The Power of EVERY

Every patient, every encounter, every place, every time.  Those aren't just fancy words on a page.  They have helped define how we deliver care at Kaiser Permanente.  What started as an initiative in 2007 to help standardize the consistency and quality of care administered at each of our 13 southern california service areas has become a culture of care delivery which is spreading like wildfire throughout our other regions.  It's a simple concept really.  Use our electronic medical record and one of our other KP home grown systems to provide decision support tools which help identify patient's preventive and chronic condition care gaps to activate EVERY appropriate employee possible within our organization and ensure those care gaps are addressed while using standardized workflows to proactively prepare the room, the patient, and the computer is ready for each visit.  What does ready mean?  Ready in Kaiser Permanente means that a room has all the proper equipment (the exam lamp isn't laying broken on the floor and the tray is prepared with all the necessary instruments) based on a patient's specific chief complaint or reason for visit. "Ready" guarantees the patient will be appropriately gowned before the physician enters the room and that all of the preventive screening orders have been appropriately staged by our medical office support staff so our providers can focus on the patient's immediate needs.  I've found that if you make the right thing easy you'll find little resistance in getting it done.

The process described above is what we call Proactive Office Encounter or P.O.E. to speak in Kaiser acronyms.   It is just one of the components that falls under the Proactive Care function which is the In-Reach portion of our SCAL Complete Care umbrella.   Proactive Care has been rolled out across our entire region - including our specialty departments.   Yes... I said even in Specialties.  Departments like Optometry, Orthopedics, Podiatry, Neurology, etc have the same responsibility and accountability for helping to identify and close patient care.  Obviously we don't do pap smears in Optometry just because you are due, but we WILL help schedule your pap smear or provide you information on how to schedule an appointment.  Was it awkward the first time we told someone in Podiatry they needed a colorectal screening done?  Sure, but our patient's have come to expect us to KNOW them.  To care about their health and the future of their health.  We are, after all, a HEALTH care organization - our focus is always on the member and keeping them healthy.

I've participated in different conferences speaking both internally and external to  our organization.  Without fail we will get looks and questions from those hearing our message of transforming care delivery from chief complaint and condition specific treatment to a complete care approach.  There is often awe and disbelief that our specialty departments would take on the work of preventive care, a role typically assigned to the primary care physician.  A study within our own system found that 38% of the women due for a mammogram came in to primary care.   The other 62% presented in a specialty department.  Imagine 62% of our opportunities to close care gaps missed because of a narrow minded traditional approach to care.   We couldn't sleep well at night with those statistics.  Under the leadership of the SCAL SCPMG Medical Director for Quality and Clinical Analysis, Dr. Michael Kanter, the case was presented to our specialty teams.  "We'll make the right thing easy to do if you help us do it."  The implementation process was slow at first, but as our EMR tools improved the process for addressing care caps became easier.  Then, a beautiful life changing moment occurred.  We saved our first life by finding breast cancer in it's earliest stage of disease because a receptionist in an Allergy department followed the POE process and insisted on scheduling a long over due mammogram for Mary Gonzales.  Saving Lives...That is the power of activating EVERY member of the care team.  By sharing the responsibility to care for our members we cultivate and foster a community of partnership which unites our care teams across our care continuum.   Kaiser Permanente has proved that not only can a proactive complete care approach work in specialties as well as primary care departments - it IS done.