Philadelphia: Cradle of Liberty
WELCOME THE DRAGON: Opening the Heart of Balint William L. Miller, MD, MA Lehigh Valley Health Network The 17 th International Balint Congress Philadelphia, PA September 8, 2011
Ranier Maria Rilke
A CASE
Who is the doctor? Where is the patient in Balint? Where is the illness located?
Change & Transformation Established Traditional Practice Critical Mass of Patients, Clinical Processes, & Staff Practice Redesign Space & Office Design Access Design Technology Design Visit Types Financial Models Identity Shift TeamsProactive, Planned Care Paradigm Shift Patient- Centered Care Accountable Population- Based Care Whole Person Holistic & Comprehensive Care Care Process Design Citizen of Medical Neighborhood Web Portal Shared Record PCMH
Who Is the Doctor?
Dragon Slayers?
Observation I ntervention DOPC STEP-UP IMPACT D irect O bservation of Primary C are ( ) S tudy T o E nhance P revention by U nderstanding P ractice ( ) Insights from Multimethod Practice Assessment of Change over Time ( ) P&CD P revention & Competing D emands in P rimary C are ( ) ULTRA Using Learning Teams for Reflective Adaptation ( ) NDP National Demonstration Project ( ) Cross-Disciplinary Literature CQI EPOCH EPIC SCOPE NRN-D
Lessons About Docs Surprising emotional reactivity & abrasiveness of docs Monumental power difference between doc and receptionist Surprising lack of self-care skills among docs Surprising lack of communication between docs Most practices want to improve, but few want to change Docs prefer hearing what to do rather than learning
A Transformed Physician Team-based Care Collaborative Care Facilitative Leadership Population Management Multiple “Channels” of Care Patient Partnership Transparency of Care Time for a Good Drink!
Where Is the Patient in Balint?
Patient Experience of Care Got Worse
Where Is the Illness Located?
Health Care Spending per capita ($US Purchasing Power Parity) 2008 OECD Data United States $7538 Germany $3737 Organization for Economic Cooperation and Development: Health at a Glance
Tomorrow’s Balint?
Welcoming the Dragon!
A Case Revisited
Ranier Maria Rilke