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The Main Thing

Over the past months, many new providers have joined Evergreen. I want to welcome each one. Each of you brings something unique, something special, something we need, to our group. All of you will add energy that can lift us toward our goals.


Warren Buffet is a self-made multibillionaire whose personal wealth was acquired entirely within his lifetime. The story is told of a conversation he had with the pilot of his personal jet.


"You must have more goals in your life than transporting me around”, said Buffet.

The Pilot admitted he did. Buffet than gave him a 3-step process for prioritizing success. This is what he shared:

  • Write down 25 career goals

  • Do some soul searching and circle the 5 highest priorities. Just 5.

  • Look hard at the 20 goals you didn't circle. These you avoid at all costs. Because these are what distracts you, they eat away time and energy, taking your eye from the goals that matter more.

This story resonated with me because of the distractions we face in doing our job. It isn't that these other things are evil or nonsense. In fact, they were included close to the top of our priorities. That is why they can be powerfully seductive in taking our eye off what we care about most.


It is only a matter of time until an author like Malcolm Gladwell or Michael Lewis comes out with a best seller book of how the focus on all the metrics, CPC+, PCPCH, social determinates of health did nothing to change patient outcomes or save money. And they sure didn't increase anybody's satisfaction. It was just a bunch of stuff we did, imposed by outsiders, which distracted from the main thing. And the main thing is medical care that is reliably available and relevant.


That last paragraph needs context. A further explanation. I do not mean to insinuate that metrics, the patient centered home, social determinates of health, or a population health focus are not important. In fact, they care critical to an effective health care delivery organization such as ours.


What is insidious, shameful, and dangerous is when bureaucracy and self-interest are imposed from outside entities with no understanding of our local culture and community needs. A most useful instrument becomes a weapon in the wrong hands. The same violin emitting painful screeches when used by a child is transformed into an instrument of beauty in the hands of the master.


And so, a patient centered medical home can reflect empty promise, paper, and check boxed forms - or an innovative, problem solving, engine providing a pragmatic foundation of health care for the community. And OHA metrics and the PCPCH certification process will never be able to distinguish the two.


We can and we will. We will not lie and pretend that it is true. And while we will do what is required for certification, to appease those appraisers from afar who could never do your job, the metrics and methods that will guide our steps and consume our time will be those we have chosen. We will protect our providers from distractions and direct our focus on the things that matter.


At Evergreen, we have but one main thing which is expressed in our mission statement:


"EFM strives to provide high quality, cost effective and compassionate medical care through a cohesive primary care- based organization. Our obligations are to our patients, our community, our families, and ourselves. We strive to establish trust and mutual respect with our patients and to advocate our mutual interests within the healthcare system. "


It is a good mission statement. It's a little long. Let me shorten it just a bit for now.


"The purpose of EFM is to deliver primary medical care throughout Douglas County, which is accessible, relational, and relevant."


That’s it. Every other goal is subservient to that one – or not. On a hierarchy graph, it looks like this:



The higher the goal, the more it is an end in itself. Lower goals are a means to an end. The lower goals are easier to amend or discard. When we fail at something, it is important to place it in the proper box. If it is a low-level goal - don't worry about it. Either try again or change goals. It is not the main thing. It is just in support of the main thing.


A metric or task imposed from outside either contributes in a significant way to financing our objective, is important to our function - or it doesn't make the cut. But the main goal which defines our very purpose never changes and is never forgotten.


The road to our goal will be fueled by purpose and passion. It is why our new providers are not just welcomed but needed. Purpose is a tremendously powerful source of motivation. And shared purpose ignites passion which is unstoppable.


When we find meaning in the journey, with a clear understanding of why we are doing this and where we are going, the long days and evenings of toil, the setbacks, the sacrifice, the disappointment, and struggle - are all worth it. Welcome to the Evergreen family.


Tim Powell MD

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