WHAT WE ARE DOING: Overview of Pursuing Perfection in Whatcom County, WA

In Whatcom County, WA, providers, payers and patients are working together to design and build the system of care that patients want.

Pursuing Perfection in Whatcom County, WA. is the current phase in our community's ongoing improvement of the healthcare system. Our efforts have been clarified by the Institute of Medicine's (IOM) Quality of Health Care in America Project and it's final pronouncement, Crossing the Quality Chasm Report, Our efforts have been accelerated by a two year, 1.9 million dollar grant from the Robert Wood Johnson Foundation; matched by the investment of more than three million dollars of local provider funds. We have as thought partners the staff of the Institute for Healthcare Improvement (IHI) and more than a dozen other organizations in the US and Europe who are working together toward very similar goals.

The Chasm Report documents how terribly broken the system is and it calls for revolutionary improvement in US Healthcare. The grant calls for nothing less than organizational transformation for all care providers and payers. Three necessary components for transformational improvement are 1) system improvements, not trying harder within the current system, 2) putting patients at the center of all system designs and in control of their own healthcare decisions; and finally 3) cooperation among clinicians both in the design/operation of the system and in support of individual patients needs.

We, in Whatcom County, WA, have chosen to improve the delivery of chronic disease care starting with diabetes and congestive heart failure. The care we provide will be based on the best scientific evidence and patient preference. We are also working to support patients and their teams of providers. There are clinical care specialists (nurses) to help patients navigate the current dysfunctional system and to help patients develop self management skills. We have developed a shared care plan that helps support the patient's efforts at self management as well as keeping all of the care team on the same page.

We are redesigning the way that clinic/office work is done so that it is much more responsive to patient needs through improved efficiency, fewer delays, use of e-mail, and internet.  All of which are being measured along with patient satisfaction.

We are making public promises to patients. We are reporting publicly our performance on these promises.

Since the current payment system can work against any of these innovations, we are formally modeling the benefits and costs of this new way of providing care so that payers and providers can do "what if" scenarios and together develop rational payment policies to support a radically improved system of care without increasing overall costs.

We plan to make the outcomes of these pilot efforts so attractive to patients, providers, and purchasers that they will be preferred by all patients and adopted by all providers in Whatcom County.

It seems very likely that the needed essential innovation in healthcare is sociological, more than technological innovation, more than economic innovation. We have more advanced medical technology than we can currently deliver to patients. We spend abut twice as much per person on healthcare delivery in the US as is spent in Great Britain and there is little to indicate our patients have better health or higher satisfaction as a result. The sociological innovation will be discovering how to cooperate. Some community will discover how they can cooperate among providers and with patients. That is the highly leveraged innovation. That community will change everything for the rest. The sciences of complex adaptive systems and social networks need to come together. To these we need to add the art of community conversations.