Tag Archives: Honoring Choices

Leadership Pulse – July 31, 2014

Get the Conversation Started

As physician leaders, you know that talking about end of life decisions is not always comfortable and many times it’s a topic both patients and physicians simply avoid altogether. In response to the Medical Officer Collaborative’s Call to Action, WSHA and WSMA have taken significant steps towards a statewide community plan to promote advance care planning through Honoring Choices Pacific Northwest.

Implementation Plan: With the guidance of the Honoring Choices Work Group, WSHA and WSMA are working with Dr. Bud Hammes from Gunderson Health and Respecting Choices to develop an ambitious five-year, six-phased strategy to bring an adaptable resource to communities across the state. The First Steps® Design & Implementation strategy offers both advance care planning (ACP) curriculum and a customizable process for healthcare delivery systems, religious affiliations, consumer advocacy groups, and other community partners to promote ACP through conversation and stewardship of information. A critical aspect of the plan is to certify Faculty, Instructors and Facilitators in our state, which will ensure the sustainability of the program into the future.

Website: The Honoring Choices Pacific Northwest website is currently being developed, with a proposed go-live in late September. The website will provide resource-rich information on advance care planning for both the public and for healthcare professionals, including a periodic e-newsletter, social media outlets and an Invite Family & Friends section for sharing the importance of having the conversation.

For more information on the initiative, please contact Tanya Carroccio, WSHA’s director of quality and performance improvement, at TanyaC@wsha.org.

Washington State Choosing Wisely Task Force

Choosing Wisely25% of patients in Washington with an uncomplicated headache receive either an MRI or CT—contrary to the Choosing Wisely recommendation: “Don’t do imaging for uncomplicated headache.”

As a result of the Medical Officer Collaborative’s Call to Action, the Washington State Choosing Wisely Task Force was formed to develop a pragmatic system to implement Choosing Wisely across the state, with a focus on changing behaviors, driving results and creating measurable improvement.

The task force is comprised of 20 physician leaders from clinics and hospitals across the state who are leading efforts within their organization to implement the Choosing Wisely recommendations. The Washington State Medical Association, the Washington Health Alliance and the Washington State Hospital Association jointly support the statewide task force.

The task force recently published the document, Choosing Wisely Claims-Based Technical Specifications (pdf 768kb), which includes a set of measures that can be used to evaluate provider integration of Choosing Wisely recommendations. Several organizations across the state have already used these specifications to run reports on their own clinical data and are identifying and addressing opportunities for improvement.

The task force is launching an initiative to “Change One Thing.” By focusing efforts on a single Choosing Wisely recommendation, we can create a measurable difference and learn how to integrate Choosing Wisely recommendations, generally speaking, into practice. The Task Force selected the recommendation: “don’t do imaging for uncomplicated headache,” which came from the American College of Radiology’s “List of 5.”

Based on the Washington Health Alliance’s analysis of 2012 claims data, 25% of patients with an uncomplicated headache received either an MRI or CT. The goal isn’t 0%; however, the general sense of the task force is that 25% is too high. Because this particular recommendation impacts a broad range of specialties and providers, has a high “N”, and exposes patients to unnecessary radiation (in the case of CTs); this Choosing Wisely recommendation provides us with an opportunity to make a meaningful impact for patients in Washington state.

The task force is currently developing a toolkit that physicians can use to integrate Choosing Wisely into their organization’s practice.

If you’d like more information about how to integrate Choosing Wisely into your organization, please email Jessica Martinson, WSMA’s director of clinical education and professional development, at Jessica@wsma.org.

Dr. John Vassall’s Book Recommendation

Why is it so hard to make lasting changes in our organizations, in our communities, and in our own lives?

SwitchSwitch: How to Change Things When Change is Hard
I recommend this book for those trying to make organizational change. We have been told that physicians will change if they are just shown good data. It turns out that is not necessarily true.

The authors of Switch, using the analogy of a rider guiding an elephant down a pathway, explore three requirements for people to make a change: they must intellectually understand the change (Direct the Rider), they must accept and embrace the emotional aspects of the need for change (Motivate the Elephant) and they must know in specific terms how to get from present state to future changed state (Shape the Path).

The authors provide valuable tools to overcome challenges with large-scale change by factoring in the human decision-making experience. This book is not only engaging, it is applicable to many of the challenges we face in the ever-changing health care environment.

Join WSHA 100K Children Campaign!

100K Kids Campaign logoRadiation in Children, Less is More

Be a national leader and join the innovative work being accomplished by the Washington State Hospital Association 100K Children Campaign! This is a statewide effort to make diagnostic imaging safer for our children through dose optimization and imaging appropriateness.

The Campaign kick-off was celebrated at the WSHA Safe Imaging Safe Table Collaborative on July 8, 2014. WSHA is partnering in this work with the national 100K Children Campaign. National experts and LEAPT (Leading Edge Advanced Practice Topics) hospitals shared compelling data on the importance of understanding dose data and ensuring providers have the information needed to make the best choice for their patients. Hospitals will be collecting data related to observation versus CT for pediatric minor head trauma, ensuring dual phase studies are performed only when indicated, making a public commitment to the use of pediatric protocols, and having a process to collect dose information for pediatric head CT.

Learn more about this initiative at the 100K Children Campaign Safe Table Webcast on August 21st from 1-2 p.m. To join or for questions, please contact Becky DeMers at beckyd@wsha.org or 206-216-2509.

Washington State Health Care Innovation Plan (SHCIP)

The effort to transform Washington’s health care system is one of the largest efforts of its kind and guided by the principal that no one individual or organization alone can make it happen. Working together, we can achieve better health and better care at lower cost for Washington’s residents. ~Healthcare Authority

WSHA and WSMA members are reforming structures and processes to improve health care quality and reduce costs. We have seen incredible changes in the past few years; including a focus on population health and how we can work together at the community level to support better health and health care.

At the same time the state has been considering ways to support transformation. To help finance and spur change, Washington state submitted a grant application to the Center for Medicare and Medicaid Innovation (CMMI) for funding to support the plan for a healthier Washington. “The $92.4 million application proposes to invest deeply in connections and active collaboration with Washington’s communities and providers to produce better health and better care at lower cost. The funding is Washington’s opportunity to take the State Health Care Innovation Plan–completed in December 2013 with the participation of hundreds of individuals across the state–to the next level of implementation.”

The State Health Care Innovation Plan for a healthier Washington is guided by three core strategies and seven building blocks. Click here for details on the plan.

To incorporate some of our work into the plan, the Washington State Hospital Association and the Washington State Medical Association teamed up with the Washington State Association of Leaders of Public Health Organizations.  Building on our success with sharing best practices in a safe table format, we suggested we could use the same structure to exchange and share ideas on community health. Where are partnerships working well? What roles do the providers play, and what roles does the public health agency play?  What barriers are there to collaboration, and how can they be addressed?

All three organizations believe our members have a lot of experiences to share and learnings best come from one another. It is too soon to know if the state will take us up on our offer of support. It is not an idea, though, that we will let die even if the state is not interested.  Expect to hear more from us in the coming months about how we can provide information, tools, and a forum to exchange ideas.

WSMA Leadership Development

The need for strong physician leadership is more important than ever. To help build these essential skills, the WSMA offers the following valuable opportunities.

WSMA & UW Physician Leadership Course

The WSMA has partnered with the University of Washington Graduate Programs in Health Administration and UW Professional and Continuing Education to offer a 40-hour leadership course focusing on:

  • Leadership and conflict management
  • Strategic planning and management
  • Safety and quality management
  • Finance
  • Communication and advocacy

The 10-week course is a combination of face-to-face and online learning. Members receive a tuition discount. This course is offered twice per year. For full course syllabus and application information, contact Lynda Sue Welch at (206) 956-3622 or lyndasue@wsma.org. This activity has been approved for AMA PRA Category 1 Credit™.

Annual WSMA Leadership Development Conference

Leadership skills are essential for physicians regardless of practice setting—and were not necessarily taught in medical. This conference is one of our most popular meetings. Sessions are highly interactive and enable physicians to walk away with concrete ideas and sills that can be put to immediate use. The 2015 WSMA Annual Leadership Development Conference will be held May 15-16 at Campbell’s Resort at Lake Chelan.

Physician/Administrator Team Leadership Course

Teamwork is necessary to produce better outcomes. Having the whole team on the same page for the right reasons is crucial to drive real change. The WSMA is currently developing our Physician/Administrator Team Leadership Course, which will employ a custom-designed curriculum to develop the skills necessary to ensure a team’s success. The program will focus on four critical areas: communication, planning, patient safety and cost effectiveness. More details about the course will be made available later this summer.

American College of Physician Executives

The WSMA, in conjunction with the American College of Physician Executives, now offers members access to ACPE’s catalog of 10 specifically chosen online leadership courses. WSMA members get the ACPE member rate, plus an additional 20% off. These activities have been approved for AMA PRA Category 1 Credit™.

For more information about the WSMA’s leadership development opportunities, please contact Jessica Martinson, WSMA’s director of clinical education and professional development, at jessica@wsma.org.

Voluntary Survey


Dear Medical Officers,

As you know the changing landscape of healthcare in the United States provides Physician Health Programs with a number of challenges and opportunities. Changes in our healthcare system including implementation of the Affordable Care Act and the aging of both the physician and general populations, the need for physicians and their services has increased at a time when many physicians are leaving practice due to age, physical and mental health issues, dissatisfaction and/or burnout.

Changes in the structure of practice as well as changes in practice patterns including the rise of multi-disciplinary teams as well as increasing reliance on physician extenders has led to ongoing increases in stress. Physician Health Programs are uniquely positioned to assist hospitals, practices, and clinics in supporting the functioning of physicians.

To respond to the many changes facing the healthcare industry, we were interested in completing a needs analysis to determine what issues (substance use, aging physicians, burnout, disruptive behavior, etc) those in healthcare leadership role face in dealing with physicians providing services in their facilities. We were also interested in exploring their knowledge of resources as well as their perceived needs for additional services.

Please take a few moments to complete this survey. Thank you for your participation.


Sandon K. Saffier, MD, MBA
Director of Consulting on Quality
Wales Behavioral Assessment

Upcoming Events

September 4 WSHA Safe Table Event – Safe Deliveries Roadmap
September 5 WSHA Safe Table Event – ADE Prevention and Antimicrobial Stewardship
September 19 WSMA Medical Staff Peer Review Workshop
September 19-21 WSMA Annual Meeting: Affordable Care Act – Challenges and Opportunities
September 23 WSHA Safe Table Event – Readmissions
October 30
WSHA & WSMA Medical Officer Collaborative Safe Table
Please note: the date has been changed from October 14 to October 30
October 15-16 2014 WSHA 82nd Annual Meeting: Embracing Disruptive Change in Health Care
 October 29 WSHA Safe Table Event – Infections


Leadership Pulse – April 15, 2014

New Release! Patient Safety: Transforming Culture Toolkit

Despite tremendous efforts to address preventable harm to patients in healthcare, we continue to see high rates of harm. Research confirms the key relationship between organizational culture and the ability to consistently deliver services which provide value and good outcomes.

A safe culture is an environment in which there is shared responsibility, role clarity and open and frequent communication related to safety. By the nature of your roles leading care in the community, at the bedside in clinical units, and in acute care operations; you as physician leaders are well-positioned to have a substantial influence in creating a safe culture.

Through the Partnership for Patients initiative, WSHA and WSMA developed a toolkit to support physician leaders in strengthening your organizations’ culture to achieve safe, timely, effective, efficient, equitable and patient-centered care. The focus of the toolkit is on high-impact approaches that are effective in a clinic or hospital’s journey toward a safe culture. Click here to access the toolkit.

If you would like more information about the initiative, please contact Jessica Martinson, WSMA’s director of clinical education and professional development at jessica@wsma.org.


Have you had the conversation?

April 16 is National Health Care Decision Day and the Honoring Patients’ Choices work group wants to know if the hospital and clinic Medical Officers have started the conversation about advance care planning in their own institutions…and at home.

Washington State Hospital Association and Washington State Medical Association, in alignment with the Medical Officer Call to Action and the Honoring Patients’ Choices work group have partnered with Institute of Healthcare Improvement (IHI) Conversation Ready to increase awareness and education on advance care planning for both the community and in the health care setting. The Conversation Project is promoting community awareness through mass communication surrounding the April 16 Health Care Decisions Day.  Recognizing the importance of respecting what patients want and the tremendous efforts regarding end of life and advance care planning, WSHA and WSMA aligned with Twin Cities Medical Society Honoring Choices® and have plans to affiliate the trademark to create Honoring Choices Pacific Northwest®, which will provide a resource rich website for both community and clinicians.  More exciting news to come as WSHA and WSMA work with leaders to continue to inspire, educate and empower the public and providers about the importance of advance care planning.

For more information on the initiative, please contact Tanya Carroccio, WSHA’s director of quality and performance improvement, at tanyac@wsha.org.


Washington State Choosing Wisely Task Force

The goal of the statewide Choosing Wisely task force is to develop a pragmatic system to implement Choosing Wisely across the state, with a focus on changing behaviors, driving results and creating measurable improvement. The task force is comprised of 20 physician leaders from clinics and hospitals across the state who are leading efforts within their organization to implement the Choosing Wisely recommendations. The Washington State Medical Association, the Washington Health Alliance and the Washington State Hospital Association jointly support the statewide task force.

Recent work has focused on developing technical specifications to analyze performance using claims-data at a county level on select Choosing Wisely recommendations with the goal of educating physicians across the state on opportunities for improvement. No current measurement specifications exist, so the task force’s “Choosing Wisely Claims-Based Technical Specifications” packet will be the first of its kind in the nation.

Going forward, the task force plans to identify one Choosing Wisely recommendation on which everyone will focus their efforts with the goal of creating measurable change. We will also develop education and communication strategies and ultimately a toolkit to support physicians’ efforts to integrate the Choosing Wisely recommendations into their practice.

If you would like to confirm who is representing your organization on the Choosing Wisely Task Force, please email Jessica Martinson, WSMA’s director of clinical education and professional development, at Jessica@wsma.org.


2014 WSMA and WSHA Joint Legislative Advocacy Priorities

The Washington State Medical Association and the Washington State Hospital Association work together on statewide advocacy efforts that are of paramount importance to physicians and hospitals. As partners in these efforts, these two associations worked together on policy and budgetary issues during the 2014 legislative session.

We wanted to take the opportunity to update you on the status of important issues we partnered on during the session:


  • Telemedicine – Advocated for legislation to guarantee that if an insurer covers a clinical service on a face-to-face basis, they will also cover the same service if it is provided using video technology; payment levels subject to negotiation.Status: Unsuccessful. This bill died in the Senate due to concerns about increasing access to “webcam abortions.” This was exceptionally frustrating as the bill would in fact increase women’s access to help to maintain high-risk pregnancies.  We urge WSMA and WSHA members to express their disappointment to members of the Senate Republican Caucus.
  • Crisis Standards of Care – Advocated for legislation to provide liability relief if providers follow state triage requirements in a government-declared major disaster or emergency when adequate health care personnel or supplies are not available, such as an earthquake or H1N1 outbreak, and allow for emergency credentialing.Status: While weakened, this bill did pass and allows for easier emergency credentialing. It grants health care providers immunity from civil liability arising out of credentialing or granting of practice privileges during an emergency.
  • Mental Health Funding – Advocated for legislation to correct an error in mental health funding tied to Medicaid expansion, secure additional funding for capital and operating costs for new evaluation and treatment centers, and create new pathways for the integration of behavioral and mental health care.Status: The legislature made major new investments totaling almost $18 million in mental health.  This includes $4.5 million to correct the previous error and will pay for mental health services that are not matched by Medicaid, including providing funding for Institutes for Mental Disease (free-standing psychiatric hospitals with more than 16 beds).  It also includes funding for three Evaluation and Treatment (E&T) facilities in King, Spokane, and Thurston-Mason counties, which if built, should help to reduce inpatient need; Program of Assertive Community Treatment teams in King, Pierce, and Spokane counties to serve people who are high risk for rehospitalizations; and recovery services in the Greater Columbia, Grays Harbor, and North Sound regions to serve people who have been committed and are transitioning back into the community.

    WSHA and WSMA also advocated for significant mental health funding in the capital budget to help create new inpatient psychiatric capacity, but the legislature reached an impasse on the capital budget and did not enact any capital funding for any projects this year. This is very disappointing. It is unclear if without capital funding, the new Evaluation and Treatment facilities can move forward.

  • Health Care Reform – Advocated to defer decision on whether to create a new state operated program (Federal Basic Health) to eliminate almost all premiums for those less than 200 percent of poverty until more information on enrollment is known. The decreased premiums are proposed to come in part through providers accepting Medicaid-like rates.Status: The decision was deferred. The legislation that took shape would have required the Health Care Authority (HCA) to perform econometric modelling and reporting regarding the establishment of the Federal Basic Health Care Program, but this was not passed.  The future of the program is unclear. The two associations will continue their strong work to enroll people in Medicaid and the Exchange and work for the success of those programs.
  • Transparency and All-Payer Claims Database – Supported the development of meaningful, accessible data that includes physician- and hospital-friendly policies when implementing a statewide All-Payer Claims Database.Status: The bill that passed includes provisions to create and implement a statewide all-payer claims database but includes only those claims from state and federal monies (i.e., Medicaid, etc.).  This is a first step, but its usefulness remains to be seen.
  • Access to Primary Care – Advocated to retain funding for primary care support through continuing the Medicare rates increase for Medicaid providers.Status: Unsuccessful. Given the slimness of the state budget, this budget request was a heavy lift at $24.8 million and was not adopted by the state legislature.

If you would like to learn more about the legislative priorities listed above and how to get involved next year, please contact Katie Kolan, WSMA’s director of legislative and regulatory affairs at kak@wsma.org or Cassie Sauer, WSHA’s senior vice president of advocacy and government affairs at cassies@wsha.org. Click here for WSMA’s 2014 Legislative Summary.


Upcoming Events

April 30 or May 1 WSHA Patient Safety CEO & Trustee Summit
May 16-17 WSMA Annual Leadership Development Conference
May 28 Washington Patient Safety Conference
July 1 Medical Officer Safe Table Learning Collaborative
September 20-21 WSMA Annual Meeting