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Philadelphia: Cradle of Liberty

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 ?

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Philadelphia: Cradle of Liberty

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  1. Philadelphia: Cradle of Liberty

  2. WELCOME THE DRAGON:Opening the Heart of Balint William L. Miller, MD, MA Lehigh Valley Health Network The 17th International Balint Congress Philadelphia, PA September 8, 2011

  3. Ranier Maria Rilke

  4. A CASE

  5. Who is the doctor? • Where is the patient in Balint? • Where is the illness located?

  6. Change & Transformation Established Traditional Practice Critical Mass of Patients, Clinical Processes, & Staff Change Change Practice Redesign Space & Office Design Access Design Care Process Design Technology Design Visit Types Financial Models Identity Shift Web Portal Shared Record Teams Proactive, Planned Care Transformation Transformation Paradigm Shift Citizen of Medical Neighborhood Patient-Centered Care Accountable Population-Based Care Whole Person Holistic & Comprehensive Care PCMH

  7. Who Is the Doctor?

  8. Dragon Slayers?

  9. ObservationIntervention DOPC STEP-UP Direct Observation of Primary Care (1994-97) Study To Enhance Prevention by Understanding Practice (1996-2000) P&CD Cross-Disciplinary Literature Prevention & Competing Demands in Primary Care (1996-99) NRN-D ULTRA Using Learning Teams for Reflective Adaptation (2002-07) IMPACT SCOPE Insights from Multimethod Practice Assessment of Change over Time (2001-2004) EPOCH EPIC NDP National Demonstration Project (2006-08) CQI

  10. Lessons 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

  11. A Transformed Physician Time for a Good Drink! • Team-based Care • Collaborative Care • Facilitative Leadership • Population Management • Multiple “Channels” of Care • Patient Partnership • Transparency of Care

  12. Where Is the Patient in Balint?

  13. Patient Experience of Care Got Worse

  14. Where Is the Illness Located?

  15. Health Care Spending per 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

  16. Tomorrow’s Balint?

  17. Welcoming the Dragon!

  18. A Case Revisited

  19. Ranier Maria Rilke

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