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From Chaos to Care: The Promise of Team-Based Medicine

From Chaos to Care: The Promise of Team-Based Medicine

by David Lawrence

Kaiser Permanente is the largest nonprofit healthcare system in the world and is a leader in integrated medical care. A team-based approach that draws on the strengths of the healthcare organization as well as on community resources, integrated care is a most cost-efficient healthcare business model. It also gives patients an all-important sense of control over


Kaiser Permanente is the largest nonprofit healthcare system in the world and is a leader in integrated medical care. A team-based approach that draws on the strengths of the healthcare organization as well as on community resources, integrated care is a most cost-efficient healthcare business model. It also gives patients an all-important sense of control over their conditions and provides the kind of care they can navigate and trust.In From Chaos to Care, Dr. Lawrence shows how integrated care succeeds on both the organizational and human fronts. A blueprint for change and a manifesto for the implementation of satisfying and cost-effective healthcare for all, From Chaos to Care illuminates the path to the future of American medical care.

Editorial Reviews

Dallas Morning News
Offers insight into how medical care can be restructured to benefit patients and their families.
Health Affairs
Must-reading...Those who regulate and legislate health care workers should use this text as a primer on medical practice.
Lawrence makes a compelling case...[His] proposal offers plenty of fodder to get all sides talking about possible solutions.
New England Journal of Medicine
Worth reading...[Lawrence's] perspective will force readers to reexamine their assumptions about what constitutes high-quality care.
Publishers Weekly
Written by the former CEO of the nonprofit health-care organization Kaiser Permanente, this book makes the case for a humane version of managed care that operates under a collaborative model. Lawrence describes how, despite the goodwill of medical practitioners, his terminally ill father suffered needlessly because the treatment he received under Medicare was not coordinated by a medical team. Lawrence also contrasts the care Rebecca (a fictional child with asthma) received when she was treated by her solo pediatrician (also fictional) with the more integrative and effective care provided after her family's insurance was changed to a health-care organization. Believing that the age of the individual practitioner is over, Lawrence emphasizes team-based delivery of medical services within managed care and argues for the necessity of making critical patient information easily available to doctors and care-providers. Collaborative care for chronic illnesses makes sense, he argues, since staff access to technology to facilitate referrals and decisions about treatment can be delivered under the umbrella of health organizations. He also identifies several HMOs that, according to him, are models of the team-based approach. However, his examples of corporate managers such as Jack Welch, former CEO at GE, as an inspiration to health-care organizations that are trying to hold down costs is ultimately unconvincing. (Nov.) Copyright 2003 Cahners Business Information.
Library Journal
Imagine a team of medical professionals, including doctors, health educators, nurse practitioners, pharmacists, and therapists, that is interested in and knowledgeable about your personal medical history. These experts have access to the latest research and technology, as well as your complete medical and pharmacological history, and communicate regularly with one another and are open to your input to form a treatment plan. Sound too good to be true? Lawrence, a physician and the longtime CEO of the large, not-for-profit HMO Kaiser Permanente, contends that team-based medical care not only works well but can also provide better treatment than traditional single practitioners. Lawrence acknowledges that there are many challenges to achieving the goal of integrated, team-based care, but he offers numerous real-life examples of organizations heading in this direction. Although the lack of bibliographical references may frustrate the scholar, this brief but persuasive book is highly recommended for public libraries and health science collections.-Tina Neville, Univ. of South Florida at St. Petersburg Lib. Copyright 2002 Cahners Business Information.

Product Details

Da Capo Press
Publication date:
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5.86(w) x 9.23(h) x 0.55(d)

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Author Essay

The sicker we are, the more people it takes to care for us.  Rarely can one physician do it alone.  Medicine has come too far, the science and technology are too complex, the diseases are too challenging.  Yet specialization often leads to fragmentation.  A high proportion of Americans describe the medical care system as a "nightmare to navigate".  We might long for the kindly family physician in the hopes of simplifying what seems an overwhelmingly complex process.  But these simple solutions are as ill-suited to the challenges we face as using the pony express to deliver today's communications.

Major forces affect medicine and will continue to do so for the foreseeable future.  We can move across the globe quickly, bringing us in contact with diseases not previously associated with our climates, while terrorism and bioterrorism have become part of our daily lives. Because of improvements in public health, the majority of illnesses with which we now live are chronic, some of them lasting a lifetime.  Moreover, as a nation of immigrants, we speak many languages, come from many backgrounds, and carry many expectations. Couple this with our skepticism about government and institutions, our strong sense of independence, and our drive for information and answers. We are a population of demanding citizens with high expectations!  And all the while, medical science and related technologies expand like a tidal wave.

Faced with these realities, how can we construct a medical care delivery system that responds to our needs for intimacy and trust, for caring and empathy so vital to our well-being?

First, patients and families must have the skills to help themselves.  What the medical care system provides is vital, of course.  But if patients don't learn to manage their illnesses, their medicines, and their food and sleep, the best medicines in the world won't help very much. 

Second, care must be given by a team of health professionals.  The complexity of medical science has moved far beyond the ability of a single doctor to deliver safely and effectively.  Physicians are absolutely critical and usually lead the team. However, help from nurses, pharmacists, nutritionists, physical therapists, and social workers -- all working in a closely coordinated team -- are essential to good patient outcomes. 

Third, the team must be part of a larger organization where the capacity exists to build the information systems, communications systems, and knowledge management systems required to practice safe, effective, and responsive medicine today and in the future. 

Finally, patients and families, teams, and organizations must be closely linked to the many resources available in the community…advocacy groups, educational resources, and public health departments. 

These four requirements weren't as important when illnesses were acute and self-limited.  But for longlasting illnesses that often require changes in our daily lives, for patients with high expectations and significant needs, they are vital. When these changes are knitted together using powerful tools adapted to the unique requirements of medicine, the results are attractive for patients and professionals alike.  Patients cared for this way report higher satisfaction, greater responsiveness, and better ability to deal with the inevitable ups and downs of their illnesses.

A road exists out of the chaos of medical care today, then, marked by important innovations around the country.  We must take it upon ourselves to ensure that the care system we require and pay so much for incorporates the lessons and completes the transformation we so urgently require. 

David Lawrence, M.D.
Chairman Emeritus, Kaiser Permanente
September 29, 2002






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