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Permanente Medicine:
The Permanente Medicine Map
By Jon Stewart, Associate Editor

Early in the effort to better clarify and articulate the basic principles of Permanente Medicine, everyone involved in the project sensed that the real value of the work was being missed or undermined by the form in which the work was presented--the usual PowerPoint discussion document, in this case running to more than 50 pages of often obtuse, highly abstract language. We all felt a need to get our arms around the concept as a unified whole rather than as a series of discrete principles. We wanted to "see" how all the pieces related to one another and to the historical, professional, and industry environment that helped shape them. Hence, the Permanente Medicine Map.

The map grew out of a series of discussions and focus groups led by Tomi Nagai-Rothe, a graphic artist/facilitator from Grove Consultants, International, of San Francisco. Her firm virtually invented the technique of graphically mapping complex corporate mission and strategy statements to enhance the clarity of strategic thinking and communication. As the map developed, various versions of the 4' by 8' graphic were mounted on conference room walls to stimulate work group discussion.

This, then, is the story of Permanente Medicine, the conceptual vehicle (or fleet, in this case) that we depend upon to carry us to a sustainable future.

The Permanente Story, So Far. . . .

The Permanente Fleet, representing all the PMGs and manned by physicians, employees, and Health Plan members, sets out upon a hazardous sea in search of the distant shores of the KP Promise, which represents success and sustainability. The Fleet, pushed along by the powerful winds of the group ethic, sails forth from distant historical streams that carried Permanente through the construction of the L.A. aqueduct in the Mojave Desert, the Grand Coulee Dam in the 1930s, the Kaiser shipyards of WW II, and past Lake Tahoe, where the fundamental Kaiser Permanente partnership was hammered out in the Tahoe Agreement in 1955.

Already, the Fleet has encountered the rough seas of the financial crisis of 1997-98, and some medical groups have drifted into the dangerous doldrums of inconsistent performance. Meanwhile, fee-for-service is vanishing beneath the waves, while some competitors are being swept up in a vicious whirlpool of industry consolidation and merger. Ahead lie the hazard-strewn narrow straits and rocky shoals of government regulation, rising medical costs, the temptations of for-profit conversion, and the punishing storms of the managed care backlash. Pharmaceutical sharks lurk in the narrows.

Fortunately, the Permanente Fleet is navigating itself into the Current of Evidence-Based Medicine, which leads through the hazards and into the Sea of Superior Care that will be made possible by new information technology acquired at Silicon Island. What's more, the Fleet is superbly equipped with the latest navigation technology and with a superstructure of time-tested, ethics-based principles. As illustrated in the cutout in the bottom right corner, the sturdy sails of self-governance, self-management, and group responsibility power each ship of the fleet. And the Labor-Management Partnership is there to hoist the dead weight of labor conflicts that have held us back in the past. In the cutout on the left, the three performance principles of quality medicine, the Permanente-patient relationship, and wise resource management help each ship steer a safe course, aided by the latest in navigational tools, including the Care Management Institute's clinical guidelines and a robust set of performance measures.