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Owning Our Own Health--Modeling Healthy Living | to pdf >> By Barbara Caruso; Michael Mustille, MD; Violeta Rabrenovich, MHA
Kaiser Permanente (KP) exists to improve the health of our members and the communities we serve. When Henry Kaiser and Sidney Garfield, MD, first designed the concept that later became KP, our first members were workers in the Mojave Desert, building the California Aqueduct, and the community became their families. After that came the shipyard workers and their families in California and Oregon. Caring for all of those members and communities required a larger and larger group of dedicated employees and physicians. Now, KP employs nearly 140,000 people across the country, all striving to deliver on that same promise. In fact, because of our success and growth, we--the people of KP--are one of the largest blocks of members and one of the largest communities we serve. So, what about us, how are we doing with improving the health of our own KP community? The answer is that there are many existing and developing programs but we should be doing even more. From feedback on employee surveys, from consulting our labor partners, and even from some of our own population health reports, we have seen that we have not paid enough attention to promoting and enhancing the health of our people. Although our KP regions have developed and adopted a variety of physician and employee health and wellness programs, regional and national executive leaders recently decided to focus additional attention on improving the health and wellness of the KP employee community. "Employee health and wellness are critical to KP's future and to our reputation," emphasizes Bernard Tyson, Senior Vice President, Brand Strategy and Management. "They are critical to our future because we depend upon people to deliver our health care. Sure, technology and well-calibrated equipment are also key tools in health care delivery, but it's the people who bring the experience to life for our members and key stakeholders. Plus, in order for us to be respected in our field and viewed as America's health leader, we must walk our talk." Supporting a work environment that promotes employee health, wellness, and work-life balance is directly aligned with KP and Labor Management intentions and goals. As a result, during the 2005 bargaining process, a number of frontline workers, managers, physicians, and union representatives shared their vision, ideas, and interests to further develop and enhance existing relationships and engage in the interest-based bargaining process. The Union Coalition, The Permanente Medical Groups and Kaiser Foundation Health Plan/Hospitals Labor Management task groups met in multiple sessions to make recommendations on nine workplace areas. The Work-Life Balance Task Group (BTG) was asked to address the question: "How might we help KP employees live long and thrive at work, at home, and in their communities." The parties were involved in a thorough review of identifying strengths and opportunities for programs and services offered to our employees. They also discussed the input they received from frontline employees, the challenges and complexities associated with our everyday realities and how we support employees' ability to adequately balance their professional and private responsibilities--to stay healthy and well. As a result of the hard work, the BTG developed a set of work-life balance recommendations for the Common Issues Committee (CIC)--the group represented by leadership from all three entities, which will negotiate a comprehensive national agreement. "What better industry than the health care industry and what better employer than KP to lead current employee wellness initiatives and to establish a new pathway for future employee health and wellness efforts," says Peter di Cicco, Executive Director, Coalition of KP Unions. "Our physicians and other clinicians have a vital role in providing clinical expertise, sharing their experience and leading development and implementation of wellness efforts and tools," notes Jay Crosson, MD, Executive Director of The Permanente Federation. "A number of our physicians are now adopting these efforts and tools into clinical practice, such as developing healthy lifestyle prescription pads, and encouraging staff members to join them exercising during the day. Physicians will continue to promote and support the adoption of these tools not only for members, but to keep our employees healthy, too. KP leaders will continue to demonstrate our commitment to the wellness of our workforce by caring and respecting the physical, emotional, and spiritual well-being of employees and physicians." With a new sense of how important the balance between work and health is to the success of our program, KP is taking some big steps toward making Thrive a reality for all of us. Health Plan and hospital leaders have collaborated to sponsor programs and events with special access and special discounts for employees, and have incorporated health and wellness goals into the business plans for the future success of their operations. There is now a solid link between our people strategy, our business strategy, and our health strategy as an organization. Regional and national departments and groups are collaborating to align and coordinate activities, leveraging existing resources and engaging in ongoing communication and promotional efforts. The interregional collaboration is facilitated by many KP departments: Care Management Institute (CMI), Human Resources Shared Services, Internet Services Group, National Communications, Permanente Medical Groups, The Permanente Federation, and many others. The regional and local content experts and peer leaders have a vital role in developing and shaping employee wellness activities, implementing operational changes, communicating and promoting programs and services, evaluating effectiveness, and disseminating successful practices. KP is known as a leader in both preventive medicine and environmental stewardship and is using this position to create a vision for a healthy, sustainable food system, which also impacts our employees and clinicians. CMI is partnering with many departments--KP Environmental Stewardship, The Permanente Federation, Community Benefits, employee wellness committees, and physicians--to encourage employees to make healthy living choices and incorporate these choices into their lives on a day-to-day basis. Making small, incremental decisions in the foods we eat, balancing our work and personal lives, and creating time and opportunities for physical activity can all add up to increasing the likelihood of being in good health. A KP Food Policy has been created, which outlines how KP can contribute to promoting healthy food choices for our employees, physicians, KP members and community members. Through the formation of a KP Food Group, their plan includes creating Farmers Markets at KP facilities and employer group sites, a farm-to-hospital demonstration project, and provision of healthier vending food options at our facilities. These projects demonstrate KP's ability to effectively support, promote, and influence changes within our organization and in our communities. William Caplan, MD, Director of Clinical Strategy and Director of CMI's Weight Management Initiative, believes that physicians have a unique opportunity to use their professional influence to advocate for and be role models for healthier lives. "When patients see their physician wearing a pedometer, taking the stairs instead of the elevator, or speaking publicly about the importance of incorporating bike paths in a housing development, they see the value their physician places on his health," says Dr Caplan. Many employee wellness efforts are underway in our regions. Colorado's Practicing Prevention Program has offered employee and member wellness programs for 12 years. From yoga classes, Weight Watchers, a six-week pedometer program, healthier food offerings in vending machines, a Farmers Market, and a stress management program, the Practicing Prevention Program follows a methodical and scientifically based needs assessment and data gathering process. A year ago, the KP Be Well program was developed, specifically for KP employees. Through this program, an assessment of Colorado staff flagged three health areas that needed to be addressed: a lack of fiber intake, lack of aerobic exercise, and a lack of sunscreen use. Because of these results, a variety of programs were introduced, such as the "5-A-Day Program," in which participating employees tracked their consumption of fruits and vegetables for 21 days. Concurrently, KP Be Well staff delivered fruits and vegetables once a week to all 4500 staff members at 22 different locations. "If we're not taking care of ourselves, then how can we take care of our members?" asks Melissa Dodd, Prevention Manager for the KP Be Well and Practicing Prevention Programs. The Practicing Prevention Program is a benefit large employer groups (100 or more KP subscribers) can purchase. It includes a preventive health initiative with incentives such as copayment discounts for primary prevention visits, including physical exams, immunizations, mammograms, and prenatal care. It's also possible to build concepts of employee wellness into business initiatives, such as the KP HealthConnect implementation. During the Colorado KP HealthConnect go-live and implementation efforts, the KP Be Well Program designed and offered a Rest, Relax and Rejuvenate program for employees at each facility. Held at every facility, the program consisted of a free ten-minute chair massage, electronic foot massages, and an aromatherapy room as a stress reliever. Many physicians attended the program as well and are incorporating their learnings into conversations with their patients. "There has been a lot of enthusiasm for these programs among our doctors and staff. I was surprised to see many local initiatives follow our initial efforts: clinics have done innovative things like bringing in a massage therapist, having broccoli cooking contests, and making space during remodeling for employee relaxation centers ... lots of unplanned, local initiatives to help employees thrive," enthuses Eric France MD, MSPH, Chief of Preventive Medicine for Colorado Permanente. Ohio recently rolled out its KPO Walking Towards Better Health: KP Employees Thrive, which provides the tools and impetus for physicians and employees to participate in a 16-week team-based walking program with pedometers and tracking logs. Many of the participants have continued to incorporate a walking regimen into their daily routine--and have encouraged their colleagues to also take steps toward better health. Within the Mid-Atlantic States, the worksite wellness efforts are designed, planned and implemented by the Worksite Wellness Committee (WWC), a multidisciplinary committee with representatives from senior leadership, human resources, medical center administration and operations, MAPMG, labor management, prevention and employee health, diversity, marketing and communications. As a result, WWC activity in the Mid-Atlantic Region has celebrated successful implementation of several Work Towards Wellness program components. For 2005, in addition to other interventions, the Mid-Atlantic plans to promote and leverage recently implemented Total Health Assessment tools and other national interventions. "Our goal is to improve employee health, satisfaction, and morale by creating the environment where we facilitate and encourage employees and physicians to thrive," explains Hanadi Shamkhani, MD, interim Cochair of Regional Pharmacy and Therapeutics Committee and member of WWC. Within the Northern California region, TPMG physician wellness and KFH employee wellness programs focus on supporting the strategic priority to become the employer of choice in health care. Programs address the diverse needs of the physician and employee population including: recruitment and new staff acculturation; reward and recognition; community building; promoting healthy practices; renewal and resiliency; work environment; and prevention and management of physician/employee impairment. Every facility in Northern California has a Professional Satisfaction/Wellness Committee dedicated to improving physician health and wellness as well as a Physician Well-Being Committee to identify and assist impaired medical staff. Each medical center has a designated Assistant Physician-in-Chief with responsibility to provide leadership for physician health and professional satisfaction issues, in addition to a range of other human resource-related functions. Regional-level staff support local efforts by providing expertise in program development, management, and evaluation, and by coordinating and disseminating successful practices regionwide. Facility-based committees meet quarterly as physician peer groups to learn and transfer best practices. A modestly funded innovation grant supports medical centers' piloting new ideas for increasing physician health and professional satisfaction. Recently, the Northern California region created an Employee Wellness department and convened an Employee Wellness Proposal Forum with stakeholders to generate ideas and strategies for 2006 planning. Incoming Chair of the TPMG Physician Satisfaction and Wellness Leaders Sarah Beekley, MD, notes that the mission of the TPMG Physician Satisfaction and Wellness Program is to ensure that each and every physician feels valued within KP. "There is no better venue for this than the complex arena of personal health and wellness. By investing in our physicians' own healthy practices, as well as their sense of community, work environment and work-life balance, we support them in their work as leaders and role models. The first steps on the lifelong path of personal health and wellness begins at home," says Dr Beekley. The efforts in Colorado, Mid-Atlantic States, Ohio, and Northern California are just a few examples of the many comprehensive programs and activities initiated within all KP regions. Our employees and clinicians are using the Thrive brand strategy to come up with their own creative ideas, based on their facility's culture and environment. Dr France emphasizes, "I believe our Thrive image has to begin at home. Our employees need to model healthy living behaviors to our members. We need to challenge ourselves to look at our workday and develop new models that allow our nurses and doctors to find time to practice what they preach regarding healthy eating and active living. We are not there yet and need to take on this challenge."
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