EXCEPTIONAL CONTRIBUTION AWARD

Sidney R.Garfield, MD2014

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Sidney R. Garfield, MD, was the physician founder of Kaiser Permanente and one of the great innovators of 20th century American health care delivery.

Dr. Garfield was a surgeon and visionary. He first applied the novel

principles of prepayment, prevention, and group medical practice in the 1930s, while he was providing medical and hospital services for construction workers building the Colorado River Aqueduct in the Mojave Desert.

Then, during World War II, he developed a medical care program for hundreds of thousands of workers and family members at Kaiser shipyards in the San Francisco Bay Area, the Vancouver/Portland area, and at the Kaiser Steel Mill in Southern California. His health care system focused as much on the prevention of illness as on caring for the sick.

Dr. Garfield looked for innovations in health care throughout his career. In the 1950s, his revolutionary hospital designs drew international praise. In 1960, he was in the vanguard of physicians who embraced the computer as a tool that could radically improve the delivery of medical care.

Historians writing about events of the 1900s see the work of Dr. Garfield in co-founding Kaiser Permanente as one of the major social contributions of the century.

The Exceptional Contribution Award

was established by the TPMG Board of

Directors in 2000 to recognize physicians

who are instrumental in the development

and dissemination of ideas and programs

that have a significant impact on patients,

colleagues and the broader community.

Sidney R. Garfield, MD

EXCEPTIONAL CONTRIBUTION AWARD

Sidney R.Garfield, MD2014

Keep your arms on each other’s shoulders and keep your eyes on the stars for innovation and change for the future.

Sepsis Management

Stealthy and swift, sepsis is the number one cause of death in hospitals nationwide. The protocol for sepsis management sounds simple: screen patients with infections for abnormal vital signs and lactic acid levels; if they meet criteria, initiate treatment with intravenous fluids, antibiotics and a central line to monitor response to treatment.

But as Dr. Craig explains, “one of the challenges is that patients with severe sepsis often look good, until all of a sudden they don’t. Those patients whose lactate levels are above four need aggressive treatment, even if they are lying on the gurney reading the newspaper.”

Dr. Craig worked with a multidisciplinary team to develop tools to better diagnose and treat sepsis. They added a test for lactic acid to blood culture orders, and instituted an alert to assemble clinicians to assess the patient and, if appropriate, begin early goal-directed therapy.

Within a year, mortality from sepsis had declined by 50% at Santa Clara, and the best practices the team pioneered were being shared with medical centers.

The team continued to build on their success. They created a “sepsis clock” to ensure the multiple components of the new protocol are completed within a six-hour timeframe; and they stressed the importance of monitoring patients with intermediate lactate levels to help prevent severe sepsis.

Dr. Craig’s focus on sepsis has saved lives at Santa Clara, and has contributed to the dramatic decline in sepsis mortality throughout KP Northern California, where the rate is currently 28% below the national average.

HOSPITAL MEDICINE, SANTA CLARA

Diane Craig, MD

The greatest reward was watching the mortality rate for sepsis fall as we got better at identifying patients quickly and treating them aggressively.

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The real heroes are the doctors who make time to involve their patients in care coordination and the specialists who work together to provide immediate advice and ensure access for our patients every day.

HEAD AND NECK SURGERY, NORTH VALLEY

Robert McLaughlin, MD

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Specialty Care AccessTo understand the spirit with which Dr. McLaughlin tackled the challenge of improving specialty care access, consider his motto: “If you don’t fall, you aren’t skiing hard enough.” “While rethinking specialty care from the patient’s perspective, I fell so many times,” he relates. “But it was worth it, because one of our patient-centered experiments evolved into pConsult.”

That experiment, conducted in the North Valley departments of Head and Neck Surgery, Neurology and Medicine in 2009, proved the value of a phone call. Building on the existing eConsult platform, Dr. McLaughlin and his colleagues demonstrated that with our integrated system of care, many problems that previously would have generated a request for a specialty appointment could be handled more efficiently or even resolved completely if the referring physician called the specialist for advice while the patient was in the exam room. Patients were thrilled to have their fears allayed and their problems solved in such a novel manner.

Based on the success of the pConsult pilot, over the next six months Dr. McLaughlin and his team consulted with physicians in more than 20 departments throughout the North Valley, helping them tailor processes to implement pConsult and provide better care and access to their patients.

Starting in 2010, Dr. McLaughlin began travelling around the region, to share the benefits of pConsult and same-day consultations. Thanks to his vision and perseverance, and to the power of group excellence, patients throughout KP Northern California now experience consistently outstanding and timely access to specialty care.

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Innovations in Emergency Department Care

How can a busy Emergency Department in KP Northern California – with 90,000 visits a year, including 1,500 trauma patients – have a virtually empty waiting room? The answer lies in the model for high-quality emergency care that Dr. Murrell developed with her colleagues at South Sacramento.

It started in 2008 with the Physician-in-Treatment program, which provides patients with immediate care by stationing physicians at the front of the ED. This model provides patients who have low-acuity problems with rapid diagnosis and treatment, and it has created capacity in the other sections of the ED for higher-acuity patients. The impact of Physician-in-Treatment on patient flow and safety has made it the standard in Emergency Departments throughout the region.

Dr. Murrell and her colleagues further enhanced the flow of patients by deploying a computerized team assignment system to match mid- and high-acuity patients with their physicians. She also established a clinical decision area, managed by emergency medicine physicians in collaboration with hospital medicine and other specialties. Another partnership Dr. Murrell forged resulted in the assignment of a hospital medicine physician to the ED.

While Dr. Murrell reports that no one in the ED would choose to go back to the old way of doing things, change is never easy. “One thing I’ve found really useful in changing a culture is to always put the patient at the center. The other critical component is having a vision. Ours is written on a big banner that says, ‘Our vision is to be the best Emergency Department in America.’”

I feel proud of the legacy that we have created. When I work my shift in the ED, I help one patient at a time, but with this enhanced model of care, we have been able to improve care for thousands of patients.

EMERGENCY MEDICINE, SOUTH SACRAMENTO

Karen Murrell, MD

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Camp Taylor

What do you say to the mother of a patient who asks you to help create a free camp for children with congenital heart disease? If you’re Dr. Desai, you say, “Yes.”

Dr. Desai now serves as medical director of Camp Taylor, where children with the disease can safely experience the joys of summer camp.

The program has grown from a single camp with 45 children in 2003, to five camps: youth, teen, family, sibling and leadership (for campers after they turn 18). Under the watchful eye of Dr. Desai and other volunteer physicians and nurses he recruits, Camp Taylor hosted nearly 250 campers and 200 of their family members in 2013.

“Most kids won’t take off their shirts until they’ve been at camp for a while, but the youngest ones aren’t self conscious,” he explains. “On the first day of camp, I saw a 3-year-old boy in swim trunks walk up to another kid about the same age. With a little tiny touch, he reached out and felt the scar on the other boy’s chest. The earth stood still for a moment as these two kids realized that there was another person just like them.”

Camp Taylor sessions last one week, but their impact is felt all year, with children and parents connecting through email and during post-operative visits.

The current challenge facing Camp Taylor is raising funds to build a permanent home, so more children with heart disease can not only survive, but thrive. For more information, visit www.kidsheartcamp.org.

Kavin Desai, MD

The kids take life more seriously because for them every moment is precious; they live life more fully because they don’t know when it may end.

PEDIATRIC CARDIOLOGYGREATER SOUTHERN ALAMEDA AREA

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2000Wendy Huber, MD Dermatology, South Sacramento Latex Allergy Prevention Program

Tom Kidwell, MD Opthalmology, North Valley Re-engineering Vision Services

Keith Matsuoka, MD Head and Neck Surgery Greater Southern Alameda Area Hearing Aid Centers

Barry J. Miller, MD Orthopedics, San Jose Medical Spine Unit

Michael Wilkes, MD Internal Medicine South San Francisco Congestive Heart Failure Program

2001 Ernie Bodai, MD Surgery, North Valley Breast Cancer Stamp

Richard Boise, MD and Maria Borquez, MD Pediatrics, Diablo Service Area Pregnancy Teen Counseling Program

Susan Kutner, MD Surgery, San Jose Breast Cancer Care Delivery

Brigid McCaw, MD Internal Medicine, East Bay Area Family Violence Prevention Program

2002 Louis Fehrenbacher, MD Oncology, Napa/Solano Oncology Clinical Trials Program

Doug Grey, MD Surgery, San Francisco Operation Access

Walter Kinney, MD Ob/Gyn, North Valley Cervical Cancer Screening

Ron Melles, MD Ophthalmology, Redwood City TrackER and Notewriter

Michael Wong, MD Allergy, Central Valley Area Neighbors in Health

2003 Charles Wibbelsman, MD Adolescent Medicine San Francisco Adolescent Health Services

Steve Bornstein, MD Ob/Gyn, South San Francisco Clinical Information Presentation System

Ronald Bachman, MD and Edgar Schoen, MD Genetics, East Bay Area Regional Genetics Service

Eleanor Levin, MD Cardiology, Santa Clara Cholesterol Management, Cardiac Rehabilitation & Heart Failure Programs

Hernando Garzon, MD Emergency, North Valley Urban Search and Rescue Team

2004John Chuck, MD Medicine and Family Practice North Valley New Physician Orientation and Mentoring Programs

Scott Gee, MD Pediatrics, Diablo Service Area CIPS Preventive Health Prompt

Pat Hybarger, MD HNS/Mohs, San Rafael Mohs Surgery Reconstruction Program

Tim Tsang, MD Urology, San Jose E-Consult System

2005Towie Fong, MD Internal Medicine, San Francisco Chinese Bilingual Bicultural Module

Preston Maring, MD Ob/Gyn, East Bay Area Friday Fresh Farmers’ Markets

Mary Pat Pauly, MD Gastroenterology, North Valley Hepatitis C Care Pathway

Charito Sico, MD Pediatrics, Fresno Community Health Fair

David Sobel, MD Internal Medicine, San Jose Health Education and Health Promotion

2006David Baer, MD Oncology, East Bay Area Case Management for Medical Oncology

Sobha Kollipara, MD Endocrinology, North Valley Programs for Children and Adolescents with Diabetes

John Rego, MD Radiology, San Francisco Virtual Radiology and Digital Imaging

KM Tan, MD Radiology, San Rafael Allied School of Health Sciences

2007Rob Burger, MD Occupational Medicine North Valley Prevention and Emergency Management of Youth Sports Injuries

Richard Fleming, MD Internal Medicine, Napa/Solano Volunteers in Public Service

Joseph Phaneuf, MD Dermatology Greater Southern Alameda Area Ashland Free Medical Clinic

Alan Whippy, MD Emergency Medicine East Bay Area Population Disease Management

2014 Sidney R.Garfield, MDEXCEPTIONAL CONTRIBUTION AWARD

2014 Sidney R.Garfield, MDEXCEPTIONAL CONTRIBUTION AWARD

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2008Tom Barber, MD Orthopedic Surgery East Bay Area CyberKaiser

Evan Bloom, MD Pediatrics, South Sacramento Physician Wellness

Paul Preston, MD Anesthesiology, San Francisco Patient Safety

Gail Wagner, MD Hematology/Oncology Greater Southern Alameda Area Matibabu Foundation

Alan Wong, MD Pediatric Hematology/Oncology Santa Clara JW House

2009Richard Dlott, MD Endocrinology Diablo Service Area Cardiovascular Risk Reduction Program

Marc Jaffe, MD Endocrinology South San Francisco Cardiovascular Risk Reduction Program

Warren Taylor, MD Hospital Medicine, Napa/Solano Cardiovascular Risk Reduction Program

Joe Young, MD Internal Medicine, East Bay Area Cardiovascular Risk Reduction Program

2009Gary Heit, MD, PhD Neurosurgery, Redwood City Americare Neurosurgery International

Susan Lindheim, MD Pediatrics, East Bay Area Allen Fischer Local Employee Assistance Fund

Nilima Sabharwal, MD Pathology, San Jose Home of Hope

2010

Brian Hoberman, MD Hospital Medicine, San Francisco KP HealthConnect Inpatient Implementation

Edward Lee, MD Internal Medicine South Sacramento KP HealthConnect Toolbar

Jerry Schlegel, MD Neurology, San Rafael Excellence in Stroke Care

Cliff Sweet, MD Radiology, Santa Rosa Radiology Information Integrator

2011Eileen Crowley, MD Dermatology, Napa/Solano Teledermatology

Douglas Holsclaw, MD Ophthalmology, Redwood City Corneal Transplant Quality of Care

Elizabeth Kass, MD Dermatology, Central Valley Teledermatology

Stephen Parodi, MD Infectious Diseases, Napa/Solano Antimicrobial Stewardship and H1N1 Pandemic Response

2012Robert Broadhurst, MD Pediatrics, South Sacramento Screening and Management for Developmental Disorders

Thomas Kaschak, DPM Podiatry, Fresno Vietnam Medical Project

Anita Lee, MD Radiation Oncology, Santa Clara Multidisciplinary Cancer Care

Daniel Navarro, MD Nuclear Medicine Medical Imaging Technology

Minggui Pan, MD, PhD Hematology/Oncology Santa Clara Multidisciplinary Cancer Care

2013Jorge Gutierrez, MD Pediatric Critical Care East Bay AreaPediatric Critical Care

Mark Hawk, MD Neurosurgery, North ValleyNeurosurgical Services Excellence

Michael Lauer, MD, PhD Cardiology/Electrophysiology Santa Clara, Cardiac Rhythm Management Formulary

Lisa Liu, MD Internal Medicine South Sacramento Cultural Awareness and Community Health Education

2014 Sidney R.Garfield, MDEXCEPTIONAL CONTRIBUTION AWARD

2014 Sidney R.Garfield, MDEXCEPTIONAL CONTRIBUTION AWARD

Visit the TPMG Awards website at tpmgawards.com