Medical Visit/Screening - Color

Screenings for such diseases as colorectal and breast cancers, high blood pressure, diabetes and obesity help us proactively identify identifying health risks and early signs of disease Here are some ways everyone can help ensure our members stay as healthy as possible.

1. During a visit, print out and review with the patient any screening gaps that are identified on his or her Proactive Office Visit summary.
2. Use KP HealthConnect™ and/or panel management tools to identify and reach out to members who are due for a screening to check for high blood pressure or such diseases as colorectal or breast cancer.
3. Have receptionists keep an eye out for age- and risk-appropriate members during office visits and target them for follow up by care providers.
4. Create outreach scripting that personalizes the importance of preventive screenings.
5. Designate a staff member to contact members who received at-home fecal immunochemical tests (known as FIT kits), to remind them to return them.
6. Capture patients’ attention by posting or mailing brightly colored literature that explains how a test detects early signs of disease and can be life-saving.
7. Work with your local radiology department to identify the best days and times for same-day mammograms, so patients can get the scan without an appointment.
8. Contact hypertensive patients at pharmacy pick-up counters for blood pressure checks and consultations.
9. Have clinical assistants and/or medical assistants increase the number of outreach calls and blood pressure checks.
10. Invite a regional or local expert in prevention and screening to meet with your team to discuss how best to support regional and local initiatives without duplicating efforts.

When the internal medicine UBT at the Los Angeles Medical Center decided to focus its efforts on African Americans with hypertension, not all team members initially were comfortable with targeting patients by race for special outreach. “We worried about how patients would react,” says union co-lead Marilyn Lansangan.  

However, when they invited African-American patients to a special clinic, they were thrilled with the results. Not only did patients show up, the team made progress toward its goal of closing the gap between African-American patients with their hypertension under control and those of other races. “The barrier was not the patients. The barrier was us,” says Lansangan.

Closing care gaps

Nationwide, nearly 45 percent of African Americans suffer from high blood pressure—a rate much higher than other racial and ethnic groups. The condition tends to develop earlier in life and is likely to be more severe for them. There is some recent research from the National Institutes of Health that suggests genetics may play a part. Such social and economic factors as discrimination and poverty also may contribute. Whatever the reason, health care organizations—including Kaiser Permanente—are working to reduce the disparity.

When Jose Saavedra, M.D., the physician champion on hypertension at LAMC , heard that colleagues at Downey Medical Center held a special outreach clinic for African-American members with high blood pressure, he encouraged the internal medicine UBT to try it as well.

Targeted outreach

Team members generated a list of their African-American patients with a certain threshold of uncontrolled hypertension. LVNs and social workers called patients every day, inviting them to the special clinic. The success of the outreach calls surprised everyone. “Even when we just left a message, people would come to our clinic,” said Elenita Petrache, assistant administrator and one of the management co-leads.

At the event, clinicians educate patients about hypertension, then take their blood pressure. Depending on the results, patients queue up for a short chat with either a doctor or a nurse, who can adjust their prescription or schedule a more in-depth appointment. Patients who successfully control their blood pressure get a certificate. Everyone gets a swag bag containing an apple, bottle of water, DVD about hypertension, and information about diet and sodium.

Improving teamwork

Gayle McDow, who attended the clinic in late April, says it make sense for KP to reach out to African-American patients. "The numbers suggest that this issue is more prevalent in our community," she says.

The project also built cohesion among UBT members who work on different floors, says Petrache. “It helped two parts of the department develop a better relationship because we have common goal,” she says. “There is communication between the teams. It’s a beautiful thing.”

South San Francisco allergy team’s specialty may be allergens and hay fever, but that didn’t prevent it from helping to improve patients’ screening rates for cancer, too.

It didn’t happen all at once—some staff members were skeptical at first. Scheduling a screening appointment for a wheezing patient didn’t seem right.

“At first people would say things like, ‘You know, I really don’t feel comfortable saying to a patient, “Oh, you’re due for mammography” when they’re sneezing and congested and here for allergies,’” says Alva Marie Aguilera, the department’s supervisor and management co-lead for the unit-based team.

Screenings as strategy

But part of delivering on Kaiser Permanente’s Total Health promise is to identify health risks and signs of disease as early as possible. Regular screenings for such diseases as high blood pressure, diabetes, and colorectal, cervical and breast cancers are an important part of our strategy.

That means caregivers and employees in seemingly unrelated departments—not just those in, say, internal medicine—have a role to play, and KP HealthConnect® provides them with a powerful tool.

Any time a patient is seen, a “proactive office encounter” message pops up in the member’s electronic record if he or she is due for a health screening or if important health data needs to be updated. It doesn’t matter what the reason is for the current visit or which department the patient is being seen in. 

The members of South San Francisco allergy department took the important work of taking the next step to heart: Following up on the prompt and offering to schedule the patient for the screening or asking the necessary questions to fill in missing information.

Scripts and reminders

To help make sure those things happened consistently, the team tried some small tests of change:

• It created a general script to help broach the questions with patients and posted laminated cards on computers to serve as reminders.
• Aguilera reports the weekly screening numbers so staff members know how they are doing and where they missed opportunities to follow through on the HealthConnect® prompts.

The small changes had a big impact. Before the team started the project in February 2012, it followed through on the prompts 80 percent of the time. In the first two months of the project, that jumped to 90 percent. By early 2013, the prompts were being followed up on 95 percent of the time and held steady at that rate for the rest of the year.

It wasn’t just staff members who were uncertain of the practice in the early days.

“At first it was kind of surprising to patients,” says medical assistant Lidia Vanegas-Casino, a member of SEIU UHW and the UBT’s union co-lead. “So we had to explain to them: ‘It’s a way to help you, and to keep up with the things you need done. It’s a proactive approach to keeping you healthy.’”

Positive example

It was one of KP’s own commercials that convinced team members of their important role in keeping patients healthy. Aguilera showed the ad that features KP member Mary Gonzalez, who had gone in—fittingly—for an allergy appointment when the receptionist noticed she was due for a mammogram and booked an appointment for her. The screening picked up a mass, and Gonzalez subsequently learned she had breast cancer. The early detection helped ensure a positive result.

It wasn’t a primary care or OB-GYN department that got her that screening. It was allergy.

“It really hit home for people,” Aguilera says. “If it wasn’t for the allergy receptionist who took that time, we don’t know what would have happened. That was a big encouragement.”

I am a big proponent of the team approach to medicine. That’s why I am an active participant of my department’s unit-based team.

As the physician co-lead for the Pediatrics unit-based team, I participate in the UBT meetings both to give and to receive ideas. Ideally, a physician brings to a UBT the vision on how to work together to provide the best possible patient care, support for the management co-lead, and the willingness and openness to listen to what other people have to say. 

According to Dr. Atul Gawande, noted author and surgeon, it used to be that doctors were trained to be cowboys. They worked alone and saved the day. In today’s world, what people really need are pit crews, teams of people where everyone’s function is vital to the overall success of the enterprise. Medicine is no longer an individual endeavor—it has grown so complex and multifaceted that no physician can know everything. So we need to foster the team approach to give our patients the best possible care. 

When I first came to Kaiser nearly 10 years ago, the thing I heard that really stuck with me was the KP Service Quality credo: “Our cause is health. Our passion is service. We’re here to make lives better.” I immediately connected with it and have used it to filter everything I do. 

In other words, I always ask myself: Does what we are doing support our cause, passion and goal? If it does, then it’s usually worth doing. 

Advice to other physicians  

• Say "thank you" and say "please." Really go out of your way to appreciate someone who comes up with an idea that has made your life easier. And do it publicly.
• Make time for daily huddles with your staff.
• Create an environment in which people feel free to share their ideas. One of the worst forms of waste is unused creativity.
• Give people the benefit of the doubt; pause and reflect when you feel yourself getting upset.
• Think outside the box. Go to staff members who aren’t at the nursing station to help out when needed. This gives the whole team a sense of ownership over patient care. 

Bottom line? Being a leader isn’t just about being in charge. Just because you’re a physician doesn’t mean you have to spearhead all of the work. If you really want to make a difference or a change, you have to include the entire staff. The work will get done better, faster and easier if we work together. And if you believe in the work that you are doing, then teamwork is a natural expression of patient care.