philadelphia: cradle of liberty

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

1000

2000

3000

4000

5000

6000

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