LMP Concepts

Our bodies metabolize the excessive sugar in processed foods just as it processes alcohol and other toxins, causing damage to our liver and other organs.

Sugar makes us more likely to develop a variety of risk factors that lead to serious illness, while making us crave sweet even more.

In fact, sugar causes a cycle of addiction in the brain in much the same way as drugs and alcohol—and cigarettes. When it comes to addictiveness, nicotine takes the, um, cake.

Physicians at the University of California at San Francisco (UCSF), led by outspoken pediatric endocrinologist Robert Lustig, MD, published a paper in February in the journal Nature showing that like alcohol and tobacco, sugar is a toxic, addictive substance. They argue that it should, therefore, be closely regulated, with taxes, laws on where and to whom it can be advertised and age-restricted sales. The researchers said that increased global consumption of sugar is primarily responsible for a whole range of chronic diseases that are reaching epidemic levels around the world.

Is sugar—so pervasive in processed foods, soda and junk food in general—the new tobacco? Let’s see.                                    

It can kill you.

If Lustig and his colleagues—and many other independent researchers—are even half right, sugar and junk food have been responsible for millions of preventable deaths. According to journalist Eric Schlosser, author of “Fast Food Nation” and the children’s book “Chew on This,” poor diet and lack of exercise may soon surpass smoking as the No. 1 cause of preventable death.

People make huge amounts of money by selling it.

Remember how long the tobacco industry denied the link between tobacco, advertising, and lung cancer and heart disease? We are hearing the same protestations from the processed food industry today. Don’t buy it!

Schlosser, a keynote speaker at the 2012 Union Delegates Conference, recounts how McDonald’s was built. Founder Ray Kroc discovered that profits were higher when kids ate out with their parents. So he lured children in with lollipops. Later, he added a clown. Today, fast food chains hire child psychologists, hold focus groups for toddlers and put 5-year-olds in MRI machines to see which part of their brain is responsible for brand loyalty.

“Think about the profit margin in a soda,” Schlosser says. The raw materials are water, food coloring, sugar and a paper cup. Nutritional value: less than zero. Cost to produce: pennies. Now there’s a profit margin!

You get to a certain age, and it’s time for a makeover. Surely you understand.

We heard you whispering. In fact, it inspired us to conduct a statistically valid survey to make sure what we’d overheard was a true reflection of what you thought. Some of it was a pleasant surprise—such praise! But you were blunt, too: Awkward size. Overly long articles. Not enough variety. And so on. 

So, here’s our equivalent of slimming down and building some muscle. (Amazing what walking a half-hour a day will do!) With our new ’do, you’ll find:

• shorter articles and more of them
• more tips and tools, information you and your unit-based team can put to immediate use
• more coverage from all the regions
• and some fun

While we’re on the subject of our virtues: Our paper is certified by the Forest Stewardship Council, ensuring the use of responsible forest management methods that address social, economic and environmental issues.

Why does that matter? Well—working in partnership addresses profound social and economic issues, too. We hope you like our makeover because we want to serve you—the frontline workers, managers and physicians of Kaiser Permanente—well. Because what was achieved this spring in National Bargaining, the subject of this issue’s cover story, makes it clear what an extraordinary journey we are on together.

Colorado

The Regional Imaging teams in Colorado are lucky to have two effective sponsors: Joseph Gonzales, clinical operations for Regional Imaging, and Rebecca “Becky” Torres, a pharmacy technician and SEIU Local 105 member. Part of their success, the pair says, is the emphasis they have placed on sharing information—with each other and with their teams. The pair also figured out a way to spread effective practices. Using a PowerPoint template, the sponsors asked co-leads to explain what they’re working on, how it supports regional goals, whether it worked and the outcome. Then, the teams came together for a UBT Fair and shared their PowerPoints.

Georgia 

David Jones, MD, has a title unique at Kaiser Permanente: assistant to the medical director for unit-based teams. He mobilizes his fellow physicians in the Georgia region to get involved with UBTs and unleash the power of partnership to improve performance and grow membership. “The first thing I tell physicians about the UBTs is that it is about improving the work that we’re already doing,” he says. “It’s not about adding more work, it’s about looking at the work you're doing and figuring out how to do it better.” Read more from Jones—including how his experience with UBTs has transformed the way he delivers care to his patients.

Hawaii

A small region, Hawaii needed a novel approach to sponsorship: Branch out rather than always branch up. Initially, a five-member unit-based team committee tried to troubleshoot issues for the region’s fledgling teams. Often, those committee members, who also had roles as team co-leads or contract specialists, were trying to wear too many hats and got jammed. So the region, which now has more than 40 teams, has tapped 19 people to receive sponsorship training. The group includes middle managers, directors and other executives, frontline nurses who serve on the Kaiser Permanente board of the Hawaii Nurses Association, OPEIU Local 50, and former labor team members and co-leads.

Mid-Atlantic States

While the Mid-Atlantic States region’s clinical unit-based teams have management and labor co-sponsors, large teams such as lab and radiology are sponsored in a different way: A UBT leadership group made up of labor and management from these area performs sponsorship functions as a united body. “We generated a vision of our UBT sponsorship. We got very specific on how we would work together,” says Jane Lewis, executive director of health plan regional services and a member of the group that sponsors eight pharmacy UBTs. The UBTs report their projects and team dynamics at monthly meetings. The leadership group reviews People Pulse, service scores, quality results and other metrics, identifies struggling teams, and recognizes teams that excel.

Northern California

The region has been on a roll with its “A Leader’s Role as UBT Sponsor” training. Launched in the spring, the tutorial gives management and labor leaders an easy-to-understand yet in-depth look at providing effective support to unit-based teams and their performance improvement work. The short, online training covers everything from outlining a sponsor’s role and how a sponsor can model partnership to tips on developing strong UBT co-leads and high-performing teams. Several facilities have combined the training with in-person, interactive exercises, and early feedback suggests the blended approach is striking a chord with sponsors. The online training can be found at KP Learn.

Northwest

“My role as a senior sponsor is to bring the message of UBTs to physician leadership,” says Rasjad Lints, MD, the region’s executive sponsor of UBTs. Lints is especially interested in helping teams focus on outcome metrics—a measure of the final result of something, such as how many patients with hypertension have their blood pressure under control—and to help everyone on the team understand that improving on process metrics often drives improvement on outcomes. It can be difficult to see the value in participating in process metrics if team members don’t see how it relates to the outcome measures. “At the end of the day, physicians have to drive the care,” Lints says. While working in UBTs presents physicians with some unique challenges, he believes that “if the physicians aren’t engaged, it’s a lost opportunity.”

Ohio

In an effort to improve the quality of team project information in UBT Tracker, the regional LMP support team solicited the help of the people who support the work of teams—sponsors. In June, an improvement adviser met with Ohio’s 20-plus sponsors and asked them to work with their teams to boost the input of that data. To illustrate the value and role of quality data in UBT Tracker, they used the data in Tracker to brief the sponsors on their UBTs’ projects and status. Their approach made an impact: The region has reported an increase in sponsor engagement, and several teams have reported performance and relationship improvements. 

Southern California

The regional Labor Management Partnership department is launching a new sponsor training curriculum that covers the nuts and bolts of what sponsors do and how they do it. Topics include: the responsibilities of sponsoring bodies (such as helping define how the teams should be structured and guiding selection of co-leads); coaching skills to help develop UBT leaders; the similarities and differences between labor and management sponsorship; how managing in partnership differs from traditional management; and how the sponsor role differs from that of facilitators, project managers, trainers and consultants. Also included in the course are basics of the Labor Management Partnership and unit-based teams, such as the key elements for UBT success, the roles and responsibilities of UBT co-leads and members, and consensus decision making.

A friend of mine with a heart flutter had to spend a day in a Kaiser Permanente emergency room recently, and he asked one of the staff members helping him, “Are you in a unit-based team?”

“Oh, yeah,” the staff member said, without much enthusiasm. “We have one of those.”

The exchange may not have been altogether surprising, but it underscores the work that still lies ahead for those of us who believe—as I suspect most readers of this column do—that partnership and unit-based teams are the right way to do business.

Naysayers nurture the old arguments. Partnership means management caving in to the unions or, conversely, partnership means unions selling out to management. Some people just sit on the fence, dismissing partnership as a “flavor of the month” and apparently hoping that if they ignore it long enough, it will go away.

Fifteen years after the Labor Management Partnership’s founding agreement was signed—at 12 flavors a year, that would be 180 flavors later—what’s a partnership advocate to do?

Spread the word. Do what you’ve been doing: Acknowledge the challenges of working in partnership, and cite the considerable achievements being piled up by UBTs. And here’s one more: Do what you can to support the increasing LMP focus on sponsorship, which is the subject of this issue’s cover article and companion stories.

Active sponsors are an essential component of a high-performing team’s makeup—and active sponsors serve as bridges between teams. They are positioned to spread effective practices up, down and sideways. Looking back after another 15 years, we may see that active sponsors were the partnership ingredient that finally turned LMP doubters into players. 

It’s not hard to figure out why people are hesitant to speak up at work. Offering a suggestion for improvement or pointing out when you think something isn’t right exposes a person to any number of possible responses—many of them unpleasant.

There’s the sarcastic retort. There’s the deafening silence. There’s the reply, pointing out exactly why you’re wrong, delivered in the nicest of tones but carrying an unmistakable edge of one-upsmanship. Who needs it? Who wants to create waves and risk a good job?

But when we don’t speak up, we put health and happiness at risk. As Doug Bonacum, Kaiser Permanente’s vice president of quality, safety and resource management, says in this issue’s cover story, speaking up “is mission critical for worker and patient safety.”

In addition to the moral imperative of protecting people from injury, there’s a strong economic incentive for speaking up. Improvement doesn’t typically come from a single person’s great idea—it comes from people sharing ideas. And we at KP have to keep improving, finding ways to deliver care as good as or better than we deliver now with fewer dollars per member. Our future depends on it.  

Since we get good at what we practice, we each have to practice speaking up. Practice means starting with lots of baby steps—don’t tackle the high-stakes stuff first! And let’s practice being good listeners, too, providing the space that lets others speak up safely.

The Labor Management Partnership and unit-based teams provide the framework for transforming what Bonacum calls a “culture of fear” around speaking up. But with that framework in place, it’s still up to each and every one of us to find the courage to address the immediate, particular obstacles that keep us silent.

An imaginary friend of mine smokes, is decidedly chunky, and has high blood pressure and high cholesterol. His kids nag him about the cigarettes and weight; his wife worries more about the hidden conditions.

This fellow could be any one of many of us, and if he wanted to track his efforts to improve his health, he could use the “cloverleaf” graphic introduced in this issue of Hank—a visual summary of the four measures of health at the heart of the new Total Health Incentive Plan.

The cloverleaf has a lot in common with the Value Compass, which illustrates the interconnectedness of service, quality, affordability and the workplace environment. The Value Compass reminds us that improving in one area at the expense of another isn’t progress—and that improving in one area frequently leads to improvements in other areas.

So it is with health. If I take up smoking and have a cigarette each time I’m tempted to eat something sweet, I may improve my Body Mass Index, or BMI—but I won’t have improved my health. If my imaginary friend starts to make better food choices and ups his exercise, however, he’s likely to see improvement across the spectrum of health issues he’s facing. By measuring improvement in several areas, the new incentive plan puts the emphasis on bringing the whole person into better balance.

And by putting the focus on collective improvement, the plan recognizes that all of us are making decisions as individuals in a social system—a system that can make it harder, or easier, to make better choices. Losing the dougnuts at a breakfast meeting may seem like a small gesture, but many such gestures add up to powerful change.

Colorado

Employees in Colorado are well on their way to wellness. The region has had a wellness program since 2004, and for the last four years has had a cash incentive to encourage employees to participate in wellness activities. The results have been positive. From 2009 to 2012, employee obesity rates have dropped from 34 percent to 32 percent. In addition, the prevention index—a composite metric that reflects the percentage of employees who are tobacco free, up to date on preventive screenings for heart disease and cancer, and not obese—has risen, with women improving from a 46 percent rating to 52 percent, and men improving from 44 percent to 50 percent.

Georgia

The Georgia region used its social media channels, including Facebook, Twitter, Instagram and Pinterest, to showcase employees, physicians and executives who mobilized for the Atlanta 2-Day Walk for Breast Cancer in October. Photos of giant, costumed characters “Doc Broc” and “Nurse Blueberry” filled the region’s news feeds, along with pictures of KP’s walkers and supporters. By using hyperlinks and hashtags, KP’s teams could connect with others involved in the event to generate online buzz for the walk. “Doc Broc” also appears at the KP-sponsored farmers’ market at Piedmont Park and other events. When not tracking the cruciferous crusader, the social media pages keep a steady diet of healthy recipes, tips and links to blog posts by top executives to show KP and its partner unions’ joint commitment to total health.

Hawaii

Safety conversations are sweeping the islands, with every employee in the region striving for at least two conversations per month, thanks to an idea pioneered by the Ambulatory Surgery Recovery unit. Brightly colored “topic stimulator” cards encourage staff members to share tips in a safe, fun manner. “Sharp attack” cards keep safe needle-handling on point. “Whoa” cards steer employees toward safer patient transport and lifting. “I spy” cards safeguard confidentiality by prompting frank discussions about hallway conversations, snooping, unattended computers and the paper shredder. Christy Borton, RN, the regional workplace safety champion—and injury rates, which were already low, are staying that way “We never talked about safety. Now we do, all the time, in the most meaningful ways.”

Mid-Atlantic States

The region’s fourth annual Learning Conference will provide opportunities to enhance skills in education and learning. Two days of workshops will provide ways to help clinical health educators improve communication skills and leverage the latest patient education technology. Informed and educated patients can participate in treatment, improve outcomes, help identify errors before they occur and reduce length of stay. This free conference also is for anyone in the region who facilitates or supports learning, including those who will be involved in engaging staff in workforce wellness activities—technical and LMP trainers, consultants, managers and supervisors, and shop stewards. Sessions begin Friday, Nov. 1, in College Park, Md. To view the conference web page and register, go to learn.kp.org and search for KPMAS Annual Learning Conference.

Northern California

Marcus Barnes and Donna Norton have been named the region’s Total Health union champions. The Total Health positions help support implementation of the 2012 National Agreement. Barnes, an OPEIU Local 29 member, works in the regional Claims department. Norton, a member of SEIU UHW, is a licensed vocational nurse at the Vacaville Injection Clinic, serves as an executive board member of SEIU UHW for Vacaville and Fairfield, and is her facility’s union co-lead. The pair will work closely with local union leaders and managers to recruit and train local workforce wellness champions, help frontline employees understand the National Agreement’s Total Health Incentive Plan, and work to integrate workforce wellness and workplace safety at the front line.

Northwest

Staff in the Northwest are getting healthy and having fun at the same time. At the Beaverton Medical Office, staff members teamed up to lose weight and sweetened the deal with an informal competition. Those who met their personal goal then took part in a drawing for a prize. Overall, staff members at the medical office have lost 89 pounds. If you come by, don’t be surprised if you see staff doing Instant Recess®, push-ups in the back office or working in the community garden.

Southern California

Panorama City Medical Center has 52 busy “Thrive ambassadors,” who talk to their colleagues about Kaiser Permanente’s wellness programs. They also recently started one community walk per month, raising awareness and funds for Alzheimer’s disease, victims of violent crime and other causes. Holly Craft Moreno, who is quoted in the cover story of this issue of Hank, says the group is always recruiting new ambassadors—adding that it’s not necessary to be a “rock star who does a triathlon every day.” The willing are welcome, she says: “Some of us can’t walk as fast as others. There is always someone on our team who will slow down, too.”