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Fellows Snapshot: Gilbert Salinas, MPA, 2013-2014 Kaiser Permanente Safety Net Fellow

By Caitlin Littlefield | Monday, January 27, 2014

Gilbert Salinas 


Gilbert Salinas, MPA, shared these reflections with Vicky Minden of IHI’s marketing communications team

What brought you here, to your IHI Fellowship?


I had known of IHI throughout my career and have always admired them for what I see as a higher level of thinking around quality and work with patients. I was also feeling like my own organization, Rancho Los Amigos National Rehabilitation Center, was at a point where we were reaching our marks, meeting what was necessary, but we weren’t going beyond. So I came here to do that; to find the right tools and guidance to drive change at a much higher level.


There was also an event about three years ago that connected me with IHI. I had an opportunity to be on a panel moderated by Maureen Bisognano [IHI’s President and CEO]. It was a meeting of executives from all over the US working for my own health insurer, Kaiser Permanente, and I was speaking as part of the patient safety advisory council.


Before the session, I met Maureen over breakfast and we had a great conversation. She asked me good questions, very straightforward, and helped me think about what I was going to say to this group.


I got up on stage and shared my own experiences with inefficiencies in the system; issues I had had for years with durable medical equipment. First of all, the processes – the fact that it would take me over two weeks to get a wheelchair tire fixed because of all the steps I had to go through. And when you’re pushing your wheelchair on a flat [tire] it’s sort of like limping. Your whole body shifts to one side and it puts pressure on your back, your arms, your shoulders, your neck.


I also brought up problems I was having with catheters, the fact that I was getting UTIs very often, sometimes hospitalized with them. I told them I felt like I just wasn’t getting what I needed. These things were lowering my quality of my life and causing instability in my health. And they weren’t being looked at the microsystem level.


It was a very powerful moment. Here I was, in a room full of Kaiser administrators and executives, and I could make something happen by putting my story out there. And the people in the audience were so receptive, so forthcoming about wanting to create change, to fix things not only for me but for all patients who had the same problems with durable medical equipment.


After this presentation, the head of urology and some administrators from my home facility came and talked with me. They said they were truly sorry for my difficulties and that they hadn’t heard about them – which is quite possible because the “complaining” process is fragmented. I had appealed for almost eight years, but letter-writing only goes so far. There’s no human face in front of you.


So they partnered with me. We went back to the drawing board, had some meetings, and started changing processes. And Kaiser changed their policies on catheters so things wouldn’t be so black and white, based on CMS standards. They would make decisions on more of a case-by-case basis, based on what the patients actually need.


I never gave up on my system. I knew Kaiser was a great system, but they did have these inefficiencies. And they were able to knock down barriers and help patients get what they need – to fulfill their mission, which is to thrive.


That meeting at Kaiser launched my relationship with IHI. Maureen and I stayed in touch. She shared my story around the world and we became great friends. Ever since then, the learning I’ve had from IHI has continuously drawn me back. We really came full circle by the Forum in 2011 [2011 IHI National Forum on Quality Improvement in Health Care], when I was asked to present with Tom Nolan, IHI Senior Fellow. That was a great experience for me.


And now that I’m here at IHI as a fellow, I’m actually seeing the inside of this organization and all it has to offer, and it’s far more than what was on the surface. I’ve seen joy in work; I’ve had great conversations with staff. I feel that people here are very genuine and driven by their mission.


That’s really what it’s all about. I’ve never been part of something I didn’t believe in. I have been blessed that way, going back to the beginning of my career, working with kids in the battlefields of LA, areas plagued by violence: Oakland, Compton, South Central LA – they called it “Murder Central.” I really believed in what we were doing and I believed in the kids we were working for – I could see the glimmering lights of hope in them.


So this organization is no different. It feeds me what I feel I need. That’s why I’m really a believer in IHI’s mission, its purpose, and the people that come with it.


What's one thing you've learned already?


This strong encouragement of teamwork, the flow of information, transparency, leadership. There’s so much … But if I had to summarize it in one thing, I would say leadership. Global leadership and collaboration and the teamwork that comes along with that. I think there’s a whole different level of leadership that the organization provides.


Also the culture at IHI, that’s also one of my biggest learnings. The culture and the people. I’ve had a chance to spend more time with people here during my year, so I feel even more embedded into the organization. I’ve made great friends and there’s always this ongoing support for your learning.


What's something that has surprised you?


What has surprised me is the strength that IHI has shown in the turmoil of dealing with all the changes in the ACA [the 2010 Affordable Care Act initiating comprehensive health insurance reform] and how they’ve really been able to bring the team back together and stay focused on the mission and purpose. Often, non-profits will change their mission and their vision in the face of such a challenge; they will chase the dollar, or they will become something that they’re not. IHI has stuck to their promise of providing quality improvement, not only in health care, but beyond.


So that has been surprising, that this organization has not bent on their purpose. That’s a great sign of leadership.


What are you most excited about?


I’m most excited about taking all the learning I’ve gotten here at IHI, all this great knowledge, back to my home organization.


When you’re pulled from [your home organization] you really see it, you have perspective. You’re not “in the trenches,” so to speak, just being reactive. Here [at IHI] you can reflect and think about all the changes that are needed to create a very high-quality, high-level system.


I have great optimism upon my return to my home organization. They are committed to supporting me in utilization of my newly acquired skills.


For more information on the IHI Fellows please click here.


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