their follow-up appointment.

Are you seeing results today?
Leslie: This turns out to be a very customer service-oriented program. Patient satisfaction surveys from SNFs are showing that people are more satisfied with aspects of their care, like getting clear instructions, and feeling supported.

Judy: The SNF surveys ask whether patients understood their medication plan, and those numbers have gone up too. Looking at reductions in readmissions—which is what EDHI emphasizes—our rate for direct rehospitalization from SNFs has been below our 15.5 percent target since September 2009, averaging 14.75 percent.

Nurse practitioners in skilled nursing facilities are proud to provide a vital component of EDHI work for medically complex and frail older adults.

Group Health Occupational Health Services was recently awarded the prestigious National Association of Occupational Health Professionals (NAOHP) certification, designating the department as a national center of excellence.

The department received a certification score of 97.8 out of a possible 100 percent acknowledging that Group Health offers an exceptionally high level of occupational health-related services to employers and employees.

NAOHP site surveyor Donna Lee Gardner gave our program particular accolades for comprehensiveness, standardization and performance measurement. “Group Health has taken total health management to a new level using their experience with an integrated care and coverage delivery model,” she said.

Applying for the certification was rigorous, but created some operational benefits, according to Dan Perrow, who coordinated much of the application process.

“The certification process has helped us gain greater clarity on reporting financial performance, quality, consistency, patient outcomes—all of our metrics,” Perrow says. “Certification has also helped us become better organized, pulling together all of our training manuals and processes. Standardized resources are in place now for orientation and ongoing training.”

“It took us about two years of preparation to achieve this status, and we’re very proud to be the first organization in Washington state to receive the award,” adds occupational medicine physician Abid Haq, MD.

Group Health At Work is our all-in-one workplace health and safety program, staffed with board-certified occupational medicine physicians and clinicians, dedicated to treating work-related injuries and providing health, safety, and wellness services at 12 clinic locations.

Special thanks to NAOHP’s VISIONS magazine for contributing to this article.