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.

1. Caring Science Journey Kaiser Permanente Northern California Patient Care Services

4. New Facility 2007

5. Collaboration: Heart Math and WCSI

6. Pre and Post Data

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. 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. Rate Overall Hospital Page

10. Willingness to Recommend Page

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.

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. 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. Spreading Across the Region 2010

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

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

25. Program Evaluation n = 53 (74% response rate) Strongly Agree Strongly Disagree Agree

28. Some Results NCAL HCAPHS Patient Satisfaction Nurse Communication

29. Some Results ED to Bed in 60 Minutes Sepsis Related Deaths

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. 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. 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%

34. 1 st Annual Kaiser Permanente Consortium