Just Breathe….Smoking Cessation Support

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While it is difficult to overcome the addiction of smoking and completely kick the habit, different strategies and tactics can help control the desire to smoke in certain situations. To help, Kaiser Permanente established an online program called “Breathe,” free for Kaiser Permanente members 18 years or older. The program gives you a closer look as to why it’s so hard to quit smoking and ongoing support based on your unique needs. Components of this program include:

  • Tools to track and monitor your everyday process
  • A personalized plan to quit smoking
  • Relaxation and guided imagery podcast
  • Finding ways to cope with stress and deal with the urge to smoke

Nurse Practitioner Louis Casa encourages members to “try the program that has successfully helped 58 percent of its participants stop smoking”. She also expresses if you aren’t able to finish the program all at once, you can save your spot, then pick up where you left off when you return. That way, you can to finish at your own pace. You could also be confident that your privacy is protected and that the security of your own personal information will be maintained.

Another supportive resource Kaiser Permanente has is personal Wellness Coaching. These convenient phone sessions provide personal support to help members achieve their goals. Kaiser Permanente’s Wellness Coaching is available for five topics; tobacco cessation, stress management, physical activity, weight management, and healthy eating.

How Wellness Coaching works?

  • Patients are assigned a coach. During their first appointment, a coach helps assess your readiness and motivation. Are you prepared to make changes at this time?
  • After your first session, your and your coach will work together on how often you should meet by phone.
  • To make an appointment, call 1-800-862-4295, Monday through Friday, 7 a.m. to 8 p.m. (no referral needed, members are encouraged to call if needed)

 

For more information, the following resources are available online:

Always remember the four D’s:

  • Deep breathing
  • Drinking water
  • Delaying gratification- 2 minute delay helps
  • Doing something else

 

Nursing Leadership Now On Display

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In November 2016, I had the distinct (and long sought after) honor of meeting alumni of the Kaiser Foundation School of Nursing (KFSN).

Deana Medinas, Clair Lisker, Deloras Jones, and Phyllis Moroney are graduates of KFSN, which was open from 1947-1976, and graduated 1,065 health professionals.

Clair Lisker was a student of Dorothea Daniels, the first administrator of Permanente Foundation Hospital Los Angeles in 1953, and later the administrator of Kaiser Permanente San Francisco. Phyllis Moroney was the first nurse practitioner in California. Deana Medinas became the medical group administrator for Kaiser Permanente Hayward.

They didn’t know as much about Kaiser Permanente when they chose KSFN. However, they did know the Kaiser Foundation School of Nursing was ranked the #1  nursing school in California. And then they practiced and later helped build Permanente Medicine.

After our visit, Deloras shared these beautiful Legacy of Kaiser Permanente Nursing video stories, which we knew should also have a home here at the Center for Total Health.

So, on the day that the Kaiser Permanente School of Medicine came to the Center for Total Health for a historic dialogue on medical student well-being and resilience, our “Leadership in Nursing” was installed and ready, thanks to the Center for Total Health team.

In the photograph above, you can see the piece being played for the first time to an audience of medical education leaders from across the United States. Marc Klau, MD, Vice Dean of Education and Clinical Integration, is next to the display. Also present are Patrick Courneya, MD, and Ed Ellison, MD.

Most all of us encounter nurses in our life’s journey. I can tell you that physicians like me are trained by nurses in my own journey. To know where you’re going, it’s important to know where you came from. And there, you usually find people who live in the future, too (these nurses were practicing the kind of medicine in the 50’s that we are trying to get to today!) just like the 54,000 nurses who care for, treat and heal 11.8 million members across the care settings and specialties of Kaiser Permanente.

Taking Bids on Hospital of the Future

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garfieldAs Silicon Valley’s main hospital system and insurer, KP has been working with tech companies to respond to patient demands, and supply what the organization envisions it may need in the near future. Much of the testing is happening at the Garfield Innovation Center in San Leandro, California.

Kaiser Permanente Chairman and CEO Bernard J. Tyson sat down with Bloomberg Businessweek writer Caroline Chen to talk about the hospital of the future.

Read the Bloomberg story here. 

The Future of Care Delivery

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You walk in, verify at a kiosk that you’ve already checked in and paid, plug in your laptop at the charging station, and soon get a text that it’s your turn. No — you’re not at Starbucks — you’re at Kaiser Permanente’s new Signal Hill Medical Office in Southern California for your medical appointment.

Signal HillSignal Hill exemplifies Kaiser Permanente’s most recent effort of evolving its care model to better integrate into members’ lives.

“Granddad’s medical office building doesn’t cut it anymore,” said Don Orndoff, senior vice president, National Facilities Services.  “We’ve all now become accustomed to the Amazon and Uber experience and that’s our new expectation.”

The medical office of the future at Kaiser Permanente means harnessing design, technology and workflow to create an intuitive and convenient experience for members and care teams. It also means developing a much more agile and flexible environment that meets the evolving technology and service needs of those increasingly tech-savvy members and care teams.

Convenience and care under one roof

Signal Hill opened to Kaiser Permanente members on June 29, 2016, and its sleek architectural design doesn’t disappoint. But it’s the convenient technology features and efficient spaces inside that really impress. When you walk inside the building, you enter into the “public square.”

Since members have the option of checking in and handling their copayments at home, a quick visit to the kiosk allows them to take advantage of a number of options available to them in the public square. They can engage with others at the community table or use computers at the docking station. Or, they can decompress in a quiet spot on the upstairs “porch.” In fact, members can use their time wherever they wish because once the provider is ready, the member will receive a text message.

At the pharmacy, there is also no need to wait around. You’ll receive a text when your medication is ready.

signalhill2The exam rooms don’t look traditional either. Instead of the long, awkward exam table and steel chairs, there’s a comfortable reclining chair and a couch for family seating. The care team also uses hand-held tablets, which is not only easier for them, but avoids having the member stare at the back of a big computer monitor. On the wall, there’s a large monitor for virtual visits or patient education programs.

Read more of this story here. 

New resource to help identify and address social and non-medical needs

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Today marks the launch of the Social Interventions Research & Evaluation Network (SIREN) website, a new resource for health services researchers, clinicians, health system leaders, and others looking for evidence on what works to identify and address patients’ social and economic needs as a part of high quality health care.

Use the SIREN website to:

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On the site you’ll also see they are accepting applications for SIREN’s Innovation Grants. The Robert Wood Johnson Foundation and Kaiser Permanente have teamed up with SIREN to support a small number of research projects to advance our understanding of the health care costs and utilization impacts of addressing patients’ social determinants of health. Grants will provide up to $150,000 total funding over two years.

Letters of Intent are due May 15, 2017 and full applications are due June 15, 2017.

SIREN’s mission is to catalyze and disseminate high quality research that advances efforts to address patients’ social and economic needs in health care settings. Learn more here.

 

When Conventional Wisdom Becomes Outdated: How new perioperative guidelines can save time, pain, and cost

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Maurice Cates, MD, is an Orthopedic Surgeon at Kaiser Permanente’s Fredrick Medical Center. He is the chief of orthopedic surgery for the District of Columbia and Suburban Maryland as well as the regional medical director for musculoskeletal service.

Surgery has been around for thousands of years. The advances in technique, pain management, and outcomes have been remarkable. Since the advent of modern anesthesia, one thing has stayed pretty consistent; those dreaded pre-operative instructions not eat or drink anything after midnight the day of your surgery. Here is to hoping you’re scheduled in the morning, right?

qem2The thing about those instructions is that they may not be helping – especially in several types of cases, one of which is total joint replacement. While improvements in minimally invasive techniques have helped reduce length of stay for something like a knee replacement from well over a week to about 3.4 days in the past couple of decades, our work at the Mid-Atlantic Permanente Medical Group (MAPMG) is validating that it could be as short as 1-2 days in most cases. Several cases are achieving “same day discharge” and we have even completed a total knee replacement in our free standing ambulatory surgery center where the patient had no need to be admitted to a hospital at all.

One in 25 adults over 50 in America lives with a knee replacement. With that kind of volume, cutting length of stay by some 2 days per case, and potentially moving cases from hospitals to ambulatory surgery centers, could deliver a tremendous cost savings for American health care with no detriment to quality. To get there, more physician practices and hospitals need to embrace the mantra of evidence-based medicine and examine how to safely apply ERAS®, as MAPMG does, to its joint cases.

ERAS stands for Enhanced Recovery After Surgery. It represents a shift in care involving all aspects of the patient’s journey through the surgical process, from preoperative care through recovery. The whole idea is to reduce surgical stress and disruption to a patient’s baseline physiology. ERAS protocols, in brief, focus on: (1) allowing the patient to have liquids prior to surgery, (2) narcotic pain medicines are minimized (we use intravenous acetaminophen instead), and (3) eating and walking/ambulation as soon as possible after surgery. Implementation requires thoughtful development of end-to-end care pathways, decision trees, and detailed post-operative outcome measurements. Doctors, support staff, and administrators must be invested in patient-centric care, and having a cadre of talented surgeons helps too – just the ingredients we have at Kaiser Permanente.

Medical evidence in the modern world of health care is an ever-growing body of knowledge. The more organizations continuously look to new studies and those producing the best outcomes (even if it comes from outside the United States, as ERAS initially did), the more people can receive the best care possible. After all, who wants to lie in a hospital bed for 3-plus days when there is the possibility of going home the same or next day? Our patient satisfaction data bump for those having surgery with ERAS and getting early discharge versus the traditional approach suggests the answer is nearly no one.

Defining Success In Resolving Health-Related Social Needs

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A recent Health Affairs blog offers a perspective on the challenges of addressing the social needs of patients – particularly when the health care system at large doesn’t have common language to describe what a successful intervention might look like. Programs such as Kaiser Permanente’s Total Health initiative and CMS’ Accountable Health Community model screen participants for unmet social needs, yet there is lack of clear definition as to how the community – or delivery system – should be accountable for resolving these needs. This will continue to be a complex area for exploration as health care increasingly moves outside of the exam room into the community, and as we continue to look at how factors such as where our patients live, work, play and pray impact their overall health.

Read the blog here

Physician Leadership in the Movement Toward Accountable Care

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Blog by Elizabeth Keating
Senior Project Manager, Council of Accountable Physician Practices

“It will not be possible to move the country toward accountable, value-based care without strong physician leadership at all levels of the organization.”

This statement was made by Robert Pearl, M.D., CEO of the Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. Dr. Pearl recently moderated a panel at the CAPG Colloquium held in Washington, DC, on September 29, 2016.

The panel, “Physician Leadership in the Movement Toward Accountable Care,” was hosted by the Council of Accountable Physician Practices (CAPP) and featured CAPP leaders discussing best practices in recruiting, training and developing physician leaders.

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“Healthcare systems should view physician leadership as a capital investment for the future with huge ROI,” said Dr. Pearl, who also serves as the chairman of the board of CAPP. “The CAPP medical groups are committed to sharing their considerable experience to help all provider organizations face the challenges ahead.”

Over the course of the discussion, the panel touched on key aspects of their physician leadership development approaches. All agreed that leadership development starts at the moment of recruitment into the organization.

“Every physician is a leader. We start with that assumption,” said Marc Klau, MD, Assistant Medical Director of SCPMG. “Take every physician on as a leader and then expand their capability, because you never know when you will need them.

Dr. Klau described how SCPMG’s expansive geography allows for unique leadership development opportunities because programs begin at the medical center level. He explained that each medical center allows emerging physician leaders to build programs that work toward the Triple Aim goal. He stressed that this display of clinical excellence is critical to growing as a physician leader, because it builds trust among peers.
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Dr. Klau also discussed how SCPMG’s leadership programs are geared toward training leaders in Permanente culture, not just administrative practices.

“It’s not about learning to log in to our electronic health record,” he said. “It’s about anchoring people in our history, quality expectations and developing communication skills.”

The panelists overwhelmingly agreed that physician leaders must possess emotional intelligence to be effective.

“The best leaders are going to be visionary but anchored in reality,” said Dr. Klau. “People who have a passion for doing something are the people who will move and change the world.”

The panelists agreed that physicians who are aspiring to lead their health systems or who think they might want to take on a more comprehensive role should start small. Emerging physician leaders could join clinical improvement committees or the first stage of a leadership program to determine if the track is right for them.

Can you see me now? Video Visits at Kaiser Permanente

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Dennis Truong, MD, is an emergency medicine specialist and the telemedicine director for the Mid-Atlantic Permanente Medical Group.

Smart phones and tablets are everywhere. Adoption of these devices now largely spans age, income, race and ethnicity. Americans, of all stripes, are emailing, tweeting, posting, banking, gaming, navigating, checking weather and so much more almost nonstop. Yet when it comes to using those nearly ubiquitous devices, only 2 percent report having access to video visits with their doctor.

In stark contrast, almost 9 in 10 family physicians believe telehealth – the suite of technologies and tactics to deliver virtual medical, health, and education services – is a way to increase access to care. Putting two and two together, that means far more than 2 percent of people should have access to video visits – a core component of telehealth.

Dr. Truong conducts a simulated video visit with a member.

Dr. Truong conducts a simulated video visit.

Why this disconnect? Telehealth regulatory policy for one. From the patchwork of state by state rules to privacy protections to reimbursement rules. Doctors (and some patients) also worry that telehealth has limited diagnostic and treatment value relative to face-to-face care and will adversely impact the day-to-day practice of an office. Not only does it interfere with the routine of quickly moving from one prepped patient to the next, it changes how you chart, plan for space in your office, bill and collect, and so much more.

The regulatory and payment framework must evolve, and technological advances in remote capabilities can help validate telehealth as a reliable solution. But it is easy to overlook the fact that none of it matters if doctors don’t want to change their norms. And, that adoption will fail if the consumer satisfaction barometer is not met as a result of a fragmented experience. At the Mid-Atlantic Permanente Medical Group (MAPMG), and all the Permanente groups of Kaiser Permanente, video visits have become a key part of our clinical offering. Making it work has been a case study in careful planning rather than chasing a “sexy” concept without judiciously working out all the details.

Since launching video visits three years ago, we carefully worked through the legal and regulatory steps. We put in the necessary equipment, trained every provider, collaboratively chose the specified set of clinical chief complaints that should be eligible for video, and slowly built video visit appointments into the schedule that gave physicians dedicated time for the care. The “competition” isn’t other providers. It is the doctor’s frame of reference. Is this as easy as when the patient is sitting in the exam room ready and waiting with forms completed, vitals collected, and nursing tasks done?

As the industry saw more platforms and pure-play video offerings emerge, we worked to stay true to a principle that says video care shouldn’t be fragmented from the normal care patients receive. Patients do not want to repeat themselves, pay for redundant tests, or fail to get a diagnosis because the doctor doesn’t have enough information to definitively make one. Nor do they want to have their “regular” doctor fail to provide care in consideration of what is known from any previous video encounters.

We purposefully integrated our solution into the same integrated electronic medical record we use for every face-to-face visit, telephone, or email visit. All the information is there to make the right clinical call. The ordering and referring process is identical (and can be done for the patient by the provider). The activity is visible to the patient’s regular provider(s).

When practiced right, it becomes as clear as the face on that smart phone screen that video visits are a powerful tool to improve access and patient satisfaction. The medical community needs to invest in making it not simply available to more patients, but making it available in a way that allows them to integrate that care with their overall primary and specialty care.

Transgender Health Meet and Greet

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In 2013, we hosted a first conversation, the Transgender Health Care Dialogue. In 2016, we hosted our next, Transgender Health Meet and Greet.

A lot has happened in three years, in our society, in the medical profession, and at Kaiser Permanente. The 2016 event included physicians, nurses, and health leaders from Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Medical Group, and The Southeast Permanente Medical Group.

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They joined with the Washington, DC, Maryland, and Virginia LGBTQ community to meet Drs. Kathy Rumer and Rachel Bluebond-Langner to learn about surgical care for people who are transgender or gender non-conforming – hence “Transgender Health Meet and Greet.”

It’s an honor to participate in the future of care delivery at Kaiser Permanente, an organization that values the diversity and inclusion of our lesbian, gay, bisexual, and transgender members (and staff).

Total Health definitely includes the doctors, nurses, and health care system that enable people to live as their authentic selves, as members, as caregivers, as leaders in their communities. I can’t wait to see what happens next.