Management

also see organisationssuch as Kaiser Permanenteas frontrunners in realisinga truly competitive healthcare market, in whichorganisations compete withregard to prices, but also serviceand quality. Moreover, for the Dutch,Kaiser Permanente is an outstandingexample of organising effective cooperationin primary care.At Kaiser Permanente, data management is the main guideline forthe provision of primary care. Since the introduction of an overallelectronic health record, the work of primary care providers hasgradually shifted from their consultation rooms to their offices. Onan average day a primary care physician can see 20 to 24 patients inperson and 80 patients electronically. In their offices, physicians checkand refill medications, answer email messages from patients and mostimportantly decide on the follow-up of test results. Moreover, labresults have become central in how care providers and patientsunderstand both disease and healthy living. An important question iswhether and under what circumstances the use of data is productiveor deceptive.“During my observation I have seen how both patients and physiciansstruggle with the shifting boundaries between normal and abnormal.It is the drugs – especially the direct costs and the possible side effects –that patients are supposed to take in, which makes both patients andphysicians feel uneasy. Yet, thanks to the widespread use ofantihypertentives, cholesterol-lowering drugs and antidiabetics,the number of deaths from cardiovascular diseases and stroke is –according to their own data – reduced by 30% at Kaiser Permamente.”In 2011 and 2012, Antoinette de Bont will further study the effectiveorganisation of primary care. With the experience gained at KaiserPermanente, she aims to contribute to the development of integratedand more powerful organisations in primary care.29