"I don't accept that," Cochran says. "We have made a concerted effort to learn and make substantial improvements in our care and outcomes over time. Our physicians combine professional satisfaction with a strong commitment to the mission of the organization. What is necessary is to move beyond self-interest. The physicians have to ask themselves, 'What is my personal mission?'"
The Permanente Medical Group is built around a core set of values and expectations. "We recruit physicians with a sense that we're a group practice. We stand for quality. We measure quality and results," Cochran says. "We think it's important that we tell patients we're going to give them the kind of quality they deserve. You then orient, evaluate, and promote people based on the same set of values and expectations. Eventually you end up with a culture that is very comfortable with a focus on quality, measurement, comparison, and improvement."
Robert Pearl, MD, a plastic and reconstructive surgeon and executive director and CEO of the Permanente Medical Group, says in a typical Kaiser Permanente referral, "our integrated delivery system structure allows the patient who, for example, needs orthopedic expertise to obtain it rapidly. We have the ability today for the primary care physician to call an orthopedic surgeon while you're in the examination room. We have the ability to offer you a same-day visit or to offer you a visit on a different day."
In a community-based medical staff model, Pearl says, the primary care physicians cannot get immediate assistance since they would need referral links to all of the orthopedists in the community, not just one or two. And they would need to have the phone and scheduling system integration to be able to offer the same-day schedule.