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In May 1951, Bay Area longshore workers participated in a groundbreaking medical program—the Multiphasic Screening Examination, the first comprehensive health assessment conducted in cooperation with a union.

The trustees of the International Longshore and Warehouse Union–Pacific Maritime Association (ILWU-PMA)Welfare Fund came up with the idea for the tests, thinking it would be a useful corollary to existing medical care by helping detect unsuspected chronic diseases so members could get early and effective treatment. The tests, given in the Local 10 offices, were designed to search out signs of lung cancer, tuberculosis, heart trouble, syphilis, diabetes, anemia, kidney trouble, and sight and hearing defects.

The trustees, together with the Local 10 welfare officer and the ILWU research department, worked out the program with the Permanente Health Plan. ILWU leader Harry Bridges promised results would be confidential and not affect job security, and complete follow-up care was assured as part of health plan coverage.

At 10:30 a.m. sharp, South Bay Medical Center appointment clerk Carolina Meza removes her telephone headset. She fires up what looks like the world’s tiniest iPod, attached to a portable speaker that’s not much bigger. She gathers four of her co-workers in a patch of open space near the coffee room. They do some neck rolls, march in place and then do a move Meza calls “the incredible hulk”—a shoulder stretch that brings welcome relief to those facing a computer screen for most of their day.

“When we go back to our stations, we feel refreshed,” says Meza, a member of SEIU UHW.

It’s called Instant Recess, and it’s the brainchild of Toni Yancey, MD, co-director of the UCLA Kaiser Permanente Center for Health Equity. It involves a quick, daily group exercise and is aimed at incorporating physical activity into a normal workday. It comes at a time when research is showing that workplace fitness initiatives targeting individual behavior (such as counseling and gym memberships) aren’t working. An organization’s whole infrastructure needs to be addressed, says Yancey. 

That’s what makes Instant Recess so appealing. It demonstrates KP’s commitment to Total Health—including for a healthy and safe work life for KP employees as well as the members and communities we serve. It’s consistent with KP’s Healthy Workforce push, and also seems to help reduce workplace injuries and improve attendance.

At the South Bay call center, for instance, annualized sick days fell almost one full day per full-time equivalent between 2010 and 2011, when the department began Instant Recess. The number of ergonomic injuries went from three to zero.  

Overcoming obstacles

While they are seeing results now, team members were wary when senior leaders at their medical center approached them about trying Instant Recess. “I was very skeptical,” says Darlene Zelaya, operations manager. “We can’t prevent the calls from coming in.” In fact, hold times for patients did go up when the team first implemented Instant Recess.

The unit-based team worked together with project manager Tiffany Creighton to adapt Instant Recess to their members’ needs. For instance, before calling a recess, team members check the reader board to assess how many agents can be off the phones at one time. They hold many small exercise bursts throughout the day instead of one or two longer ones. And they keep the music turned down low to avoid disturbing agents on the phone with patients.

Making it work locally

In the South Bay lab, Instant Recess looks and sounds totally different—but is getting similarly promising results. That department blasts a boom box for 10 full minutes during the Instant Recesses it incorporates into its huddles at shift change twice a day. Clinical lab scientist Nora Soriano steps away from her microscope to join in. She’s lost 43 pounds recently, and she partly credits Instant Recess. Soriano, a member of UFCW Local 770, says the initiative inspired her to exercise more at home. “My son got me an Xbox,” she says. “I don’t stop for half an hour, sometimes 45 minutes.”

Not all of Soriano’s co-workers were so enthused when they first heard about Instant Recess. “I was kind of negative,” admits Julia Ann Scrivens, a lab assistant and UHW member. “I thought, ‘I am so busy. You want me to do what?’ ” Area lab manager Dennis Edora says, “It was a shock. No one knew what to expect.” But the lab’s staff had just been through some stressful changes—including getting new equipment and moving to a new floor—and team members were hungry for something that would help rebuild morale.

“We collaborated with all the different job codes,” says Edora. “Everyone added their different flavor,” she says, noting that employees rotate as a leader, some choosing Hawaiian dance moves, others yoga-inspired stretches. “Instant Recess really got us together. It wasn’t just exercise.” Moreover, it was helping reduce injuries: the lab reported only one repetitive motion injury in 2011, after beginning Instant Recess in April. There were five such injuries in 2010.   

And Scrivens is sold as well. “It is fun,” she says. “It makes me happy.”

When Webster Parker brought his prescription glasses back to the clinic in Redlands (Southern California), he thought he just needed to replace a lens that had fallen out. But when Parker reported his eye was watering excessively, optician Alicia Rendon spotted a red flag in Parker’s Kaiser Permanente HealthConnect™ record and, within the hour, set up an eye-saving appointment with an ophthalmologist.

“The prescription was fine,” says Rendon, a Teamsters Local 166 member whose unit-based team recently embraced a new workflow, including use of KP’s electronic health record system, to troubleshoot their redos—instances where patients return eyewear purchases. “Once I looked into HealthConnect, there was this big stop sign.”

Her review of the record suggested that Parker, 85, might need a common surgical procedure to lower the intraocular pressure in his right eye, a condition often associated with glaucoma. An old eye injury exacerbated the problem, and Parker’s ophthalmologist had set up a flag in the system to watch for changes to the eye.

“I had surgery that week,” says Parker, a retired pharmacist who once ran a drugstore with his pharmacist wife. “The eye feels better. It feels normal. They did a wonderful job.”

Looking at the whole system

Focusing on redos not only saves KP in terms of the cost of materials and labor but also helps improve service scores. By bringing in ophthalmologists and optometrists, who examine eyes to treat disease as well as prescribe the lenses that opticians dispense, the team could better identify redos linked to eye-health problems rather than product defects—as in Parker’s case.

But opticians, used to handling paper charts and focusing on frame styles, were reluctant to try one of the team’s first tests of change: using KP HealthConnect to rule out medical reasons for unsatisfactory eyeglasses.

“We got buy-in” to overcome the initial resistance, says management co-lead Darren Smith, site supervisor for optical dispensing and a former optician. “It takes just two or three to really commit and spread the practice. Now, it’s not just a retail store where you come and buy something. Here, we are talking about your health.”

Educating patients and staff

To protect patient privacy, opticians' access in HealthConnect was mostly limited to conditions related to eyeglasses' prescriptions rather than a broader range of eye issues. Now the optometrists and ophthalmologists help the optical UBT members spot problems and counsel patients on practices that will protect their eyesight and enhance their eye care.

“Not everyone is going to be able to see 20/20,” says Trissy Bastin, business line manager for Vision Essentials. She directs the service area’s five optical clinics and serves as sponsor for the UBT. “The patients have to be reminded of that. You have to be able to see what kind of eye conditions they have.”

Parker has been a KP member for just seven years. But three decades in the health care industry fostered his appreciation for the electronic patient record—and cooperation and coordination among caregivers.

“What makes Kaiser special is that any doctor can have your complete record at his fingertips,” Parker says. “They can track problems and make recommendations.”