The 2000 Bayer Institute Program Partner Award Recipient:

Permanente Medical Group

Kaiser Permanente is America's leading integrated health care organ­i­za­tion. Founded in 1945, it is a nonprofit, group-practice health maintenance organ­i­za­tion (HMO) with headquarters in Oakland, California. Kaiser Permanente serves the health care needs of its eight million members in 11 states and the District of Columbia. Today, it encompasses Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals, and the Permanente Medical Groups, and has an affiliation with Group Health Cooperative based in Seattle, Washington.

The Bayer Institute for Health Care Communication began working with the Permanente Medical Groups (PMG) in 1989 and now works with five regions within PMG to teach communication skills to clinicians. During the past 11 years, more than 158 workshops have been offered and more than 2,430 phy­si­cians have been educated. There are 33 Bayer Institute faculty members in the five regions. In addition to partnering to offer workshops, the Bayer Institute and PMG have jointly developed several communication workshops.

Given these accomplishments, the Bayer Institute chose to award the five regions of the Permanente Medical Group, with the 2000 Program Partner Award. The regions are:

• The Permanente Medical Group, Northern California
• Southern California Permanente Medical Group
• Southeast Permanente Medical Group, Inc.
• Mid-Atlantic Permanente Medical Group
• Northwest Permanente Medical Group

In addition to their partnership with the Bayer Institute, these five regions offer their own communication programs. Because of their shared-interest and commitment to communication, these regions hold monthly conference calls and annual meetings to share insights and resources on successful programs and strategies. Recently, they began publishing a list of all communication programs offered throughout the individual regions.

The growth and success of the partnership is a direct result of the value the Permanente Medical Groups place on clinician patient communication and their encouragement to member phy­si­cians to participate in workshops designed to enhance these skills.

THE PERMANENTE MEDICAL GROUP, NORTHERN CALIFORNIA

In 1989 the Permanente Medical Group, Northern California (TPMG) wanted innovative medical education programs to ensure that its member clinicians had the best possible training in the area of clinician patient communication. The Permanente Medical Group learned of the Bayer Institute and its Clinician Patient Communication (CPC) Workshop. Using existing Bayer Institute programs as a guide, TPMG created a CPC workshop for its phy­si­cians which was attended by more than 1400 clinicians between 1990 and 1995.

In 1995, TPMG Physician Education and Development, the depart­ment that designs and offers CPC communication programs for the region, recognized that they needed a communication skills workshop that went beyond the one-day program. The result was the creation of the five-day Communication Skills Intensive workshop, a residential program for clinicians who would like to enhance their interactions with patients.

The program was the brainchild of Bayer Institute Associate Director, Dr. Vaughn Keller and TPMG Director of Clinician Patient Communication, Terry Stein, M.D. To date, more than 200 clinicians have participated in the Communication Skills Intensive workshop. (Outside TPMG, the five-day workshop is offered by the Bayer Institute as the Intensive Communication Skills workshop.)

In initiating the Communication Skills Intensive workshop, TPMG Physician Education and Development was forced to deal with the stigma that many of its clinicians attached to the program. Physicians initially saw the program as something developed for "problem communicators." After hearing positive par­ti­ci­pant feedback, member clinicians began to view the workshop for what it was meant to be: a powerful tool to help clinicians develop better relationships with their patients through effective communication.

To date, TPMG and the Bayer Institute have collaborated on the following additional projects:

• Meeting Point: A Communication Workshop for Hospitalists. A one-day educational program for hospitalists focuses on communicating with patients, their families and other team members. The program, piloted in March 2000, is a collaboration between the region's CPC team and the Bayer Institute.
• Communication Consultants. Given the large number of individual centers, TPMG created a formal group of 40 consultants. Each consultant serves the role of bringing educational programs and services to colleagues at their own facility. The Bayer Institute staff helped to train some of the initial consultants.
• Communication Skills Intensive Study. This research study was conducted in 1997 to determine the impact of the five-day program. The study examined several outcomes including actual communication behaviors, visit and professional satisfaction, patient satisfaction and orientation/attitude.

In general, attendance for programs is voluntary. Clinicians identified as needing the Communication Skills Intensive workshop are encouraged to enroll, but again, participation is voluntary. Due to the overwhelming demand for the Intensive Skills workshop, TPMG does screen applicants to determine if the appropriate level of motivation exists to participate.

With its consultant and hospitalist programs, one obstacle the region faces is having the time and administrative staff to properly execute these programs.

All of TPMG Physician Education and Development and Bayer Institute CPC programs are well received by clinicians and this is reflected in written evaluations. Many clinicians have gone so far as to say that the Communication Skills Intensive workshop "makes a radical difference" in their patient relationships. In addition, clinicians say they feel more relaxed when dealing with patients.

NORTHWEST PERMANENTE MEDICAL GROUP

Kaiser Permanente Northwest recognizes the direct link between patient satisfaction and the clinician patient relationship with communication being the number one driver between the two. The leadership of the Northwest group has been very supportive in providing resources to improve clinical and staff communication to increase patient satisfaction.

In 1991 the Northwest Permanente Medical Group's Continuing Medical Education & Professional Development Department began offering the Bayer Institute's Clinician Patient Communication workshop. The workshop was presented through the Northwest Center for Physician-Patient Communication, a subsidiary of the Foundation for Medical Excellence.

In 1995 the Department of CME and Professional Development began offering the Bayer Institute's Clinician Patient Communication workshop to interested depart­ments. As the requests increased, the Northwest Group began to offer regional programs for all interested phy­si­cians.

In 1997 the Foundation for Medical Excellence offered tuition for two Kaiser Permanente consultants to attend the Clinician Patient Communication to Enhance Health Care Outcomes faculty development Program. Three years later, Kaiser Permanente has 11 Bayer Institute trained faculty members.

In 1999 the Northwest Permanente Medical Group administration mandated that all new clinicians attend the workshop, "Clinician Patient Communication to Enhance Health Outcomes" within their first year of hire. The region has recently had great success offering Bayer Institute workshops to the workgroups within the regions Health Care Team level. That same year the region began offering additional communication programs including: Communication: A Risk Management Tool; Difficult Clinician Patient Relationships and Choices and Changes beginning in 2000.

Workshops are evaluated on an individual basis. To date, evaluations have been positive. The biggest challenge the region faces is generating and sustaining continued energy for participants to attend the workshops.

SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP

When Southern California Permanente Medical Group (SCPMG) decided to survey its patients about their satisfaction with individual doctors' communication styles, Dr. Tom Godfrey was selected to chair a committee to explore avenues to introduce internal communication and training workshops to the Permanente Medical Group, Southern California.

Dr. Godfrey knew his colleague Terry Stein was using the Bayer Institute workshops in her region with much success. After ongoing conversations, Dr. Godfrey decided to be trained as a Bayer Institute faculty member.

Following Dr. Godfrey's training, the Bayer Institute Clinician Patient Communication Workshop was rolled out regionally. Enrollment for the workshop is voluntary. In rare cases, those clinicians identified as indi­vid­uals who could benefit from this program are encouraged to enroll, but again, participation is still voluntary. The Southern California Permanente Medical Group has found that its Member Assessment of Physician Service (MAP) survey motivates many phy­si­cians to participate in the workshop. This internal survey serves as a device for phy­si­cians to benchmark their own communication skills and see the progress as a result of workshop participation.

In addition, Southern California has developed its own tools, including video-coaching, a one-on-one experience using actors simulating patients in a realistic clinical setting, and video visits, which has been adopted nationally as a training tool. Southern California has also introduced programs that dig into cultural issues and diverse lifestyles.

As of June 2000, most of the region's phy­si­cians participated in both the Clinician Patient Communication and the Difficult Clinician Patient Relationships workshops; evaluations have been positive. The following are benefits that have been reported:

• Increased Insight. Member phy­si­cians are continually commenting on how insightful and rewarding it is to share information with their colleagues.
• Visibility of Issue. The workshops keep the issue of good communication skills in front of phy­si­cians so that they continue to improve their skills.
• Rewarding Overall. It is also rewarding for phy­si­cians to see their MAP survey results increase after participating in the workshops.

With the success of Bayer Institute programs, the region is looking to the next level to keep workshops and information fresh. The Group is also working to make the workshops available to all phy­si­cians in the region.

THE SOUTHEAST PERMANENTE MEDICAL GROUP, Inc.

Sandra Gauthier, the Southeast Permanente Medical Group, Inc., Director of Communications, learned about the Bayer Institute while attending an Accreditation Council for Continuing Medical Education (ACCME) conference several years ago. After attending the Clinician Patient Communication workshop, Sandra began to inquire about ways to bring the program to the Georgia area.

The Southeast Permanente Medical Group, Inc., has long recognized the importance of strengthening clinician patient communication. Georgia was actually the first region in the history of the Kaiser Permanente system to implement team-based care with their members. The leadership of the Georgia group recognizes that good communication skills are a measure of patient satisfaction with their clinicians. Outcomes of the satisfaction survey are incorporated into the clinician's performance evaluation and numerous other quality programs within the organ­i­za­tion.

To successfully rollout the Bayer Institute program, Sandra Gauthier and Rob Schreiner, M.D. were trained to lead the Clinician Patient Communication workshop. Following their training, Ms. Gauthier and Dr. Schreiner received approval from senior leadership to implement the Clinician Patient Communication program in the Georgia region.

The initial workshop was held in March 1999. Enrollment for this workshop was on a volunteer basis. Clinicians were allowed to utilize their CME stipend to cover their out-of-office time. The phy­si­cians who attended the workshop appreciated learning innovative communication skills to increase patient satisfaction.

Based on the positive response from phy­si­cians, patients and administrators, the Bayer Institute Clinician Patient Communication and the Intensive Communication Skills workshops are offered on a continual basis. The Choices and Changes workshop will be offered beginning in 2001.

The Southeast Permanente Medical Group Inc. met its goal to present the CPC workshop to 100 clinicians within 12 months. To date, an additional 30 phy­si­cians have attended the workshop. Clinicians identified as indi­vid­uals who could benefit from this program are encouraged to enroll, but again, participation is still voluntary.

The residential workshop, Intensive Communication Skills has been offered twice with 11 phy­si­cians attending.

Since The Southeast Permanente Medical Group, Inc. began implementing Bayer Institute programs, the region has seen an across-the-board increase in overall satisfaction rates. This includes:

• Steadily increasing patient satisfaction values
• Increasing clinician satisfaction
• Increasing quality of clinical data received
• Increasing quality of decisions
• Reduction in the risk of malpractice suits

The Permanente Medical Group, Southeast is also pleased that healthcare providers from other plans have heard about their communication programs and have observed them.

MID-ATLANTIC PERMANENTE MEDICAL GROUP

The Mid-Atlantic Permanente Medical Group has always felt that the physician-patient relationship is the cornerstone for the delivery of high-quality, satisfying patient care. Effective interaction between both parties is instrumental to the healing process. When patients feel informed, they are more likely to adhere to therapy and continue with their pres­crib­ed treatment modality.

It was a logical decision for The Mid-Atlantic Permanente Medical Group, to offer skills affirmation and enhancement to their phy­si­cians. In this ever-changing world, courses such as Bayer Institute workshops enable phy­si­cians to learn new communication skills while sharpening those they already have.

As a founding member and vice president of the original provider group for Georgetown Community Health Plan (Kaiser Permanente's original partner in this region), Dr. John Hurley was contacted by Bayer Corporation Pharmaceutical Division about their communication courses for phy­si­cians. After hearing about the Clinician Patient Communication workshop, Dr. Hurley decided he wanted to be trained as a faculty member.

The Mid-Atlantic Permanente Medical Group established the expectation that every Group physician would go through the Bayer Institute programs. In order to implement this rule, mul­ti­ple workshops were offered to all group members.

By 1996 most members had completed the workshop. To date, approximately 450 phy­si­cians have participated. The Clinician Patient Communication workshops are offered on a continuing basis; six are planned for the year 2000. The Group is now gearing up to roll out the Choices and Changes program.