This profound paper will help you understand RETAIN

Jennifer Christian MD

Hello all –

I really really hope / recommend that you read – and especially that you request (require?) the “system level” agency people involved in your RETAIN group to read -- pages 1-9 of the attached paper.   Please do not dismiss this paper because it concerns workers’ compensation.  Those early pages are an admirable piece of crystal clear policy thinking about strategies to improve outcomes for a POPULATION currently being ill-served by the status quo – and accomplish that goal via a series of programmatic initiatives.   Isn’t that what you want to do with your RETAIN program?  

Tom Wickizer just sent the paper to me; I had never seen it.  It is dated 2001, before COHE got underway.  Entitled “Improving the Quality of Workers’ Compensation Health Care Delivery: The Washington State Occupational Health Services Project”, it lays out in very clear language the initial rationale for Washington state’s efforts to improve outcomes for injured workers.  It answers the question WHY they undertook COHE, and also explains why some supporting initiatives need to be included.   The short answer appears on page 8:  “These factors argue for adopting a community-based public health approach to quality improvement and injury prevention.”  Because Washington’s thinking has become more refined since 2001, today they would no doubt replace the last term “injury prevention” with this one “secondary prevention of adverse secondary consequences of injuries.”   

This 17 year old paper leaves unstated two significant policy /strategic issues.  Perhaps they weren’t recognized at the time – but they are noticeable now: 

  1. The nation’s healthcare delivery system has proven surprisingly intransigent to efforts to “transform” it – for many reasons laid out in agonizing detail elsewhere.  (Too many features of our healthcare, disability, and workers’ comp systems are being terribly distorted by greedy people whose main aim has become maximizing money.)  The solution Washington came up with is brilliant:  non-combative in tone, admirably limited in size/scope, and thus more likely to succeed than other broader initiatives. 
  2. COHE allows the solution to grow up alongside the status quo – more or less like a better mousetrap with delicious cheese.  Hmmmmm, that analogy is not good because mice get killed.  It’s more accurate to say that COHE creates a positive “brand” in the community and becomes a beacon or outpost of quality in an otherwise cynical system with a lot of negative press.  The twin messages of “best practices” and “better outcomes for workers” that COHE sends appeal to and attracts the “good guys” in all stakeholder groups:  workers, physicians and employers -- and allows them all to thrive and prosper and have good outcomes.   (As an indication of their intention to build buy-in by workers/labor, Washington LNI steadfastly REFUSED to discuss monetary savings as a goal, or even measure them for quite a while.)    When I visited a family practice in Spokane Washington, they had a big placard on their reception desk saying “COHE member physician” or something like that.   

Jennifer Christian, MD, MPH
Moderator, RETAINers List-Serv and Website on
(a volunteer activity – not an officially sponsored group)
Chair, 60 Summits Project
(non-profit organization founded in 2006 and mothballed since 2010)