Posts Categorized: Culture

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Finding Joy in Practice Again

In 2018, after 14 years with Kaiser Permanente, I joined Iora Primary Care. Already, this change is one of the best decisions I’ve ever made. My wife and two daughters regularly comment on how I’m happier, less grouchy, and don’t get gloomy on Sunday nights anymore. I’ve always enjoyed going home from work, most recently to our little hobby farm on the river in Lyons CO, where we raise sheep, goats, chickens, bees and a new little pig. But now, surprisingly, I also look forward to going to work on a daily basis.

I came to Iora because of its mission to restore humanity to health care. I have been following Iora in the national press ever since the 2011 New Yorker “Hot Spotters” article (read it if you haven’t!).

I’ve long been a student of health systems and policy, working for a Master of Public Health and an MBA in health administration. I served on the Board of Directors for the Permanente Medical Group and as Chief of a large primary care practice and a cluster of primary care practices serving over 100,000 patients. I’ve worked as the Medical Director of Prevention, responsible for the wellness of over 600,000 patients. I never thought I would leave my previous career…until Iora arrived in Colorado.

When the Arvada clinic had an opening for Practice Medical Director, I applied. I was immediately impressed by the man who would become my boss, Doug Golding, a very bright and thoughtful leader. More importantly, I was sold on working with the team of Health Coaches, Operations Assistants, Nurses, Nurse Practitioners and Behavioral Health Specialists that interviewed me. They asked insightful questions that made it clear that culture and mission were valued at Iora. They were bright, kind and passionate about taking care of patients. It was clear that this was an opportunity to work with a team where each member contributed as much as they could to the care of patients. In past roles, decisions had to be funneled through doctors who become a bottleneck for care.

Over the past month, I’ve found that this team truly lives by the Iora values; courageously and passionately caring for our patients, treating them with empathy. The team works to improve every day, acting with the humility to ask tough questions and challenge each other to improve. They continue to inspire me and challenge me to be better, making sure that we always address the issues most important to our patients. The team helps me to be truly present in interactions with patients. They support me in my learning and they allow me to support and teach them. We learn from each other.

The culture is collaborative rather than competitive, supportive rather than critical. This is unlike anything I’ve experienced in health care before. I recently attended a meet and greet with some of our current patients. I asked many of them, “What do you think about Iora?” About half of them became tearful as they described how they were treated with kindness and respect in a way that made them feel important. There was not a single complaint about the team, but they did ask that I would consider staying for a long time. That won’t be a problem.

– Eric Harker, MD, MPH, MBA

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A Culture of Respect

In a recent Washington Post article, reporter DeNeen Brown wrote about how Aretha Franklin’s classic song Respect took “a man’s demand for respect from a woman when he got home from work and flipped it.“

Everyone deserves respect. And yet, as we go through life, it’s easy to see that some groups need to fight more for it than other groups. Aretha sang, as a black woman, demanding respect, a message she belted out with gusto.

In my time working with older adults at Iora Health, it’s been very clear that older adults are another group that too often have to fight for respect. While some belt it out, many have resigned themselves to a life where they don’t feel respected and give up trying to get what they deserve.

At Iora, I’ve had the honor of speaking with countless older adults – patients and otherwise – to understand what’s important to them and learn how Iora and our care teams can help them live better lives. It’s surprising to me that more often than not, one of the most common answers I get when asking folks what’s important to them from their doctor is time. They want less time waiting for an appointment, less time in the waiting room and more time with their doctor and care team. A lot of doctors say they give their patients more than the average 7-15 minute appointment, but patients still aren’t satisfied. So are the patients not getting the time,  or is there something else going on?

I’m betting on both. At Iora, our teams spend more time with our patients than a typical doctor’s office – as much time as each patient needs. The extra time is key. But the real magic is what happens during that time. During the time our teams spend with patients, they are able to build meaningful relationships that engender trust and openness. Our patient relationships are built on this trust and, perhaps, more importantly respect.

One woman in one of our Arizona practices explained to me what she is looking for in a doctor’s office:

”I want them to listen to me. And not treat me like I’m… ‘she’s an old lady, she doesn’t know anything…because a lot of people I know have gone to the doctor and the doctor just blew them off…I want you to listen and be nice and don’t act bored. And if I’m wrong, explain to me why I’m wrong. And if I’m right, tell me I’m right. And I realize that not everybody is willing to listen ….”

I’ve encountered this theme over and over and over again in my conversations with older adults. While most people, no matter their age, would say that they want more time with their doctors, it turns out that isn’t enough. Most people under 65 don’t have to say that they are looking for someone to be nice, not act bored and explain things. People 65 and older shouldn’t have to either. Everyone deserves to be listened to and respected. I came to work at Iora – and stay here – because this is exactly what we do for all of our patients.

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Values in Action: Addressing Needs in Venezuela

At Iora Health, our mission is to restore humanity to health care. Each day, our teams lead the way by showing courage, creativity, empathy, humility and passion.

We see these values embodied in large and small ways every day. A compassionate encounter with a patient, an empathetic ear for a colleague, or recently, through a passion project by an Iora employee.

Gabrielena (Gaby) Alcala, director of Medicare Risk Operations, saw the decline in quality of life in Venezuela with her own eyes. Her father was ill and she saw the struggle to get his basic medical supplies. Unfortunately, his situation was not unique in Venezuela. Once-controlled diseases like diphtheria and measles have returned due to insufficient vaccines and antibiotics and Venezuelans suffering from chronic illnesses like cancer or diabetes must often forgo treatment for lack of supplies.

Motivated by the struggles of Venezuelans to access basic healthcare, Gaby reached out to her fellow Iorans for aid. The response she received was overwhelming.

In an email to Iorans, she described how Venezuela is experiencing one of the biggest humanitarian crises in the world. She shared that Venezuela is facing an 85 percent shortage of medicine, an economic crisis, severe hyperinflation and food scarcity. She contrasted this with the United States, where two out of three dispensed medications go unused and are discarded. National projected costs range from $2.4 billion to $5.4 billion in wasted prescriptions.

Gaby had a simple ask, “Do you have unused prescriptions or medical supplies you can donate?”

Here are some of the responses:

“I have a box of things that I’d like to go to a good cause!”

“Thank you for finding this opportunity for us, we really appreciate the honor to be able to do this.”

“I would much rather send to places that need things than throw things away.”

“Definitely!! Thanks for reaching out to the practices. Perfect timing too for our Earth Day efforts…love it!”

“This should be something that happens every six months so that things don’t go to waste.”

Gaby coordinated the supply donation to the Programa de Ayuda Humanitaria para Venezuela, which has strong ties with health providers and hospitals in Venezuela. With the program’s aid, the items were sent to where they were needed most. Now, Iora Primary Care practices are aware of the donation opportunities for unused medical supplies and can continue to support places in need on a regular basis.

There is a tradition at Iora Health that on your company anniversary you can reflect on your time at Iora. In Gaby’s reflection she said, “I have learned many things during my tenure at Iora, but the most important one is that I work with the kindest people I have ever met.”

Everyone rallying together in support of Venezuela demonstrated Iora Health’s mission and the passion that Iorans bring to their work every day.

 Thank you to Gaby and the local care team members for their efforts! It’s inspiring to work with you!

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Interested in joining a team that is committed to making a difference? Check out our current job openings and apply!

Amy Veronneau

Why I joined Iora – A Nurse’s story

As a Registered Nurse, I have played many roles in multiple hospital systems throughout my career. When I worked as a Float Pool Nurse, I supported a multitude of nursing floors, chronic conditions and environments. I discovered that although the hospital is intended to be a place for healing, there are many problems: when a patient is in pain, we push pain medication, and when we see a patient with a chronic condition, we put a Band-Aid on them with medications and temporary interventions—without always taking the time to find the underlying cause. The intentions are good, but the execution is poor, especially when nurses are given so many patients that we aren’t allotted the time to provide adequate education, let alone understand the entire patient situation.

After much frustration with a broken hospital system, I found Iora Primary Care. At Iora, our mission is to restore humanity to health care… and this is so much more than just a slogan. Everyone at Iora takes action to make a difference in the lives of our patients. The patients have longer initial visits with us, where team members spend time with the patient to understand the patient’s goals, desires, support system, and comfort with his/her illness, and we then provide education. We share the medical chart with the patient—which is unheard of at other institutions!

I have finally found a place where I can make a difference….not through pushing medications or through the agenda of the institution I work for, but by working with the patients to help them live their fullest and healthiest lives. I couldn’t be happier as a Nurse at Iora Primary Care.

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A part of something bigger

What led me here to Iora? That’s an interesting question. Healthcare was never interesting to me. I went to school for filmmaking and the only real thoughts I had of the health system was that it was expensive. I avoided doctors and hospitals like the plague. Being healthy, I could get away with that.

Then, life changed. I met my husband, a type 1 diabetic, and about nine months later, my video editing job came to an end. After several months of hard thought I realized that while I was pretty good at filmmaking, it wasn’t the right place for me. Not knowing what was, I took a job doing accounts receivable at a Skilled Nursing Facility.

Work was disheartening. I watched families struggle to try and figure out how to pay for rehab and long term care. I called 85 year old widows on social security to tell them they owed money for their time with us while they were trying to figure out how they were going to pay to heat their house that winter. And the worst was the sad realization that the work wasn’t about what was right for the patients, but rather what was best for the facility.

And it was just as disheartening on the personal side. There was a lack of communication between my husband’s doctors. We had little to no support in general, especially when we had to figure out how to do what the doctors prescribed. While his primary care doctor was better than most, she didn’t have the time to spend with him or with his specialists that would have been truly beneficial. We felt like numbers, not names and certainly not people.

We are told from a young age that we can do anything we put our minds to; that we can change the world. But on so many levels, at work and at home, it felt like I was constantly swimming upstream, with someone telling me why we couldn’t do something, why some change or another wouldn’t work. Just three years out of school and I had stopped believing that change was possible.

The spring after we got married, I started looking for a new job. I stumbled across an administrative/finance position at Iora Health. While I had no interest in continuing in healthcare, I needed to pay my bills. Honestly, I didn’t expect much, but when I read the company description, I felt an immediate connection. You could feel the honesty in it. These people believed they could change things.

I applied for the job knowing that I could do about half of what they were looking for, and that I could learn the rest if someone was willing to teach me. I never expected that I would actually get a call, but the next day I received an email asking for a phone screen. After talking to Paul Dufault for a half hour, I was hooked. I dug up everything I could on Iora (which wasn’t much beyond the The New Yorker’s “The Hot Spotters” article), and the more I read, the more excited I got. As the interview process progressed, I realized that I wanted this job more than I’d ever wanted any job. What they were doing made so much sense to me. I never thought about the fact that it was a start up or that in six months I may not have a job, or that they could fail. It didn’t matter to me; I wanted to be a part of this.

When Iora’s Chief Operating Officer, Zander Packard, told me that they wanted to hire me but they weren’t sure when they could bring me on, I told him I would wait. We set up a time to check in in a few weeks. That was in March of 2012 and I started in May and haven’t looked back since.

The past three years have been an incredible journey. I’ve watched the company grow from 30 people with two practices in two states, to 150+ people with 12 practices in seven states. I’ve grow in leaps and bounds as my role evolves. I’ve done everything from ordering lunch and scheduling meetings, to writing company policies and creating processes. I found a company that believes that if you do the right thing, the rest of the pieces will fall into place. The bottom line is important, but it’s not the first thing.

Margaret Mead once said “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” I never felt that this was a truer statement than I have working with this amazing group of people at Iora Health.