Dominique

Help Us Write Our Veteran’s Story

dominiquwOn Memorial Day, we recognize and honor our fallen soldiers, those who have made the ultimate sacrifice. We also thank those who have returned home forever changed. At the Center for Total Health, we remember veterans every day with one of our personas, Dominique.

When we refreshed the content at the center last summer, we added several sculptures to represent a diverse set of individuals and their total health stories. Some of their stories were fully written, but some we decided to leave open and have our guests help us write. Dominique is one of those. So, even if you are unable to visit the center, we’d love to hear what you think her personal story is, in terms of her health and in general.

In the comments section below, share your ideas with us.

  • What do you think is on her mind? Is she worried? Optimistic? Determined? Depressed?
  • Does she look healthy?
  • How do you see her, beyond her amputation?

We’ll compile your ideas with those we’ve heard from hundreds of visitors since last September to write a formal story for Dominique. There is no wrong answer or bad idea!

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Bike to Work (or Lunch) Day 2016

Across the country, bike commuting grew 62% from 2000 to 2014. Washington, DC is among the top ten cities for bike commuters with over 13,000 in 2014 (an increase of 124% from 2005) according to the League of American Bicyclists. As the annual Bike to Work Week and Bike to Work Day (both of which fall right in the middle of Bike Month) is upon us, the Center for Total Health team hit the streets for a mid-day bike break.

Bike commuting isn’t for everyone – some people may not have access to a bike, may not feel comfortable riding on city streets, or may simply work too far from home. However, for those who are able and interested, DC’s Capital Bikeshare provides an affordable opportunity to access bikes. Since arriving in DC in 2008 (as SmartBike DC), Capital Bikeshare has become increasingly popular. In the past six years, Capital Bikeshare has grown from 114 to 378 stations, with a total of 12.8 million trips as of April 2016. This system has undoubtedly contributed to the increase of bike commuting in Washington, DC and across the region.

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In honor of Bike to Work Day, our team took a mid-day break to Bike to Lunch together. If biking isn’t for you, consider commuting on foot to celebrate active transportation and build exercise into your day. And please, don’t forget a helmet if you’re getting on a bike today. After all, bike helmets are the new seatbelt.

 

This Week in Total Health: Keeping it in the KP Family

This week, the Center for Total Health team got to spend time with hundreds of our Kaiser Permanente colleagues. The week began with training sessions for DC and Maryland area Ambulatory Surgery physicians, nurses, clinicians, and staff. It was a thrill to get to spend some time with these incredible people.

We also welcomed colleagues from Kaiser Permanente’s Health Plan Institute, Kaiser Permanente Ventures, and the Kaiser Permanente Institute for Health Policy. These groups reminded us of the incredible, diverse, and passionate people working to serve our members every day.

 

Colleagues from Kaiser Permanente’s Health Plan Institute & Kaiser Permanente Ventures visit the CTH Farmers Market

 

First Mother’s Day Without Mom

Patti Harvey, senior VP, Medicare Clinical Operations and Population Care, and executive director, Care Management Institute, has been a nurse for years, but nothing in her training prepared her for her role as her mother’s caregiver.

On Mother’s Day, I will be thinking about the enormous influence my mother had on my life and work.

Over the past 10 years, I have felt a strong personal connection to my work as a leader in care delivery at Kaiser Permanente. Even before then, my mom had joined KP as a member in 2002, after she and my dad moved to California to live with my family. My dad passed away in 2003 and my mom was a constant in our family for many years, providing care and comfort to all of us.

My mother passed away in November of 2015, so this will be my first Mother’s Day without her. She was not healthy for many years. She smoked cigarettes for almost 40 years and was plagued with almost every bad thing that smoking can do to a woman’s body, except cancer. I was her primary caregiver for 13 years, with help from all of my family.

I have been a nurse for many years, but my role as a caregiver for my mom was one that nursing school and graduate school did not prepare me for. My mom’s needs were complicated and she required support at home during the day while we were off working and going to school. We learned that caregiving for a loved one can create a physical, emotional, and financial burden for the entire family. Our KP members and employees have these same challenges.

My children learned to give insulin and breathing treatments. Walkers, wheelchairs, oxygen, many medications, and frequent trips to the doctor and hospital were a routine part of our lives. These were the physical things, but my mom made each one of us feel special and kept us smiling and enjoying her Texas humor. She told us what she wanted and needed and we worked to make it possible.

Her doctors and nurses knew her and she was a part of their family. Her primary doctor and I are good friends, and KP nurses at the Thousand Oaks clinic have my cell phone number. Her doctor was my support, too. We cried and laughed together trying to keep my mom strong. When it came time for him to have conversations about how my mom wanted to be cared for in her final days, he could not bring himself to talk to my mom about dying. He loved her and wanted to help in any way he could. My mom and I had conversations about what she wanted if she couldn’t make her wishes known. We completed her advanced directives and medical power of attorney.

Still, she had a lot to live for and she set goals for herself. She wanted to see my daughter graduate from college, she wanted to see my middle son graduate from college and pursue his love of flying, and she so wanted to see my baby boy graduate from high school. I am so thankful that she was able to accomplish these things in her life.

My mom fell and broke her leg and her health and well-being deteriorated rapidly. She was in the hospital and had gone through so many painful procedures, she couldn’t eat or sleep. She finally said she didn’t want to do this anymore and asked me to get her doctors to come to her bedside.

Later that afternoon, her hospitalist, her surgeon, her case manager, the nurse executive, her nurse, and I had one of the most powerful conversations of my life. My mom asked us to sit at her bedside and she began to tell us her wishes. Her doctors were both women and my mom said, “I am going to talk to you like I talk to my daughter because I have grown to love all of you. I want some tomato soup, I want to sleep until I wake up, I want to leave the hospital and go somewhere that has flowers and good smells. I don’t want any more pokes, tests, and pain. I want to go home.”

This conversation left us all in tears. Her hospitalist asked my mom, “Mary, what end-of-life care would you like?” My mom looked at me and said, “What the heck did she say?” I asked her doctor to rephrase the question: “Mary, what does a good day look like to you?” When her doctor asked her that question, her eyes sparkled, her voice lifted, she smiled and told us all stories of what a good day for her is. Later that day, her surgeon brought her some homemade tomato soup and ice cream.

My mom passed away five days later with my baby boy and me by her side. My grandson was born two weeks after my mom passed. She is his guardian angel and we will tell him stories of his angel “Nanny” and how she is with him.

I am sharing my story for two reasons. One is to remind me and those I get to touch that we have an opportunity to make the lives of those we serve better and to support their well-being throughout all stages of life. To do that we must listen and respond. The second reason is to help others understand the power of the voice, presence, and partnership of our patients and their families. Without listening and responding to my mom’s wishes, she wouldn’t have had her last good days.

Now to end this chapter in my story, I am a “granny.” Every day I try to make my grandson’s life better; and at work, I try to make our patients, their families, and my colleagues lives’ better — by listening, responding, and ensuring that we don’t lose sight of what we are blessed to get to do each day.

Happy Mother’s Day, Mom! Thank you for all you give me and us every day.

Categories: Guest Blogger
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This Week in Total Health: Championing the Future

As we tend to do, we hosted leaders who look ahead. The Accelerated Leadership Development Program came to the Center to see how the Washington, DC environment impacts their work in health, with an additional special guest Armond Kinsey, who’s the Director of Diversity, Kaiser Permanente Mid-Atlantic States.

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This week was also the American College of Physicians Internal Medicine Meeting 2016, held in Washington, DC, which brought additional champions of the future our way, including Priya Radhakrishnan, MD, from the Practice Innovation Institute, in Phoenix, Arizona. Always here to learn and to teach.

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See all of the photos from this week here.

CEO Roundtable Policy Summit 2016

 

On April 29, the Kaiser Permanente Center for Total Health hosted a policy summit convened by the American Heart Association’s CEO Roundtable. The CEO Roundtable represents 26 CEOs, including Bernard J. Tyson, from some of America’s largest corporations and organizations that have joined together to create and sustain a culture of health and well-being in the workplace by collaborating on best practices and measurable new strategies for employee engagement. Together through the AHA’s CEO Roundtable, these CEOs are leading by example to collectively engage their nearly eight million employees and family members, along with countless other community members, to improve health by making simple behavior changes that produce significant results.

Attendees at the CEO Roundtable Policy Summit

 

While many companies offer workplace health programs, program quality and outcomes data vary, so there are unanswered questions about the most cost-effective strategies to improve employee health and well-being. Technological advances in “big data” are opening new frontiers in generating deeper insights about what works and why. That’s why the CEO Roundtable was developed as a leadership collaborative dedicated to evidence-based approaches to workplace health and employee engagement.

The policy summit focused on issues critical to improving the health of our Nation’s workforce. Discussion included the policy implication of current wellness related tax issues and legislation, effective incentive design, the role of workplace culture and leadership, developing and promoting best practices for data privacy.

The summit included national thought leaders Judith Feder and Kevin Hassett to discuss policy and the political landscape for employer sponsored healthcare for 2016 and beyond. Judith Feder is an Urban Institute fellow, a professor of public policy and, from 1999 to 2008, was dean of what is now the McCourt School of Public Policy at Georgetown University. A nationally recognized leader in health policy, she has made her mark on the nation’s health insurance system through both scholarship and public service. Kevin Hassett is the State Farm James Q. Wilson Chair in American Politics and Culture at the American Enterprise Institute (AEI). Before joining AEI, Hassett was a senior economist at the Board of Governors of the Federal Reserve System and an associate professor of economics and finance at Columbia (University) Business School. He served as a policy consultant to the US Department of the Treasury during the George H. W. Bush and Bill Clinton administrations.

Shane Doucet, Principal from Williams and Jensen, moderated the day’s conversation. Over the last 15 years, Shane has represented clients in a variety of areas including health care, public pensions, law enforcement, and high-tech. Shane has also moderated panels comprised of top union, business and trade association representatives on the impact of health reform and has been a featured speaker for over 250 CFOs on health and wellness provisions of the Affordable Care Act.

For more information on the American Heart Association’s workplace health solutions, visit www.heart.org/workplacehealth

Paving the Way to Active, Sensored Streets: Part 2

Our guest blogger this week is Sam Piper, Senior Planner, Alta Planning + Design. Alta Planning + Design designs and implements bicycle and pedestrian infrastructure for cities and institutions. This is part 2 of his blog. Click here to read Part 1. 

The streets of the future in the United states will be active, sensored streets, and will include dedicated infrastructure that makes travel by all modes of transportation comfortable. New technologies are paving the way to better understand mobility in urban contexts so that investments can be made where they are needed most. 

There are a number of current and emerging technologies that can capture and process non-motorized data efficiently and economically. After researching several of these technologies, Alta Planning + Design, a company that designs and implements bicycle and pedestrian infrastructure for cities and institutions, is excited to announce the publication of the Innovation in Bicycle and Pedestrian Counts white paper. This paper outlines the challenges that many communities face with conventional pen and paper count programs. It then identifies many new technologies that can automate, simplify, and expedite the collection of bicycle and pedestrian data.

Through Alta’s research, it became evident that new technologies generally fall into three broad categories:

  • Mobile Technology: software that can be downloaded onto a mobile device.
  • Imagery: technology that uses sensors to capture bicycle and pedestrian movements
  • Low-cost hardware: stand-alone technologies that are deployed to capture non-motorized data.

The graphic below lists the range of technologies that were reviewed for the white paper. Together, these technologies can be leveraged to plan and implement active transportation infrastructure, such as new paths, sidewalks and bicycle facilities, where they are needed most. When connected systems of comfortable facilities are implemented, more people will choose to bike and walk for more trips, as has been seen in multiple North American cities that have prioritized the development of bicycling and walking infrastructure, and are beginning to reap health benefits from these choices.

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Paving the Way to Active, Sensored Streets: Part 1

Our guest blogger this week is Sam Piper, Senior Planner, Alta Planning + Design (@altaplanning). Alta Planning + Design designs and implements bicycle and pedestrian infrastructure for cities and institutions. This is Part 1 of 2 blogs by Mr. Piper.

A new study from Imperial College London published in April 2016 had startling findings: “There are now more adults in the world classified as obese than underweight.”

The study, which pooled data from 183 countries, found thatthe number of obese people worldwide had risen from 105 million in 1975 to 641 million in 2014”. While the World Health Organization previously set a goal to have no rise in obesity above 2010 levels by 2025, the new research predicts that the probability of reaching this goal is “close to zero.”1

Negative health outcomes and obesity trends have coincided with other major trends. Consider the correlation between the growth in American obesity during a period over which Vehicle Miles Traveled (VMT) have persistently increased nationwide. In recent years, this trend has halted, with VMT actually decreasing.

 

alta1This dip has been attributed to a variety of factors, including the Great Recession, the recent growth in urban populations (which for the first time since the 1920s exceeded the growth of suburban areas), a diversification of transportation options (think car share, uber, lyft, and real time transit information) among other factors.

More recent data indicates that VMT growth rates could be shifting to pre-recession rates, and it is yet to be seen if the reduction in driving will last.

Regardless, the growth in obesity levels has steadily increased during this period: “Over the past 35 years, obesity rates have more than doubled. The average American is more than 24 pounds heavier today than in 1960.”

What has attributed to this incessant rise in obesity?

One factor is the fundamental change to the American built environment that has occurred over the past 100 years, which encourages sedentary lifestyles.  At the turn of the 20th century, most people lived in farming communities (60 percent) and worked labor intensive jobs, while 28 percent lived in dense, walkable cities. Relatively few people at this time, about 12 percent, lived in “suburban” areas.2

By 2000, the landscape of America had drastically altered, with the majority of Americans (52 percent) living in sprawling suburban communities designed to move vehicles.

Although correlation is not causation, that our culture is so dependent on the automobile for daily life has impacted, to some degree, our health and our well-being. Most Americans now live in places where it is uncomfortable to walk or bike for most trips, making driving the most viable option for transportation. Multiple data sources indicate that a majority of people, 76 percent (according to 2013 data) drive alone to work.

Cities and states across the country are well aware of the obesity epidemic. As a result, they are working to prioritize bicycling and walking infrastructure development to provide more healthy travel options. Doing so represents an attempt to halt the growth of obesity through transformative tools such as complete streets programs and safe routes to school programs.

Transportation planners and engineers rely on data to develop better infrastructure and to prioritize investments. Longitudinal data on vehicular travel is robust, but equivalent data for walking and bicycling is almost non-existent. The ability to access more robust data helps communities:

  • Determine where investments in walking and biking infrastructure are most needed
  • Assess changes over time, draw conclusions about the impact of new facilities, and improve the design of future facilities
  • Understand crashes involving people walking or bicycling more than is typically possible with crash data alone
  • Quantify the benefits of walking and biking, which ultimately makes active transportation projects more competitive for funding

Fortunately, there are a number of current and emerging technologies that can capture and process non-motorized data efficiently and economically. After researching several of these technologies, Alta Planning + Design, a company that designs and implements bicycle and pedestrian infrastructure for cities and institutions, is excited to announce the publication of the Innovation in Bicycle and Pedestrian Counts white paper.

Learn more about Alta Planning and Design’s findings tomorrow in Part 2.

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[1] http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30054-X/abstract

[1] https://www.wvdhhr.org/bph/oehp/obesity/section1.htm

[1] http://www.healthdata.org/news-release/vast-majority-american-adults-are-overweight-or-obese-and-weight-growing-problem-among

[1] https://www.wvdhhr.org/bph/oehp/obesity/section1.htm

[1] 2014 State Indicator Report on Physical Activity. National Center for Chronic Disease Prevention and Health Promotion. Division of Nutrition, Physical Activity, and Obesity.

Health Care That Targets Unmet Social Needs

Targeting the social determinants of health is a critical piece in improving an individual’s overall well-being and total health, according to an article written by a couple Kaiser Permanente physicians in Southern California. The article appeared recently in the New England Journal of Medicine.

The authors say this doesn’t mean Kaiser Permanente should, for instance, build affordable housing for their homeless patients. But it does mean taking on the responsibility for the full scope of their patients’ needs, consistent with Kaiser Permanente’s social mission and business imperative to improve the health of the communities it serves. Kaiser Permanente has begun to bolster that effort by aiming to target their members’ unmet social needs as part of their overall health care. After all, social, environmental, and behavioral factors account for an estimated 60% of health, compared with just 10% from factors traditionally defined as “clinical.” And research shows that nations that focus on food insecurity, housing, transportation, and other “nonmedical” factors spend less overall on health care while improving quality and quantity of life.

 To achieve this goal, Kaiser Permanente is partnering with existing community organizations, identify gaps in linking with those resources, and (in the process) demonstrate the value of directly addressing the social determinants of health.

You can see the article in full here and learn more about a pilot project the organization is doing with Health Leads,  a social enterprise organization that aims “to address all patients’ basic resource needs as a standard part of quality care.”

 

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This Week in Total Health

This week, the Center hosted a three day private board meeting, so we’re a little light on photos. Behind the scenes, though, it was an exciting an active week.

We did have an amazing visit from Leadership America – Leadership Women (@LeadershipAmer), a great organization connecting women in leadership roles across states, ages, and industries. Talk about innovation!

Leadership America

Leadership America Visits CTH

Community Catalyst (@HealthPolicyHub) also visited to learn about the center as they consider an consumer-facing center of their own. Such an exciting time and so glad to be helpful to others beginning this journey.

Community Catalyst

Community Catalyst

To see or download photos from this week, visit our Flickr page.