Caring Science Journey  Kaiser Permanente Northern California Patient Care Services
Kaiser Permanente Facts: <ul><li>Founded in 1945 </li></ul><ul><li>Headquarters in Oakland CA </li></ul><ul><li>8.6 Millio...
The Beginning 2005 <ul><li>Significant Changes:  </li></ul><ul><li>State Mandated Ratios </li></ul><ul><li>Electronic Medi...
New Facility 2007
Collaboration: Heart Math and WCSI
Pre and Post Data
Pre and Post Data  N = 37  % of individuals who responded: often – always: Pre Post I feel optimistic about the future 76%...
Pre and Post Data  N = 37  % of individuals who responded: often – always: Pre Post My sleep is inadequate 41% 21% Body ac...
Rate Overall Hospital Page
Willingness to Recommend Page
Medication Safety Q407 Total # of Medications Administered 81,517 Medication Administering Error Rate .01% Q208 Total # of...
<ul><li>; </li></ul><ul><li>Safest Place to Work  in 2008 In KP NCAL </li></ul><ul><li>Hand Hygiene   </li></ul><ul><li>Au...
March 27, 2008 I am writing this letter on behalf of my spouse and myself. My wife recently underwent total knee replaceme...
Dear Dr Poppert, On July 11 th , my husband had surgery on his shoulder at the Sand creek facility.  Dr XX was his surgeon...
Spreading Across the Region 2010
Relationship between caring science theory, culture, and professional nursing practice Page  Caring Science  Theory Profes...
Expected Operational Impact  <ul><li>Science of Caring as a framework: </li></ul><ul><ul><li>Reignites the Passion  of the...
Caring Sciences – Integration with WCH Page  “ Tactical” Strategic yet Prescribed Processes “ Consciousness” Professional ...
Caring Sciences – Key Milestones in 2010 April May June July Aug Sep Oct Nov <ul><li>Phase 1:  Gain Leadership sponsorship...
Caring Sciences – Changing Practice in our Med Centers <ul><ul><li>An  outburst of “infectious” caring  is taking place by...
Caring Sciences – Changing Practice in our Med Centers <ul><li>Morning Report in  San Rafael  – July 19 th   </li></ul><ul...
Staff RN Forum – Feedback Rejuvenated Hope / Hopeful Enlightened Excited Encouraged Caring / Caritas Love / Loving Inspire...
Staff RN Forum – Feedback  Frustrated Cautious Reflective Enlightened <ul><li>Waste of money </li></ul><ul><li>Too touchy-...
Level 1 Human Caring Program –  Knowledge Base <ul><ul><li>Structure:  3-day program developed by the Watson Caring Scienc...
Program Evaluation n = 53  (74% response rate) Strongly    Agree  Strongly Disagree   Agree
Level 1 Human Caring Program <ul><li>Feedback: from program participants as well as their CNOs has been extremely positive...
Level 1 Human Caring Program <ul><li>Feedback: from program participants as well as their CNOs has been extremely positive...
Some Results NCAL HCAPHS  Patient Satisfaction Nurse Communication
Some Results ED to Bed in 60 Minutes Sepsis Related Deaths
Our Heart Math Facilities: Antioch Walnut Creek Fresno Vacaville Redwood City South San Francisco Santa Rosa Santa Clara F...
HeartMath Staff Training POQA-R: pre and post measurements N = 88 % of responses: often – always: Pre Post Grateful 78% 90...
HeartMath Staff Training POQA-R: pre and post measurements N = 88 % of responses: often – always: Pre Post Depressed 6% 3%...
Training and Observations   <ul><li>Training </li></ul><ul><li>ANT </li></ul><ul><li>FRS </li></ul><ul><li>RWC </li></ul><...
1 st  Annual Kaiser Permanente Consortium
Engage CNA: Potential Strategies <ul><li>Engage Regional CNA Leadership in discussion  (April - May 2010) </li></ul><ul><u...
Medical Center Implementation Strategy <ul><li>Facility leadership Intensives  (May-August 2010) </li></ul><ul><ul><li>One...
Medical Center Implementation Strategy <ul><li>Executive </li></ul><ul><li>Maintain unity of purpose – quality caring </li...
Key Implementation Strategies <ul><li>Ensure all SOC/SOPs incorporate the principle of human caring “Caritas”  </li></ul><...
Facility Implementation Manager  Assistant Manager  Director RN/ RT /PCT (Together or Separate Groups) Physicians, Other L...
Reinforcing the Model 6th Month 1st Year 2nd Year <ul><li>Continue to develop links between the theory and practice.  </li...
Caring Science — Changing the Culture of Patient Care Services <ul><li>Creating environments that support both the patient...
<ul><li>Questions </li></ul>
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Delivering Results Through Person-Centred Care: Kaiser Permanente Patient Care Services, Northern California

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This session provides a living example of how care at the practice, team, organisation and system levels have been transformed through person-centred approaches using ‘Caring Science’ impacting on quality variables across the whole organisation.

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  • ©HeartMath 2004 Power to Change Performance -- ICLIF
  • ©HeartMath 2004 Power to Change Performance -- ICLIF
  • ©HeartMath 2004 Power to Change Performance -- ICLIF
  • December 6, 2008 Boy am I lucky. I found a treasure in Antioch! Recently I had the misfortune of having to go to the hospital. I went to the emergency and got in quickly. From there I was admitted for a couple of days. If you have to be in the hospital this is the place to be. Sure it is new, clean, and nice but it is the people who make the place a treasure. All the staff was the BEST especially the nurses. I don’t know if Kaiser picked the best personnel from all the hospitals around but it sure seems that way I was in the emergency Monday night the third, admitted, had a procedure Wednesday the fifth and then was released. I was in room 310. The nurses and other staff were like friends taking care of me not people doing a job. All the nurses on all the shifts should receive something in recognition of their jobs well done. My wife had one complaint. All the handicap parking is full by 7:30 AM. There needs to be more in both front parking lots. Thank you to everyone.
  • December 6, 2008 Boy am I lucky. I found a treasure in Antioch! Recently I had the misfortune of having to go to the hospital. I went to the emergency and got in quickly. From there I was admitted for a couple of days. If you have to be in the hospital this is the place to be. Sure it is new, clean, and nice but it is the people who make the place a treasure. All the staff was the BEST especially the nurses. I don’t know if Kaiser picked the best personnel from all the hospitals around but it sure seems that way I was in the emergency Monday night the third, admitted, had a procedure Wednesday the fifth and then was released. I was in room 310. The nurses and other staff were like friends taking care of me not people doing a job. All the nurses on all the shifts should receive something in recognition of their jobs well done. My wife had one complaint. All the handicap parking is full by 7:30 AM. There needs to be more in both front parking lots. Thank you to everyone.
  • Hope, ful = 16+13+9 = 38 Caring / Caritas = 7+9+8 = 24 Love, ing = 7+9+6 = 22 Enlightened, ing = 7+10+5 = 22 Inspired, ing = 11+4+3 = 18 Excited, ing = 8+5+4 =17 Compassion, ate = 4+6+1 = 11 Rejuvenated, ing, Renewed, al = 5+4+2 = 11 Empowered = 5+3+2 = 10 Heart, felt, ful = 2+1+6=9 Encouraged = 5+0+2=7 Motivating = 0+4+0=4 Energized, ing = 3+0+1=4 Unrealistic = 0+3+5=8 Skeptical = 4+2+1 = 7 Curious = 1+3+0=4
  • Watson Caring Science Institute | © WCSI. All Rights Reserved.
  • Anita Culture is complex. One of the major reasons that organizational change efforts reportedly fail is a lack of understanding about culture and the significant role it plays. Despite the best-laid strategic and tactical plans, any significant organizational change must include not only changing structures and processes, but also addressing the underlying organizational culture. Appreciating the complexity of culture is particularly important when attempting to manage organization-wide change, because culture is multifaceted, deep, broad and stable. It provides tacit rules that guide behavior, meaning and predictability (Schein, 1999). Culture, by definition, provides a framework to live in, to cultivate and to honor. Challenge is to engage the front-line staff To transform Beliefs in addition to influencing Behaviors requires a cultural transformation Past conversations with CNA about adverse reaction to “service” have demonstrated the need to be cautious about our approach to how we engage the registered nurse in this work CNA is very resistant to prescriptive processes and language; seen as demeaning to the professional nurse Cannot argue with caring
  • Delivering Results Through Person-Centred Care: Kaiser Permanente Patient Care Services, Northern California

    1. 1. Caring Science Journey Kaiser Permanente Northern California Patient Care Services
    2. 2. Kaiser Permanente Facts: <ul><li>Founded in 1945 </li></ul><ul><li>Headquarters in Oakland CA </li></ul><ul><li>8.6 Million Members </li></ul><ul><ul><li>3.2 Members in Northern California </li></ul></ul><ul><li>156,853 Employees </li></ul><ul><ul><li>66,778 Employed in Northern California </li></ul></ul><ul><li>45,000 Nurses </li></ul><ul><li>13,729 Physicians </li></ul><ul><li>36 Hospitals </li></ul><ul><ul><li>21 in Northern California </li></ul></ul><ul><li>416 Medical Office Buildings </li></ul><ul><ul><li>180+ in Northern California </li></ul></ul>
    3. 3. The Beginning 2005 <ul><li>Significant Changes: </li></ul><ul><li>State Mandated Ratios </li></ul><ul><li>Electronic Medical Record </li></ul>
    4. 4. New Facility 2007
    5. 5. Collaboration: Heart Math and WCSI
    6. 6. Pre and Post Data
    7. 7. Pre and Post Data N = 37 % of individuals who responded: often – always: Pre Post I feel optimistic about the future 76% 97% My life is deeply fulfilling 62% 85% Grateful 74% 88% Dynamic 55% 76% Peaceful 41% 68% Relaxed 29% 47% Tired 53% 12% Fatigued 41% 9% Anxious 18% 6% Worried 35% 6% Unhappy 18% 3% Annoyed 24% 6% I get upset easily 21% 3%
    8. 8. Pre and Post Data N = 37 % 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%
    9. 9. Rate Overall Hospital Page
    10. 10. Willingness to Recommend Page
    11. 11. Medication Safety 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.
    12. 12. <ul><li>; </li></ul><ul><li>Safest Place to Work in 2008 In KP NCAL </li></ul><ul><li>Hand Hygiene </li></ul><ul><li>Audits 1 st Qtr 09 92% </li></ul><ul><li>This hospital is a good place to work 75% </li></ul><ul><li>I like my job 86% </li></ul><ul><li>Working in this hospital is like being part of a large family 64% </li></ul>Safety Attitude Questionnaire Aug 08 We literally hold another person’s Life in our hands and are the source for sustaining our own and others humanity Logstup, Danish philosopher Other Results
    13. 13. 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,
    14. 14. Dear Dr Poppert, On July 11 th , 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 4 th 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,
    15. 15. Spreading Across the Region 2010
    16. 16. Relationship between caring science theory, culture, and professional nursing practice Page Caring Science Theory Professional Practice Culture World Class Hospital Delivering the best 21st century hospital care
    17. 17. Expected Operational Impact <ul><li>Science of Caring as a framework: </li></ul><ul><ul><li>Reignites the Passion of the nurse </li></ul></ul><ul><ul><li>Reinforces the Power of the Nursing profession/role </li></ul></ul><ul><ul><li>Reaffirms the Perspective on the Patient and on creating a healing environment </li></ul></ul><ul><ul><ul><li>Establishes the professional practice structure </li></ul></ul></ul><ul><ul><ul><li>Enables the nurse and patient to experience an authentic relationship </li></ul></ul></ul><ul><ul><ul><li>Infuses the behavior, thinking and feeling of the nurse </li></ul></ul></ul>
    18. 18. Caring Sciences – Integration with WCH Page “ 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
    19. 19. Caring Sciences – Key Milestones in 2010 April May June July Aug Sep Oct Nov <ul><li>Phase 1: Gain Leadership sponsorship and PCS management ownership </li></ul><ul><ul><li>4/12 Executive Leadership Launch </li></ul></ul><ul><ul><ul><li>Area Mgrs / COOs / CNOs </li></ul></ul></ul><ul><ul><ul><li>Select Regional leaders </li></ul></ul></ul><ul><ul><li>4/19 CNO Planning Intensive </li></ul></ul><ul><ul><li>5/18 PCS Management Forum </li></ul></ul><ul><li>Phase 2: Attain commitment from RN staff and implement nursing model within the medical centers </li></ul><ul><ul><li>as of 7/1 PCS candidate interviews include Caring Sciences/Caring Moment question </li></ul></ul><ul><ul><ul><li>Thereby achieving 1 of 3 Stretch performance goal criteria </li></ul></ul></ul><ul><ul><li>7/14-16 Registered Nurse Forums with Dr. Jean Watson and Robert Browning </li></ul></ul><ul><ul><ul><li>Approximately 1,000 nurses attended the forums across the 3 days </li></ul></ul></ul><ul><ul><li>as of 8/9 PCS management intensive kick-off session conducted by all medical centers </li></ul></ul><ul><ul><ul><li>Thereby achieving Target performance goal </li></ul></ul></ul><ul><ul><li>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 </li></ul></ul><ul><ul><ul><li>Remaining 2 of 3 Stretch performance goal criteria </li></ul></ul></ul><ul><li>Phase 3: Further develop knowledge base of nursing staff and management </li></ul><ul><ul><li>9/15-17, 12/13 – 15, 3/7 – 9, 4/4 - 6 </li></ul></ul><ul><ul><li>Level 1 Human Caring Program </li></ul></ul><ul><ul><ul><li>301 participants (FRS, HAY, RWC, SSF) , primary focus on frontline RN staff </li></ul></ul></ul><ul><ul><ul><li>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 </li></ul></ul></ul>Dec Jan Feb March April May <ul><li>Phase 4: Develop Management Skills in Creating Healing Environments for Our Patients and Staff </li></ul><ul><ul><li>4/22, 5/16, 6/13, 6/27 Leading with Care Modules available for Nurse Managers and Assistant Nurse Managers </li></ul></ul><ul><ul><li>May 2011 Kaiser Consortium </li></ul></ul>2010 2011 June
    20. 20. Caring Sciences – Changing Practice in our Med Centers <ul><ul><li>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. </li></ul></ul><ul><ul><li>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 : </li></ul></ul>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
    21. 21. Caring Sciences – Changing Practice in our Med Centers <ul><li>Morning Report in San Rafael – July 19 th </li></ul><ul><li>A quick note to all of you to express how pleased and impressed I am in seeing the &quot;Thank you&quot; and &quot;Caring Moment&quot; 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. </li></ul><ul><li>Tony (Fiorello, CNO) </li></ul><ul><li>Super Report 2300-07 July 19- </li></ul><ul><li>Good Morning! </li></ul><ul><ul><li>Beginning Census : 50 </li></ul></ul><ul><ul><li>Ending Census : 53 </li></ul></ul><ul><ul><li>Admissions: 3 cath beds needed; 1 post op ortho </li></ul></ul><ul><ul><li>EPRP : none </li></ul></ul><ul><ul><li>Overtime: none </li></ul></ul><ul><ul><li>No Cancels: 1RN nights 3W </li></ul></ul><ul><ul><li>Chemo: one on days </li></ul></ul><ul><ul><li>Falls/Issues: None </li></ul></ul><ul><li>Thank yous: Jan Reno for excellent staffing skills and cheerful demeanor </li></ul><ul><li>Caring Moment: Maryse Aldax in ICU remembers a recent incident where ICU teamwork saved a pts life. &quot;I am happiest when we all work in harmony and treat each other with respect…look what we can do!!&quot; </li></ul><ul><li>Kay McCoy, ANS </li></ul>
    22. 22. Staff RN Forum – Feedback Rejuvenated Hope / Hopeful Enlightened Excited Encouraged Caring / Caritas Love / Loving Inspired Empowered Compassion Heartfelt Skeptical Unrealistic Motivating Energized Curious 7/16 OAK RCH FRE HAY FRS ANT WCR 7/15 SRF SRO SFO RWC SSF SCL SJO 7/14 ROS SAC SSC MAN MOD VAC VAL <ul><ul><li>Staff were asked to share ONE word that best expressed how they were feeling about the journey to embed Caring Sciences within Kaiser ‡ </li></ul></ul><ul><ul><ul><li>A vast majority of staff felt hopeful and inspired, though some expressed frustration and concern about feasibility and level of support </li></ul></ul></ul>‡ Representation of words mentioned at least 4 times across all participants Positive-leaning Passive / Neutral Negative-leaning 14-Jul 85% 7% 8% 15-Jul 82% 8% 10% 16-Jul 71% 8% 21%
    23. 23. Staff RN Forum – Feedback Frustrated Cautious Reflective Enlightened <ul><li>Waste of money </li></ul><ul><li>Too touchy-feely </li></ul><ul><li>Unrealistic expectations </li></ul><ul><li>Management disconnected – expectations are not aligned to theory </li></ul><ul><li>Focus on technology and speed at odds with focus on patient relationship </li></ul><ul><li>Idealistic </li></ul><ul><li>Inadequate staffing </li></ul><ul><li>Need more time </li></ul><ul><li>Manager support lacking </li></ul><ul><li>Need to fix system issues </li></ul><ul><li>Concern about staff that rebel or resist change behavior </li></ul><ul><li>One moment can impact viewpoint </li></ul><ul><li>Importance of self care </li></ul><ul><li>Power of honesty and trust </li></ul><ul><li>Interest in learning more about HeartMath techniques </li></ul><ul><li>Empower nurses to use caring touch </li></ul><ul><li>Promote respect and kindness within nursing team </li></ul><ul><li>Be an instrument for change </li></ul><ul><li>Relationships with co-workers have flourished </li></ul><ul><li>Reaffirm importance of role as a nurse </li></ul><ul><li>Patients are positively affected </li></ul><ul><li>Renewed passion for nursing profession </li></ul><ul><li>Thrilled KP is adopting this theory </li></ul>
    24. 24. Level 1 Human Caring Program – Knowledge Base <ul><ul><li>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 </li></ul></ul><ul><ul><ul><li>Specifically targeted at frontline RN staff </li></ul></ul></ul><ul><ul><ul><li>Co-sponsored by Regional Patient Care Services </li></ul></ul></ul><ul><ul><li>Participants: 290 PCS staff, representing all 21 NCAL medical centers, have graduated from this program between Sep 2010 and Apr 2011 </li></ul></ul><ul><ul><li>Desired outcome: to empower participants by developing greater: </li></ul></ul><ul><ul><ul><li>understanding of the theory and how the 10 caritas processes serve as a framework for clinical decision-making </li></ul></ul></ul><ul><ul><ul><li>comfort in using caring-healing modalities with patients </li></ul></ul></ul>Page
    25. 25. Program Evaluation n = 53 (74% response rate) Strongly Agree Strongly Disagree Agree
    26. 26. Level 1 Human Caring Program <ul><li>Feedback: from program participants as well as their CNOs has been extremely positive </li></ul><ul><li>Participant Comments: </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>Page
    27. 27. Level 1 Human Caring Program <ul><li>Feedback: from program participants as well as their CNOs has been extremely positive </li></ul><ul><li>CNO Comments: </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Before they returned we heard of wonderful personal and professional transformations. The group enjoyed the content, fellowship of there experience and LOVED the faculty. </li></ul>Page
    28. 28. Some Results NCAL HCAPHS Patient Satisfaction Nurse Communication
    29. 29. Some Results ED to Bed in 60 Minutes Sepsis Related Deaths
    30. 30. Our Heart Math Facilities: Antioch Walnut Creek Fresno Vacaville Redwood City South San Francisco Santa Rosa Santa Clara Future Heart Math Facilities: Roseville Vallejo Fremont Hayward
    31. 31. HeartMath Staff Training POQA-R: pre and post measurements N = 88 % 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%
    32. 32. HeartMath Staff Training POQA-R: pre and post measurements N = 88 % 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%
    33. 33. Training and Observations <ul><li>Training </li></ul><ul><li>ANT </li></ul><ul><li>FRS </li></ul><ul><li>RWC </li></ul><ul><li>SCL </li></ul><ul><li>SSF </li></ul><ul><li>SRO </li></ul><ul><li>VAC </li></ul><ul><li>WCR </li></ul><ul><li>Observations </li></ul><ul><li>Rate Hospital : 5 at or above the 85 th percentile </li></ul><ul><li>Nurse Communication: 5 in our top ten </li></ul><ul><li>4 Significantly improved </li></ul><ul><li>NKE: 4 above the 75 th percentile </li></ul><ul><li>Attendance: 5 with a greater than 10% improvement </li></ul>
    34. 34. 1 st Annual Kaiser Permanente Consortium
    35. 35. Engage CNA: Potential Strategies <ul><li>Engage Regional CNA Leadership in discussion (April - May 2010) </li></ul><ul><ul><li>Identify the “What’s in it for me” for CNA </li></ul></ul><ul><ul><li>Provide education regarding the theory and model to CNA Executive Directors and Leadership </li></ul></ul><ul><ul><li>Request both formal and informal support from CNA Leaders for the roll out </li></ul></ul><ul><ul><li>Identify frontline advocates from the nursing staff at Antioch Medical Center who could work to support the implementation </li></ul></ul><ul><ul><li>Include CNA Representatives in the facility manager/leader education sessions </li></ul></ul><ul><ul><li>Engage CNA Staff Nurse Representatives to co-teach the caring theory roll out to frontline RNs with management </li></ul></ul>
    36. 36. Medical Center Implementation Strategy <ul><li>Facility leadership Intensives (May-August 2010) </li></ul><ul><ul><li>One day CNO-led, facility-focused session with key PCS leadership: </li></ul></ul><ul><ul><li>CNO, Service Directors, Managers, Assistant Nurse Managers, Educators, CNS </li></ul></ul><ul><ul><li>Support from Regional PCS Project team </li></ul></ul><ul><ul><li>Objectives: </li></ul></ul><ul><ul><ul><li>Commit to developing a culture of caring and professional nursing practice at the medical center. </li></ul></ul></ul><ul><ul><ul><li>Develop a thorough understanding of Caring Theory fundamentals and implications for operationalization </li></ul></ul></ul><ul><ul><ul><li>Identify the principles and contribution of transformational leadership to large scale cultural change </li></ul></ul></ul><ul><ul><ul><li>Develop strategies to address local staffing and cultural challenges, barriers, systems, and opportunities </li></ul></ul></ul><ul><ul><ul><li>Develop strategies to integrate into our value system to provide the basis for all decisions </li></ul></ul></ul>
    37. 37. Medical Center Implementation Strategy <ul><li>Executive </li></ul><ul><li>Maintain unity of purpose – quality caring </li></ul><ul><li>Stimulate constant learning </li></ul><ul><li>Set high expectations </li></ul><ul><li>Receptive to change </li></ul><ul><li>Provide support </li></ul><ul><li>Maintain ‘self-awareness’ </li></ul><ul><li>Unit Level </li></ul><ul><li>Set tone for departmental relationships </li></ul><ul><li>Visible, hands-on </li></ul><ul><li>Bring individuals together </li></ul><ul><li>Recognize and celebrate small changes </li></ul><ul><li>Practice ‘self-awareness’ </li></ul><ul><ul><li>Duffy, J.R. (2009): Quality Caring in Nursing : Applying Theory to Clinical Practice, Education, and Leadership, (pg. 119) </li></ul></ul>Leadership Roles: Leadership Roles
    38. 38. Key Implementation Strategies <ul><li>Ensure all SOC/SOPs incorporate the principle of human caring “Caritas” </li></ul><ul><li>Document the new ‘Caring Patient Relationship’ </li></ul><ul><li>Hire for intrinsic values </li></ul><ul><ul><li>Invest in “knowing who we hire” </li></ul></ul><ul><li>Incorporate into quality/PI infrastructure </li></ul>
    39. 39. Facility Implementation Manager Assistant Manager Director RN/ RT /PCT (Together or Separate Groups) Physicians, Other Leaders and Stake Holders <ul><li>First 30 days </li></ul><ul><li>Full day mandatory orientation </li></ul><ul><li>Pre-work: Chapters on Transformational Leadership </li></ul><ul><li>Overview: </li></ul><ul><ul><li>Reconnect the individual about why they became a nurse or went into health care? </li></ul></ul><ul><ul><li>Why a theory? What is theory guided practice? </li></ul></ul><ul><ul><li>Review of the Caring Science theory: </li></ul></ul><ul><ul><li>Key Concepts to concentrate on: authentic relationships, intentionality, compassion and competence and ethics of face. </li></ul></ul><ul><ul><li>What are anticipated barriers </li></ul></ul><ul><ul><li>Solutions to anticipated barriers. </li></ul></ul><ul><li>Bi-weekly meetings first 3 months for progress updates </li></ul><ul><li>4 Hour Mandatory class </li></ul><ul><li>20 per session </li></ul><ul><li>Overview: </li></ul><ul><ul><li>Reconnect the individual about why they became a nurse or went into health care? </li></ul></ul><ul><ul><li>Why a theory? What is theory guided practice? </li></ul></ul><ul><ul><li>Review of the Caring Science theory: </li></ul></ul><ul><ul><li>Key Concepts to concentrate on: authentic relationships, intentionality, compassion and competence and ethics of face. </li></ul></ul><ul><ul><li>How does this look in practice? </li></ul></ul><ul><ul><li>What will they begin to do differently tomorrow? </li></ul></ul><ul><li>Unit Journals to share stories and ask questions. </li></ul><ul><li>Open Forums every month for 3 months to share journaling. </li></ul><ul><li>2 Hour Session </li></ul><ul><li>Overview of Caring Science </li></ul><ul><ul><li>Reconnect with why they are in healthcare. </li></ul></ul><ul><ul><li>Why is this important? </li></ul></ul><ul><ul><li>How theory relates to Safety, Quality, Leadership and Service </li></ul></ul><ul><ul><li>Evolving caring healing practice environment </li></ul></ul><ul><ul><li>Relationship/Partnerships </li></ul></ul><ul><ul><li>Negotiation/ Coordination </li></ul></ul><ul><ul><li>Authentic Connections </li></ul></ul><ul><li>Hardwire communications based on organizational culture </li></ul>
    40. 40. Reinforcing the Model 6th Month 1st Year 2nd Year <ul><li>Continue to develop links between the theory and practice. </li></ul><ul><li>Incorporate the caritas principles into Policy and procedure </li></ul><ul><li>Focus is on the patient, the impact to the patient is considered and articulated in all decision making. </li></ul><ul><li>What is the impact on the member or family? </li></ul><ul><li>Reward and recognize examples where integration of the Theory have been accomplished. </li></ul><ul><li>Directors, Managers and Assistant Managers lead the staff in creating healing environments on each unit level. </li></ul><ul><li>Use of IDEO or Appreciative Inquiry to address barriers and issues on the unit. </li></ul><ul><li>Healing environments include the concepts of safety, quality, comfort . . . </li></ul><ul><li>Empower the Manager, Assistant Manager and staff to create these environments </li></ul><ul><li>Review Caritas Processes at each unit. </li></ul><ul><ul><li>Have them demonstrate which processes are evident in their units, and which are not. </li></ul></ul><ul><li>Program analysis with established performance targets </li></ul><ul><ul><li>Service scores </li></ul></ul><ul><ul><li>Nursing satisfaction </li></ul></ul><ul><ul><li>Practice outcomes </li></ul></ul><ul><ul><li>Others </li></ul></ul>
    41. 41. Caring Science — Changing the Culture of Patient Care Services <ul><li>Creating environments that support both the patients and the health care worker influences results across the organization </li></ul><ul><li>Reconnecting front line care givers and with their passion, unleashes creativity and innovation at the unit level. </li></ul><ul><li>Culture can kill the best strategic plan </li></ul><ul><li>If culture is the sum of our values, beliefs, rights, and rituals … culture is reality </li></ul><ul><li>Leaders set the culture </li></ul>
    42. 42. <ul><li>Questions </li></ul>

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