Total Health

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Bryant Terry is a vegan chef, author and advocate for food justice. His new cookbook, Afro-Vegan, will be published next year. Terry will whip up a batch of citrus collards with raisins for the Union Delegates Conference and share how to use cooking and urban gardening as a tool for social change. He recently spoke with Laureen Lazarovici of LMP Communications.

What was your journey?

My entree into this work was as a grassroots activist in low-income communities of color. I was living in New York City, going to cooking school, and seeing the disparity in the types of food available and the impact that had on the health of communities. When I learned about the risk of a shorter lifespan for our youth, that made me want to help young people be leaders to solve this problem. So I founded b-healthy!, which stands for Build Healthy Eating and Lifestyles to Help Youth.

I realized it was their parents making the purchases, so we had to figure out how to bring parents in, how to raise their food IQ. I saw how little time people have to cook. Cooking is this lost art. People don’t even know how to make a stir fry with vegetables. It is easy to cook meat. It is a lot harder to tease out the flavors and textures just using fruits, vegetables and grains. You’ll have negative connotations of vegetables if you’ve grown up eating vegetables from a can. Those don’t taste that good.

I’ve gone from omnivore to vegetarian to vegan. But it was not a linear path for me. We are all on a journey. There is no room for judgment. My mission is not to convert people into vegans or vegetarians. I am looking to improve public health through cookbooks.

What obstacles have you encountered and how did you overcome them?

When we start talking about what people eat, folks might say, ‘It’s my decision.’ But it is important to realize we are influenced to eat things that are unhealthy by marketing. Yes, we have some autonomy. But there are forces influencing us. I want to provide a counter-narrative. We are in a beautiful moment when people are more open to things like meatless Mondays. These diets are a tool; they are not the tool, to address the crisis.

What role can Kaiser Permanente and its workforce play?

I come from a family of health care providers. They tell me all the ways the current health care system does not provide tools to them to help their clients. They are taught to respond to crises and to give pharmaceuticals. So, the first thing I would say to health care workers is: it is important to take care of yourselves. I’m referring to diet, exercise, and stress reduction, especially since you all work such long hours. The people who are working to heal people can heal themselves.

I am impressed by how Kaiser Permanente is taking the lead in prevention. Kaiser Permanente is part of that counter-narrative. And I love the farmers’ markets at hospitals. That is brilliant.

What is your favorite recipe?

I do like the citrus collards with raisins. It is symbol of my embracing the African-American community. That community is so heavily impacted. If we can make a change there, we can change the whole system.

Bringing joy and meaning to work may sound like a lofty aspiration. But if your workplace is lacking these things, it's more than dreary—it’s also dangerous, according to the Lucian Leape Institute at the National Patient Safety Foundation.

Start with the fact that health care itself is dangerous. The institute’s March 2013 report on workplace injuries in health care, “Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care,” noted that:

• Health care workforce injuries are 30 times higher than other industries
• More work days are lost due to occupational illness and injury in health care than in such industries as mining, machinery, manufacturing and construction
• Seventy-six percent of nurses in a national survey said unsafe working conditions interfere with the delivery of care
• An RN or MD has a five to six times higher risk of being assaulted than a city cab driver
• Emotional abuse, bullying, threats and learning by humiliation often are accepted as “normal” conditions of the health care workplace

These conditions are harmful to patients, caregivers and the organization, according to the report:

“Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams.”

Role of leaders

The authors conclude, “The basic precondition of a safe workplace is the protection of the physical and psychological safety of the workforce.”

Physical and psychological safety is also a precondition to “reconnecting health care workers to the meaning and joy that drew them to health care originally,” said Lucian Leape Institute President Diane Pinakiewicz, at Kaiser Permanente’s second annual Workplace Safety Summit February 12.

“These preconditions enable employers to pursue excellence and continuous learning,” she said. “The purposeful maintenance of these preconditions is the primary role of leadership and governance.”

Systemic causes of harm

While pointed in their assessments, Pinakiewicz and the report’s authors refrain from finger-pointing. Pinakiewicz outlined systemic organizational stresses that work against workforce and patient safety. These include:

• People feeling overwhelmed (58 percent of workers surveyed by the American Society of Professionals in Patient Safety cited overwork as an issue)
• The volume of non-value adding work
• Workforce safety and patient safety being managed separately and non-systemically
• Operating pressures exacerbating traditional behavioral norms

The report identifies several “exemplar organizations,” including the Mayo Clinic, Virginia Mason Medical Center, Kaiser Permanente and the Coalition of Kaiser Permanente Unions, that are working to “create cultures of safety and respect.” KP’s 2012 National Agreement provisions for workforce total health and interest-based problem solving are cited as contributors to that culture.

Seven strategies for improvement

The Lucian Leape Institute offers seven strategies for improving safety and restoring joy and meaning to the health care workplace:

1. Develop and embody shared core values of mutual respect and civility; transparency and truth telling; safety of all workers and patients; and alignment and accountability from the boardroom through the front lines.
2. Adopt the explicit aim to eliminate harm to the workforce and to patients.
3. Commit to creating a high-reliability organization and demonstrate the discipline to achieve highly reliable performance.
4. Create a learning and improvement system.
5. Establish data capture, database and performance metrics for accountability and improvement.
6. Recognize and celebrate the work and accomplishments of the workforce, regularly and with high visibility.
7. Support industry-wide research to design and conduct studies that will explore issues and conditions in health care that are harming our workforce and our patients.

“Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care” is available online from the Lucian Leape Institute at the National Patient Safety Foundation.