Physician Accountability for Physician Competence: Summit VI

The Alliance for Good Medical Practice

Final Reports


Team 1 Team 2 Team 3
Timeline for GtGMP 1.0 Distribution & Feedback Round (Inclusive of Bullet Survey) Draft cover Letter for GtGMP 1.0 Distribution to Alliance Participants and Identify Sidebar Notes to be Added to GtGMP Next Summit: Topics and Outcomes, Invitations (expand the tent?) and Timeframe
Annis, Joseph Adams-Ender, Clara Kowalski, Timothy
Dalton, Claudette Stack, Steven Bailey, Susan
Bechamps, Gerald Cohen, Jordan
Becher, Jr, John Brim, Melanie
Melnick, Donald Spivey, Bruce
Nylen, John
Hafner-Fogarty, Rebecca
Team 4 Team 5 Team 6
Next Alliance Steps for Work on the Shift Good Enough for Now Participant Agreement and Date for Return What's happening out there? And How do we Find Out?
Sheppa, Michael Wilson, Modena Panagopoulos, Amy
Gallagher, Thomas Schneidman, Barbara Davis, Nancy
Kahn, Norman Heard, Jeanne Cox, Malcolm
Wolfson, Daniel Clothier, Carol Clark, Danny
Clyman, Stephen Turton, Frederick
Swartwout, James Rhodes, Robert
Susank, Edward Ayres, Ronald
Galbraith, Robert
Weiss, Kevin
Schoenbaum, Steve
Team 7
System Conditions for GMP Next Steps (Appendix 4)
Pohl, Henry
Van Etta, Linda
Watt, David
Aschenbrener, Carol
Meoli, Frederick



Timeline of Dissemination of GMP

We have two sets of volunteers that we’re going to have sign ups for. For the timelines, first are the steps for dissemination of GMP-USA version 1.0.  We’re going to ask for volunteers for some of this.

In July 2008 we will complete and approve the cover letter here at Summit VI.  Agree on authors and "approvers" for side-bar comments.  Final version of GMP approved within 2-3 weeks of Summit VI. 

In August 2008 we will publish version 1.0 with cover letter and with database comment facilities on the GMP-USA web site so it is captured in a structured manner. 

In September 2008 we will notify Alliance participants that they can now take charge of further distribution of information about the GMP-USA web site These groups are the ones we talked about:

In October 2008 we'll add the "bullet" survey to the web site, open it to public comments (with the results to be segregated from controlled investigational sample). Since there is limited availability, there is no reason not to collect the extra data as that is informative to our further discussions.

In January 2009 we will close first round of comments. We would include in the cover letter information that this will happen. Staff will collate feedback for review by mid-January. We need a panel of Alliance volunteers to review feedback and suggest Summit VII activities relating to the feedback (and maybe version 1.1 or 2.0). 

In February 2009 a group from the Summit reviews feedback and decides on changes based on feedback and next steps. 

Secondly, we have a timeline with steps related to the bullet survey (research format):

In July 2008 we will revise survey instrument based on input from Summit VI and discuss distribution with appropriate sponsors for participants to give us feedback. These could be:

In September 2008 we will finalize plans for inviting individuals to participate.

In October through December 2008 we will do data collection of the feedback.

In January 2009 we will have the data analysis with the primary goal to identify those bullets needing work at Summit VII. 

There are some assumptions about staff availability and volunteers. We recommend two volunteer groups: one to review and develop the sidebar comments and the other to review and analyze the feedback.

Ideally there will be a group who will pre-process some of these comments to save us some work at the next summit.

Let’s get volunteers.

Sidebar Committee
Adams-Ender, Clara
Dalton, Claudette
Melnick, Donald

Feedback Analysis Group
Ayres, Ronald
Bechamps, Gerald
Cox, Malcolm
Meoli, Frederick
Pohl, Henry
Rhodes, Robert
Stack, Steven
Wilson, Modena



Draft Letter

We want this to be simple and reflect what’s in the document without saying everything that’s already in the document.

Click here to open the letter in a new window

I thought having a link to the web site is a good idea on the cover letter either in the body or in the header.

I don’t know if we should list all the organizations who are involved? This could be done by listing them on the left column, on the back, or as a separate attachment.

Would it add value to add “living’ to the document?

If not living, maybe add either dynamic or evolving?



Participant Agreement

Click here to open the document in a separate window

Some of the issues that came up in the previous discussion centered around the idea of inviting and what to do about other stakeholders, how we’re going to address individuals, and how to address funding.

We made a big change by adding individuals and accountability. We are now silent about eligibility. Maybe they will go through the steering committee? We want to maintain the inclusivity that we’ve had so far. We’ll rely on peer pressure from the group to maintain a civil conversation and a civil commons. We eliminated the part that said, if you don’t behave you’re out.

We hope that it’s welcoming to other stakeholders. It will go out with a cover letter that will say more about the Alliance. We have addressed individuals. Some of the points are only applicable to organizations and we reflected them separately.

We think the financial language is good enough for now.

Our next steps if you agree this is good enough, this will go out with a cover letter with a second page with a place to sign. We will defer the language of the cover letter to the steering committee. The assumption has been that it will go to all the organizations that have been participating. But we haven’t talked about whether we’re going to go out and seek other participants.

Q: Is the intent organizational? I think we want to convey that.
A: The document was precisely that this morning and we got feedback that it should also include individuals. So it feels a bit like ping-ponging.
Response: I think it’s actually okay the way it is.



Next Summit

Here are our suggestions for pre-summit reading materials:

  • Information on lessons learned from the VA system
  • Summary of the feedback on GMP 1.0
  • Summary of any recommendations coming from the Steering Committee (if necessary)
  • Summary of the use of the trusted agent within the Common License Application Form (CLAF)
  • Examples of data from initiatives such CAP, IPPI, the Minnesota data project, etc.
  • Copy of the final participation agreement


We hope to have these outcomes:

We want to continue to extend an invitation to all individuals and organizations that have attended any of the summits, consider adding other medical organizations that are not yet participants in the Alliance, and consider extending an invitation to CMS

Our time frame is that the next summit would be in mid-January or February to allow sufficient time to obtain feedback on GMP 1.0.  We also suggest setting the GMP response deadline for mid-November.

Comment: I think we’ll want to identify some outcomes that we’ll want to achieve.

I think the summits are wonderful but I’m not that young, I don’t have that many more years left, I think every 6 months is not urgency and I’d like to see that work is happening more frequently and between summits.


What is happening out there?

We explored several categories of things that are happening out there. We look at the educational continuum (UME, GME, CME). We need to index and catalogue resources with a focus which is less on the system (QI) and more on performance improvement. We also want to consider those initiatives that are top down vs. bottom up vs. a mixed (or hybrid) model.

Our next steps are to survey what's out there, to categorize results by shifts and other dimensions, to mount on an informational web site, to learn from the projects, to develop criteria for success, and to share results more widely.




System Condition for GMP

Although physicians strive to demonstrate the desirable characteristics of a good doctor as outlined in A Guide to Good Medical Practice, the current environment prevents full realization in many settings.  We believe that physicians must take a critical leadership role in addressing the current systems barriers to good medical practice.  Success is dependent on strong collaboration with other key stakeholders.  Opportunities for change that would support physicians' ability to realize the tenets set forth in the Guide to Good Medical Practice to include, but not be limited to... and this is where we want you to go into the wiki and make your suggestions.



Next Alliance Steps for Shift

Click here to open the document in a new window

This group was tasked to discuss ways the Alliance could promote the shift from the old to the new for the 14 items identified by a previous group's work.

Perhaps we do have leaders in some of these areas. We should probably choose which areas that the alliance should or could be involved in moving things along.

We also want to point out what was novel and not already done. We thought that we should have this group appoint an author to a piece that can be developed for publication. We also need talking points we can use with our organizations.

We need to be able to explain what this new state is all about.

We discussed prioritizing the items and focusing on those that the Alliance might be best suited to promote. We recognized that promotion and endorsement of the 14 items by the Alliance might have a secondary benefit of 'putting the Alliance on the map’. We discussed the role of the Alliance in assisting each participant's Board/organization's acceptance of the 14 items. We discussed the role of the alliance participants' boards and organizations promotion of the individual items. We discussed educational tools to 'spread the word', such as speakers kits and information packets. We reviewed the relationship between the GMP and the shift items. We talked about levers the alliance might be able to employ to promote the shift items. 

It appears clear that further discussion regarding the development of strategies to promote the Alliance's endorsement and promotion of the shift items needed to occur.

The publication also represents the messaging. It has a convening power that can be emulated in my own organization. It stimulates collaboration. If our goal is to bring a culture of improvement, then what are the strategies and goals that this group represents? We’re not replicating what other organizations are doing, but highlighting what is unique in this shift.

Let’s collect volunteers to write the shift paper.

Cohen, Jordan
Cox, Malcolm
Dalton, Claudette
Galbraith, Robert
Gallagher, Thomas
Kahn, Norman
Little, Brian
Turton, Frederick
Watt, David

And for the strategic group to discuss how the Alliance should support the shift.

Clothier, Carol
Clyman, Stephen
Davis, Nancy
Finelli, Frederick
Schneidman, Barbara
Sheppa, Michael
Stack, Steven
Stack, Steven
Wolfson, Daniel


Michael Kaufman:  Any closing comments?

I want to thank everybody. This has been an extraordinary two days. I would like to thank Don Mel nick and the others who authored the GMP. It’s a fantastic document.

Let’s recognize Jim Thompson, Carol Clothier, and Frances Cain, for making this whole thing possible.

Also, InnovationLabs for helping us through it.

MK: It’s really an honor and we appreciate being invited to participate with you.

At the first summit we talked about bringing together groups that have tension between them and I appreciate the way we’ve been able to navigate through this.

I appreciate the way you put up the information for us. It was really helpful.

MK: Thanks to Chad for inventing this Illumination Gallery, which is what we call this structure behind us. This is the first time we’ve used this video wall and I think it really brought another dimension to displaying the information.


top of page