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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 ? - PowerPoint PPT Presentation
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Philadelphia: Philadelphia: Cradle of Cradle of LibertyLiberty
WELCOME THE WELCOME THE DRAGON:DRAGON:
Opening the Heart of BalintOpening the Heart of Balint
William L. Miller, MD, MALehigh Valley Health NetworkThe 17th International Balint CongressPhiladelphia, PASeptember 8, 2011
Ranier Maria RilkeRanier Maria Rilke
A CASEA 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
Teams Proactive, 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
PCMHPCMH
Who Is the Doctor?Who Is the Doctor?
Dragon Slayers?Dragon Slayers?
ObservationObservation IInterventionntervention
DOPC STEP-UP
IMPACT
Direct Observation of Primary Care (1994-97)
Study To Enhance Prevention by Understanding
Practice (1996-2000)
Insights from Multimethod Practice Assessment of Change
over Time (2001-2004)
P&CDPrevention & Competing
Demands in Primary Care (1996-99) ULTRA
Using Learning Teams for Reflective
Adaptation (2002-07)
NDPNational Demonstration
Project (2006-08)
Cro
ss-D
isci
pli
nar
y C
ross
-Dis
cip
lin
ary
Lit
erat
ure
Lit
erat
ure
CQI
EPOCHEPIC
SCOPE
NRN-D
Lessons About DocsLessons 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 PhysicianA 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!Time for a Good Drink!
Where Is the Where Is the Patient in Balint?Patient in Balint?
Patient Experience of Care Got Worse
Where Is the Illness Located?Where Is the Illness Located?
0
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2000
3000
4000
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7000 United StatesGermanyCanadaFranceAustraliaUnited Kingdom
Health Care Spendingper capita ($US Purchasing Power Parity)
2008 OECD Data
United States $7538
Germany $3737
Organization for Economic Cooperation and Development: Health at a Glance 2010 http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html
Tomorrow’s Tomorrow’s Balint?Balint?
Welcoming the Welcoming the Dragon!Dragon!
A Case RevisitedA Case Revisited
Ranier Maria RilkeRanier Maria Rilke