Caring Science Journey

Kaiser Permanente

Northern California

Patient Care Services

Kaiser Permanente Facts:

o Founded in 1945o Headquarters in Oakland CAo 8.6 Million Members

o 3.2 Members in Northern Californiao 156,853 Employees

o 66,778 Employed in Northern Californiao 45,000 Nurseso 13,729 Physicianso 36 Hospitals

o 21 in Northern Californiao 416 Medical Office Buildings

o 180+ in Northern California

The Beginning 2005

Significant Changes: oState Mandated RatiosoElectronic Medical Record

New Facility 2007

Collaboration: Heart Math and WCSI

Pre and Post Data

% of individuals who responded: often – always: Pre Post

My sleep is inadequate 41% 21%

Body aches (joint pain, backaches, etc.) 38% 12%

Muscle Tension 33% 6%

Headaches 9% 3%

% of individuals who agree or strongly agree: Pre Post

I feel a strong sense of rapport with my supervisor 36% 56%

There is tension b/w management and staff 41% 26%

I feel very useful in my job 74% 94%

I constantly work at full capacity 71% 88%

I feel conflict b/w work & personal priorities 29% 15%

I am creative and innovative 53% 74%

We have great confidence about being successful in the future.

72% 91%

Pre and Post Data

N = 37

Page 9

Rate Overall Hospital

Page 10

Willingness to Recommend

Q407

Total # of Medications Administered

81,517

Medication Administering Error Rate

.01%

Q208

Total # of Medications Administered

196,889

Medication Administering Error Rate

.005%

Benchmark

Medication Administering Error Rate

1.21%

Source: Rough S et al. Improving the Medication Administration Process: The

Impact of Point of Care Bar Code Medication Scanning Technology. ASHP Midyear Clinical Meeting, New Orleans

2003.

Medication Safety

• ;

oSafest Place to Work in 2008 In KP NCAL

Hand Hygiene

oAudits 1st Qtr 09 92%

oThis hospital is a good place to work 75%oI like my job 86%

oWorking in this hospital is like being part of a large family 64%

Safety Attitude Questionnaire Aug 08

We literally hold another

person’sLife in our hands and are the source for sustaining our own

and others humanityLogstup, Danish philosopher

Other Results

March 27, 2008

I am writing this letter on behalf of my spouse and myself.

My wife recently underwent total knee replacement surgery March 24 under the care of Dr XXXXX.

I spoke with Dr XXXXX and expressed to him as well, how my wife (her patient) felt about his surgical team and how they made her feel that her case and her pending surgery was the most important surgery being performed that day. However, if you will please ensure he receives a copy of this letter it would be appreciated.

She felt so comforting and reassured that she was going to receive the best medical care in the world. And this includes from the front reception desk to your Volunteer Mrs. XXXXX (I think) her name was. She was wonderful and discussed with my wife her very successful and positive knee surgery now four years out.

She spent three days recuperating in room 406 under the care of Hospital West staff.

It would be greatly appreciated by both of us if you would circulate this letter of appreciation to the staff of Hospital West. My wife wanted me to share with you the fine professional medical care she experienced during her hospital stay. I visited her twice a day in the morning and in the late evening and I can also attest to the outstanding care she received from the nursing staff and her therapist XXXXXX.

Everyone was so attentive, genuinely caring and professional. The floor was maintained in a clean condition everyday without fail.

We realize that the Deer Valley Kaiser Hospital Facility is very new and moral may be at a high point with a new facility. But please share with the staff there how important their work is to the real people those who they meet very fleetingly at times as the are sick and they are in pain, some lonely and yes some may be dying.

I sincerely hope that the staff approaches their profession everyday as they are collectively approaching it at present. And I hope Ms Anne Foss-Durant that you and your subordinate managers continue to ensure that the staff is held to the highest standard of care their profession demands and that you continue to support and provide your staff the same level of leadership your presently providing. I was also a manger of a large facility and I know that it takes leadership and dedication and job-know-how to make people want to do their best. Once again thank you all very much for all you did for my wife

Sincerely,

Dear Dr Poppert,

On July 11th, my husband had surgery on his shoulder at the Sand creek facility. Dr XX was his surgeon and he was so kind and descriptive to him. The day of surgery we were informed that there could be a problem getting the breathing tube down his throat. The anesthesiologist doctor and nurse both spoke with him and couldn’t have been nicer to the both of us. We were worried but everyone quickly put our fears to rest. After the surgery Dr XX came out and went over the surgery with me and was very pleased with how well it had gone. I was very happy. My husband is 66 years old and as you get older you worry more about having surgery of any kind.

He was taken to the 4th floor for the night as he has sleep apnea and was being kept for 23 hours. He was resting comfortably and then approx. 2 hours after he got to the room all hell broke loose. He went into respiratory failure and I honestly thought that he was going to die right in front of me. (I know that you must have waiting for the but . . .)

Anyway the respiratory therapist on the floor ran and got XXXXXXXX who along with Dr XXX literally saved his life. The nurses were running to get test done that Dr XXX was ordering. They were absolutely amazing. I am so sorry that I could not get everyone’s name, but this happened at approx. 3:30 in the afternoon and I was a nut case at that point. Dr XXX and XXXXXXXXX were so professional and kind to him. They saved him and I am most grateful.

At approx. 4 hours later, he was moved to ICU. Our nurse that we had the most contact with was XXXXX. She was the most competent, kind and wonderful to be with. I told her she took no prisoners. All of the staff in the ICU for the 4 days was truly great. Again I am sorry that I did not record all of the names. They let me stay in the room with my husband and I really appreciated the kindness shown to both of us.

After 3 days, He was moved to CCU. Again the staff couldn’t have been nicer there as well. This was his first hospital stay in all of his 66years, and let me tell you he was not thrilled with the experience, but we both wanted to tell you that you the most wonderful people working at that hospital. I am sure that you expected this letter was one to complain, but quite the opposite. We were so happy to leave and to have the memories of the kindness and professionalism shown to us by your people. Great job and we apologize for not being able to name everyone by name. People so seldom take time to compliment and we want to make sure that we told you that your staff is the best and say a big thank you. Please pass this along to your staff.

Sincerely,

Spreading Across the Region 2010

Page 16

Relationship between caring science theory, culture, and professional nursing practice

Caring Science Theory

ProfessionalPractice Culture

World Class HospitalDelivering the best 21st century

hospital care

Expected Operational Impact

o Science of Caring as a framework:o Reignites the Passion of the nurse o Reinforces the Power of the Nursing

profession/roleo Reaffirms the Perspective on the Patient and on

creating a healing environmentoEstablishes the professional practice structure oEnables the nurse and patient to experience an

authentic relationshipo Infuses the behavior, thinking and feeling of the

nurse

Page 18

“Tactical”Strategic yet Prescribed Processes

“Consciousness”Professional Practice Framework

Align Hearts + Reignite Passion + Reinforce Power + Reaffirm Perspective + Inspire

Accountability

Beliefs & Behaviors

Transform Approach, Practice & Relationships(e.g. policies & procedures, workflows, interactions, culture)

Hardwire Performance Excellence // Assure WCH Outcomes

Align Goals + Reinforce Behavior Standards & Communication Tactics + Define

Accountability

Behaviors

WCH Initiatives(Highly Skilled & Motivated Workforce //

Quality Leader // Exceptional Care Experience // Care without Delay)

Caring Sciences(Heart // Voice // Home // Path //

Journey)

feedback loop

Captures the

heart and mind

of the nurse

Caring Sciences – Integration with WCH

Caring Sciences – Key Milestones in 2010

April May June July Aug Sep Oct Nov

Phase 1: Gain Leadership sponsorship and PCS management ownership

o 4/12 Executive Leadership Launcho Area Mgrs / COOs / CNOso Select Regional leaders

o 4/19 CNO Planning Intensiveo 5/18 PCS Management Forum

Phase 2: Attain commitment from RN staff and implement nursing model within the medical centers

o as of 7/1 PCS candidate interviews include Caring Sciences/Caring Moment questiono Thereby achieving 1 of 3 Stretch performance goal criteria

o 7/14-16 Registered Nurse Forums with Dr. Jean Watson and Robert Browningo Approximately 1,000 nurses attended the forums across the 3 days

o as of 8/9 PCS management intensive kick-off session conducted by all medical centers o Thereby achieving Target performance goal

o by Q4 2011 Caring Science Advisory Circles established at all medical centers; Adoption/adaptation of at least one caring-healing ritual/practice by 80% of inpatient units o Remaining 2 of 3 Stretch performance goal criteria

Phase 3: Further develop knowledge base of nursing staff and management

o 9/15-17, 12/13 – 15, 3/7 – 9, 4/4 - 6 o Level 1 Human Caring Program

o 301 participants (FRS, HAY, RWC, SSF), primary focus on frontline RN staff

o Provided more in depth education on Caring Sciences and HeartMath, as well as a practicum on how to apply caring healing modalities in their care setting

Dec

Jan Feb March April May

Phase 4: Develop Management Skills in Creating Healing Environments for Our Patients and Staff

o 4/22, 5/16, 6/13, 6/27 Leading with Care Modules available for Nurse Managers and Assistant Nurse Managers

o May 2011 Kaiser Consortium

2010

2011June

Caring Sciences – Changing Practice in our Med Centers An outburst of “infectious” caring is taking place by staff at

Sacramento Medical Center. As we begin our journey of implementing Watson’s “Science of Caring” theory…(we) use innovative ways of providing “caring moments” to their patients and members.

These “Caring moments” are carefully orchestrated, so that when a request comes in to the “Caring Code Team” (CCT), the team goes into action to fulfill the request. Requests as simple as:

providing pina coladas to a

patient who had a thirst

request after being on tube

feedings for over 4 months

deploying several departments for a complicated request making a wish come true for a terminal, ventilated

patient, cooped up inside the unit for over 5 months and only wanted to

feel the sun on his face

having a dog visit

Caring Sciences – Changing Practice in our Med Centers

• Morning Report in San Rafael – July 19th

• A quick note to all of you to express how pleased and impressed I am in seeing the "Thank you" and "Caring Moment" additions to your supervisor reports-- this is just phenomenal. This is exactly the grass-roots effort that it's going to take for us to change our culture. I am so proud of you as a team-- you have come so very far in the last 1-2 years and the quality of your reports is just one tangible example of that.

• Tony (Fiorello, CNO)

Super Report 2300-07 July 19-Good Morning!

Beginning Census: 50 Ending Census: 53 Admissions: 3 cath beds needed;

1 post op ortho EPRP: none Overtime: none No Cancels: 1RN nights 3W Chemo: one on days Falls/Issues: None

Thank yous: Jan Reno for excellent staffing skills and cheerful demeanor

Caring Moment: Maryse Aldax in ICU remembers a recent incident where ICU teamwork saved a pts life. "I am happiest when we all work in harmony and treat each other with respect…look what we can do!!"

Kay McCoy, ANS

Staff RN Forum – Feedback

Rejuvenated

Positive-leaning Passive / Neutral Negative-leaning

14-Jul 85% 7% 8%

15-Jul 82% 8% 10%

16-Jul 71% 8% 21%

Hope / Hopeful

En

lig

hte

ne

dExcite

d

En

cou

rag

edCaring / Caritas

Love / Loving

Inspired

Empowered

Compassion

Heartf

elt

Skeptical

Un

realisti

c

MotivatingEnergized

Cu

riou

s

7/16OAKRCHFREHAYFRSANTWCR

7/15SRFSROSFORWCSSFSCLSJO

7/14ROSSACSSCMANMODVACVAL

Staff were asked to share ONE word that best expressed how they were feeling about the journey to embed Caring Sciences within Kaiser‡

A vast majority of staff felt hopeful and inspired, though some expressed frustration and concern about feasibility and level of support

‡Representation of words mentioned at least 4 times across all participants

Page 24

Level 1 Human Caring Program – Knowledge Base

Structure: 3-day program developed by the Watson Caring Science Institute to serve as an entry-level or alternative to the graduate level Caritas Coach program

Specifically targeted at frontline RN staff Co-sponsored by Regional Patient Care Services

Participants: 290 PCS staff, representing all 21 NCAL medical centers, have graduated from this program between Sep 2010 and Apr 2011

Desired outcome: to empower participants by developing greater:

understanding of the theory and how the 10 caritas processes serve as a framework for clinical decision-making

comfort in using caring-healing modalities with patients

Program Evaluationn = 53 (74% response rate)

5.72

5.75

5.72

5.62

5.72

1 2 3 4 5 6

The program metstated objectives

Teaching methodswere appropriate

The course wasapplicable to my

I learnedmethods/principles

The facultyembodied Caritas

Strongly Agree Strongly Disagree Agree

Page 26

Level 1 Human Caring Program

Feedback: from program participants as well as their CNOs has been extremely positive

Participant Comments:• You said this was going to be different from customer service models

and it is! It speaks to the heart and soul of our profession.

• It speaks volumes that Kaiser would invest this much time and money into their staff to (re)educate them in the healing art of caring. It makes you want to give back 100% to Kaiser for believing, trusting, and investing that much in me.

• The most valuable lesson I have learned from this encounter is that in order to be able to effectively take care of the needs of our patients, we also need to take care of ourselves first… and fill ourselves with positive energy that we can transmit to the patients we are taking care of. That sometimes just by being there, holding his/her hand and really listening to them is already a road towards their eventual recovery.

Page 27

Level 1 Human Caring Program

Feedback: from program participants as well as their CNOs has been extremely positive

CNO Comments:• Before they even came home from the program, I had nurses

sending me emails, asking to participate in creating a Caring culture here. They immediately planned events on their units, developed powerpoints from the materials and educated staff, and planned an experiential session for members of the Quality Forum.

• ASD commented on how well meetings are going. In particular they have learned to listen to each other. It has made meetings like the PPC go much smoother. // CASD commented on how different it has been sitting in the PPC, less adversarial.

• One nurse shared a story on how she was able to be with a family of a dying patient. She said before this class she would not have been able to help this family.

• Before they returned we heard of wonderful personal and professional transformations. The group enjoyed the content, fellowship of there experience and LOVED the faculty.

Some ResultsNCAL HCAPHS Patient Satisfaction

Nurse Communication

Some Results

ED to Bed in 60 Minutes

Sepsis Related Deaths

Our Heart Math Facilities:

AntiochWalnut Creek

FresnoVacaville

Redwood City

South San Francisco

Santa Rosa

Santa Clara

Future Heart Math Facilities:

Roseville

Vallejo

Fremont

Hayward

HeartMath Staff TrainingPOQA-R: pre and post measurements

% of responses: often – always: Pre Post

Grateful 78% 90%

Motivated 69% 78%

Enthusiastic 68% 78%

Peaceful 45% 58%

Tired 34% 26%

Exhausted 24% 18%

Anxious 19% 7%

Worried 31% 15%

Uneasy 7% 3%

N = 88

HeartMath Staff TrainingPOQA-R: pre and post measurements

% of responses: often – always: Pre Post

Depressed 6% 3%

Unhappy 8% 1%

Cynical 11% 6%

Annoyed 22% 7%

Angry 11% 4%

I sometimes have a short fuse 8% 2%

My sleep is inadequate 38% 26%

Body aches (joint pain, backaches, etc.) 25% 15%

Muscle Tension 33% 19%

N = 88

Training and Observations

Trainingo ANTo FRSo RWCo SCLo SSFo SROo VACo WCR

Observationso Rate Hospital : 5 at

or above the 85th percentile

o Nurse Communication: 5 in our top ten

o 4 Significantly improved

o NKE: 4 above the 75th percentile

o Attendance: 5 with a greater than 10% improvement

1st Annual Kaiser Permanente Consortium

Caring Science —Changing the Culture of Patient Care Serviceso Creating environments that support both

the patients and the health care worker influences results across the organization

o Reconnecting front line care givers and with their passion, unleashes creativity and innovation at the unit level.

o Culture can kill the best strategic plan o If culture is the sum of our values, beliefs,

rights, and rituals…culture is realityo Leaders set the culture

Questions