Blogging Matters

I think anyone who blogs will tell you it is a commitment of time and energy that sometimes leaves you wondering if the effort you are putting in even matters.  Blogging, can be emotionally draining, incredibly rewarding, or uplifting, and... more and more so, all those emotions at the same time. We blog for different reasons: To share best practices, to help relate to the work, to inform, to engage with others, to vent... the list is exponential. Our blogs impact our readers in different ways.  My blogging buddy and physician partner Tim Ho provides analogies in his blog that help me relate to each issue better. His blogs help me think outside of the box and add a richer perspective. 

It's funny... people say you have to MAKE time for exercise.  I like to think of blogging as exercising my mind, strengthening my resolve, and sharing my spirit, so, like exercise, I am trying to make time for it.  Recently, before I left the office, I checked my email one last time and found one from the doctor I saw for my "brain tumor" (which wasn't a tumor).  He wanted to thank me for acknowledging his MA and sending the blog link to his DA and AMGA.  It meant a lot to her and it meant even more to him. If a physician is going to go out of his way to read my blog and take the time to send me an email to thank me, it tells me people out there care about what we do and what we write.  I had another reader who sent me an email in response to a blog I wrote about a visit to their clinic.  She wrote... "The title "Leading With Heart" really brought me to tears.  The article was wonderful.  Your kind words and how you captured our clinic was so much appreciated." Last week at a site visit to one of our medical centers, one of the department administrators came up and gave me a very big hug and said, "I've been meaning to thank you for your blog on Insomnia! I read it and applied the changes you mentioned and I am SLEEPING now!" I also received several private emails to thank me for sharing my personal experience with Domestic Violence. Those moments feel like few and far between sometimes, but when they come, it makes it all worth it.

Just in case you were thinking that blogging doesn't make a difference, let me share with you the impact of my domestic violence blog. I posted that blog on October 11, 2011 on Ideabook. It has had 81 views since that posting.  I received about 10 personal emails in response, but then that was it. The blog views died down and I moved on to the next blog. Last week, nearly 6 months after the original posting, a coworker came to me seeking assitance for a friend. I was able to help connect her friend with the appropriate resources so she could begin her journey to freedom. Later that night, I told my husband how hard it was to relive my past, but rewarding to know that my blog could help someone else. He had so many questions that it dawned on me, he and I have never REALLY talked about what happened to me because it was too upsetting for him.  How could I expect him to understand what someone else was going through if I couldn't even share what I had gone through? So I pulled out my ipad and read him my blog. Three days later... my husband called me from work and asked if I could forward him the link to my external blog. When he came home he explained he didn't know how to approach the subject with his employee who came in with bruising on her face, so he shared my blog.  She admitted needing help and being terrified, so together they went down to the police station where she filed for a temporary restraining order.  This morning before work I was talking with my oldest daughter and explained how posting one blog 6 months ago is making an impact today. She asked if I would leave my blog up so she could read it when I left. Here's what she posted on Facebook this morning to her 631 Facebook Friends who are mostly in the 20 something age range. 

That particular blog post had 34 hits today, which my blog tracker says came from Facebook url's.  That... my friends, is the power of social media and blogging.

Fellow blogger Ted Eytan and I had a blog conversation last week and he made the following comment:

You know, more than a few doctors tell me, "I don't see the role of social media in health care." And I agree with them, if we are talking about the way social media is being used by most health care organizations today.

However, if we talk about the way you are using it, to share authentic stories related to care delivery that is person-centered, by leaders who bring themselves to the conversation, that's a different story.

For those of us who blog, having people read our blogs, provide feedback, comments, or even turning the blog in to a discussion forum means a lot.  It gives us inspiration and tells us we aren't wasting our time. On behalf of all of us who have poured our ideas, thoughts, and emotions out in writing, thank you to all of you who keep reading.  We want to hear your thoughts. These forums are for you just as much as they are for us. Together, we can share successful practices, encourage new ways of thinking, and enlighten each other. Together... we can improve and save lives.

What is Proactive Care?

PROACTIVE CARE IS...

Is having the computer programmer who builds the front line tools 
see how our tools are used by the front line so they can make improvements

PROACTIVE CARE IS...

A Call Center agent who informs a patient 
that they are due for a pneumonia immunization

PROACTIVE CARE IS...

A Security Guard who helps a member find her way 

or who starts up the Mammogram machine in the morning
So our first patient doesn't have to wait

PROACTIVE CARE IS...

Our Environmental Service team stocking Domestic Violence materials 

along with other bathroom supplies
Helping us Save Lives by leaving information in a "safe" place 

PROACTIVE CARE IS...

A receptionist in the allergy department helping patient 

Mary Gonzales book the Mammogram appointment that 
caught the cancer and saved her life

PROACTIVE CARE is...

Medical Assistants who make sure the rooms are stocked...

including a box of Kleenex
Because it may be the only place for a patient to "safely" break down.

PROACTIVE CARE is...

The LVN who reminds a patient presenting to Podiatry 
about the importance of getting her cervical cancer screening done.

PROACTIVE CARE is...

An RN ready with her Diabetes Education Cart

to help teach a nervous patient how to start taking insulin

PROACTIVE CARE is...

A pharmacist who reminds their patients to take their medications
EVERY DAY.

PROACTIVE CARE is...

A physician who understands how people and programs can save lives
because hers was saved too

PROACTIVE CARE is...

A doctor who wants to encourage a patient to exercise
So he starts a Walk With Your Doc program and walks with her

PROACTIVE CARE is...

Is leadership meeting with the front line care team
To hear and share ideas on how we can improve patient care 

At Kaiser Permanente a Proactive-Complete Care approach supports our mission... to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve with a caring and personal touch.

Proactive Care is NOT a department. It is a culture. It is making the right thing easy to do. It is a culture where the systems, tools,  processes, leadership, back end support, and front line come together for one reason and one reason alone... to support the patient.

I'm Thriving Too!!!

Recently, my husband and I were out shopping for a new bed frame when a sales member came up to my husband and asked him if I worked at Kaiser (I was wearing one of my KP Thrive shirts). When my husband replied, "For the past 20 years" this gentleman asked if I would mind if he asked me a question. My husband laughed and said "not as long as you are prepared for a passionate answer."

This man I'll call "John" came up and introduced himself (as I was laying on a tempur-pedic mattress). He introduced himself as "John" and told me my husband said it would be okay to ask me a question.  Giving my husband one of those "what did you do now" looks, I rolled off the bed to face this sweet man. He said he was a new member to Kaiser and recently went in for a physical where he was encouraged to get a TDAP since he is around his young grandchildren. His concern was that he was feeling sore and tired since he had the vaccine a few days back. I told him that I also had a similar experience with the TDAP, but as long as his symptoms weren't severe, it would most likely dissipate in the next few days. I asked him if he had signed up on KP.ORG yet and he was, so I showed him how to pull up information on Tdap which lists the side affects and warning signs. He went on to tell me about his experience at the San Dimas clinic and how impressed he was that they had called him a week before his appointment to let him know he was due for some lab work and ask that he have those labs done before his visit. He was even mailed an IFOBT kit. John said he did as he was asked (including "doing the poop sample") and was so surprised when just a few hours later he received an email that told him most of his labs results were ready to view on KP.ORG. I was so excited because this meant San Dimas was doing the full Monty of POE! Grinning from ear to ear I said, "They are doing pre-encounter! That is so great!" John just looked at me and my husband in bewilderment. After a brief explanation of KP's preventive care programs, my husband shrugged at John and told him "I said you would get a passionate answer!"

John went on to explain that he was surprised how the nurse knew everything he needed to have done and that she even gave him information about a Smoking Cessation program that he has since enrolled in. When John met Dr. Cadido Gamez, he felt like he really listened. John had an HMO before that he thought was good, but they only seemed to care about what he was going in for, not smoking, or exercise, or other stuff we asked him. Dr. Gamez asked John how he was feeling and if there were any specific concerns he would like to address. John, an older gentleman, said he was experiencing some "male" issues. Dr. Gamez was able to adjust John's medications and the side affect he was experiencing went away. John said the doctor put everything in the computer and even gave him a "visit summary" so when he got home he was able to "just hand that paper to his wife and it answered all of her questions before she could ask them."

After about 10 more minutes of small talk, John said, "well... I better let you two go. I just saw your shirt and wanted you to know that apart from that Tdap shot, I feel like I'm thriving too!. Thank you!"

So this blog post is dedicated to everyone who works behind the scenes to those on the front line who make positive patient care stories like this happen every day. Together, we provide our members a complete care experience. Together... we save lives. One person at a time.

My sincere thanks and appreciation to:

• San Dimas MOB staff, physician's and leadership who have made POE and the complete care experience part of their culture
• Local and regional leaders who set and support the vision of patient centered care
• Regional Workflow Consultants who help train those workflows
• Long Term Support for being the go to people for our front line
• SSD for implementing an EMR that allows us the ability to really "KNOW our patient's" and provide a "visit summary"
• PAS programmers who help us make the right thing easier to do
• Our KP.ORG staff who make information easy to get to
• Clinical Decision Support and Clinical Content for building tools that increase efficiency
• Clinical Operations for developing programs to support our front lines

And everyone else who supports our Kaiser Permanente members - we wouldn't be thriving without you.

Saving Lives... One at a Time

Photo Credit: Ted Eytan

It seems strange to put power and strength behind a simple button. But this is more than the act of giving the support staff a token of appreciation for their work. It is a symbolic reminder that with every action we take we have the ability to help save someone's life. Our staff don't know and don't really care about what HEDIS numbers are, so we had to find a way to make this work personal. Our leadership team goes around our SCAL region and gives out buttons at site visits to our support staff as a small gesture to say "We can't save lives without you."  We don't say, "thank you for helping us meet our HEDIS goals". Instead, we say, "thank you for helping us save lives. The work you do is very important." 


The interesting and unintended benefit was the button, worn proudly on I.D. badges and uniforms, has become an opportunity to share how we care for our members at Kaiser Permanente. When a member asks what the button means, I've heard stories of our staff proudly saying "At Kaiser Permanente we care about our members and our Proactive Encounter tool helps us do that." Another said "It reminds me that I am here for YOU. To help keep you healthy and thriving."

My husband was at a recent appointment with a surgical specialty department when he noticed his MA wearing the button. He asked her what P.O.E. was (as a test for me of course), and she smiled and said "POE is how Kaiser helps us know what we need to do to keep you healthy." He teased her and said "Am I healthy?" and she said "You will be when I'm done with you!" She went on to tell him how they knew exactly what each patient needs because of POE and then turned the computer screen to show him the proactive care checklist in HealthConnect. All of this because he asked about a button... Now that's patient/staff engagement!

Curious to see some of the conversations and blogs spurred by the button?

http://www.tedeytan.com/2011/03/31/7943

http://www.tedeytan.com/2011/06/11/8384

http://www.tedeytan.com/2011/06/14/8432

There was even a flurry of twitter conversations after the Health Care Innovations conference in D.C. which created some positive swirl around changing the focus from "Outcome Measures" to "Saving Lives".

Trade You a Makowsky Purse and Good Health for Those Cigarettes

My oldest sister Kellie and I are very close.  She is a Neonatal charge nurse at LA County USC Hospital and amazing at doing a really difficult job which often involves helping parents learn to say good-bye to a premature baby or teaching someone how to hold and care for a baby that fits in the palm of their hand. I have a tremendous amount of respect for her and growing up was nothing different.  Being four years older than myself, I pretty much idolized her. (Especially when she started driving and could give me rides everywhere). She and her boyfriend took me out on my first date - which had to be a double date by my mom's rules.  My boyfriend was even her boyfriends brother. (We went to a drive in theater and they made us get in the trunk of her mustang so they wouldn't have to pay extra for us) I wanted to do everything she did.  When she started wearing bell-bottom pants, so did I.  When she had Farrah Faucet hair, I wore mine the same. Blue eye-shadow... I was in!  When she started smoking however, I drew the line. 

Smoking is/was the one thing that every one in my family has done except for me.  Instead, I am the one who developed Asthma around the age of 10, most likely from living in a house of smokers.  I have always been a little pushy about trying to get my family to quit smoking.  When I was a teenager, I decided to write a report on lung cancer so I went to the local American Cancer Society and borrowed a lung that had emphysema (which I rode home on the handle-bars of my 10-speed) and set it on our kitchen table for all of my smoking family members to see.  I also went around the house and turned up all of their lighters so it would singe their eyebrows when they lit up and dipped their cigarettes in milk so they wouldn't light.  I was grounded for my antics many times and I'm sure my family thought I was a pain in the rear, but I felt like it was the only way I could get my point across.  My bedroom even had to have an air purifier and an air conditioner so I could get some fresh air.  I'll never forget having to run from the front of the house to my room, holding by breath all the way, as I ran through the billowing clouds of cigarette smoke.  I made a vow that when I grew up I would never permit anyone to smoke in my house so my kids didn't have to experience what I did.  When I did grow up, I accepted a job as the Southern California Kaiser Permanente Proactive Care Lead where I get to be an adovate for our Tobacco Cessation program.  Go figure :-)

Fast forward about 30 years... My sister and I were hanging out together several months ago and I was showing her a new Bruce Makowsky purse I had purchased.  Makowsky's are my one true splurge and they cost around $200 bucks a pop.  She asked me if she could have one of my old purses.  In my heart, I wanted to give her one because I knew she would never splurge on herself with a purse and it feels so good to have just the right purse made of excellent quality. (Okay... not all of you guys out there will get this, but some of you will - especially if you have ever owned/carried a well-made purse.) My response to her though, was done teasingly and with a hint of sincerity that only a sibling could get away with, "Makowsky's are to be respected.  It doesn't deserve to smell like an ashtray. Quit smoking, and you can have a purse."  Again... I said it teasingly, but what I didn't know is she took it to heart.  

A few weeks ago I posted a comment on her Facebook Wall congratulating Kellie on having reached two months of a quit smoking status.  Here is the response she sent me.

Last Sunday, Kellie came over and I pulled out my Makowskycollection (Shhhh....Don't tell my husband, he thinks I only have a couple) and let her pick the one she wanted as her reward. (Kicking myself for not taking a picture of that moment)  After she choose her purse, we laid down on my bed and talked for a little over an hour.  I asked her if I could blog about her.  Surprised, she said "Really?"  I said, "Yes. I'm really proud of you and want to share your story."  She agreed and the following conversation transpired.

Me: "When did you start smoking?"

Kellie: "I would smoke every now and then as a teenager because my friends would try it.  Then, I smoked socially, like when I would go to bars and clubs.  Nana used to bust me when I got home at night, but she never told anyone.  But, I guess I really started smoking regularly when I was about 24."  "Wow..." she whispered softly, "That was almost 26 years ago."

Me: "How did you feel health wise when you were smoking?"

Kellie: "Well... I guess I thought I felt okay, but it was getting harder to make the trip up the hill from the parking lot to work. I didn't notice how much it affected me until after I quit"

Me: "What do you mean by that?"

Kellie: "Well... I notice it's a lot easier to get up that darn hill now.  Before, my throat would burn and I felt like my chest was tightening.  It was really hard to breathe."

Me: "Dumba--, did you ever think that maybe the smoking was giving you asthma?!" (We both laughed a bit after that comment)

Me: "So what made you want to quit?"

Kellie: "I always had to have my first cigarette right after I woke up and one day I thought, "this doesn't really taste good", but I would just convince myself that it did, because I was so used to smoking I couldn't imagine not.  Then I started counting how many cigarettes I would smoke on my way to work and between breaks - not to mention the ones I smoked before I left.  I was smoking any where from 10 cigarettes a day to a pack and a half a day.  When I added up the cost, it came out to over $50 a week."

Me: "Holy heck... that's one Makowsky purse a month!" (more laughter)

Me: "So how did you do it?"

Kellie: "I switched to electronic cigarettes.  You buy the liquid that contains specific amounts of nicotine.  I'm able to taper down to just liquid."  "It helped me get through the urges I had to smoke, which wasn't easy after a lifetime of smoking."

Me: "What have you noticed that is different about your life now?"

Kellie: "Matt (her husband) asked me if I had noticed something out on our patio and I realized I haven't been on our patio in about 8 weeks!"  "I notice how other smokers smell now and think I must have smelled awful.  No wonder you wouldn't let me have a purse." "I also have extra money now, which is a nice treat. I've been gaining weight though and that sucks :-("

Me: "Weight you can always loose. I'll walk with you if you want.  If you just add 3 10 minute walks a day, I promise you'll start feeling better. You, though, can't be replaced. So if you have to choose between a little extra weight or cigarettes - choose the one that won't destroy your lungs."

Me: "Smelly..." (my nickname for my sister) "I'm proud of you."

Kellie: "Me too."

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If you're a smoker who's thinking about quitting, a concerned family member or friend of a smoker, or a former smoker looking for support, Kaiser Permanente has information and programs that can help.