Total Health

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 Helen Bevan told her National Health Services colleagues in the United Kingdom she would be speaking at a conference of Kaiser Permanente union employees, they were surprised.

“What could they possibly learn from us?” they asked.

A lot, she says.

“Kaiser is a role model for us,” explains Bevan, chief of service transformation at the NHS Institute for Innovation and Improvement, part of the largest government-sponsored health care system in the world.“We look at and learn a lot from Kaiser in terms of innovations, efficiencies, use of new technology and its approach to patient care.”

We have much to learn from them as well—especially when it comes to large-scale change.

How to move forward

“To move forward in health care, leaders must tell their story, make it personal, create a sense of ‘us’ and include a call for action,” says Bevan, one of the plenary speakers at this year’s Union Delegates Conference in Hollywood. “The way to build and sustain health care reform is to learn the lessons of social movement leaders.”

Bevan’s point is on the mark. The 700 delegates attending the conference, themed “You Gotta Move,” were called to act on improving their own health and the health of their communities. They took that message to the streets of Hollywood, distributing fliers with tips on easy steps to take to improve health. Some also gathered for a flash mob in front of Hollywood’s Grauman’s Chinese Theatre, dancing to Beyonce’s “Move Your Body”—a song made for Michelle Obama’s “Let’s Move” campaign to end childhood obesity.

“It’s such a great experience to see the extent to which union members are stepping up to be a part of the change process,” Bevan says.

Building commitment and energy

The actions at the delegates conference—and beyond—are precisely what’s needed to reform health care in America and the world, she says, adding: “We can only create large-scale change if we build a platform of commitment and energy.” 

Because unit-based teams, KP’s platform for improvement, engage frontline workers, managers and physicians, they “already have that commitment and energy,” Bevan says. UBTs “create a sense of coming together around a common cause and achieving the same outcomes.”

But UBTs alone can’t bring about the large-scale change needed to meet the unprecedented challenges to improve quality and reduce costs.

Engage and inspire

“Transformation needs to occur at all levels of the organization in order for it to be sustainable,” Bevan says. “Senior leaders need to stop being pacesetters and start engaging, inspiring and emotionally connecting with employees. The passion is there. We just have to tap into it.”

As the task of delivering health and health care becomes more complex and the scale of change increases, “We need to think widely and innovatively about how we define the role of senior leaders,” Bevan says.

That’s where social movement thinking comes in. “Successful movements often have charismatic leaders—think Martin Luther King or Nelson Mandela—but what ultimately guides and mobilizes the movement are leaders at multiple levels.” The key, she says, is to depend less on reorganizing structures and processes as the catalyst for change and more on unleashing emotional and spiritual energy for change.

“People are much more likely to embrace change if it builds on the passion, the sense of a calling that got them into health care in the first place,” Bevan says. By connecting to that shared passion through storytelling, “We can create an unstoppable force for change.”

Managers newly charged with co-leading unit-based teams sometimes need to build team cohesion before diving into the nitty-gritty of setting goals and improving performance.

Brenda Johnson, optical site supervisor at the South Bay Medical Center in Southern California, has found a way to do just that—and improve her staff’s eating habits at the same time.

Inspired by a presentation at a regional leadership conference hosted by Jeffrey Weisz, MD, executive medical director of the Southern California Permanente Medical Group, she launched a healthy eating club in her department. Every week, staffers chip in $12 each—and get four healthy, fresh-cooked meals in return.

At the early spring meeting, Dr. Weisz discussed Kaiser Permanente’s Healthy Workforce initiative and distributed a booklet listing the calorie count of hundreds of food items.

Making change easier

“I looked at the book, and I thought, ‘Oh, my goodness,’” said Johnson, shocked at the number of calories in some of her favorite foods.

“I looked around at my employees,” she said. “Some have health issues. Some drink sodas by the 32-ounce cup every day.” The medical center is ringed by mini-malls with fast food restaurants. “We’ve been eating the same stuff for years,” she said. “The only question was who’s going to go pick it up.”

Gil Menendez admits he was one of the 32-ounce-cup soda drinkers—a habit he gave up when he joined the club. Menendez, an optical dispenser, SEIU UHW member and  labor co-lead of the UBT, was so motivated by the changes in his lunchtime habits that he also began a strict diet and exercise routine. He’s lost 20 pounds.

New ways to work together

Johnson cautions that the healthy eating club isn’t a diet club. She picks recipes out of a pamphlet produced by the California Department of Public Health, Champions for Change, and prepares the ingredients at home. Others sometimes prepare recipes from their families and cultures. She combines ingredients in the morning, steams them in a slow cooker the staff keeps at work, and a meal is ready by lunchtime.

“I have to cook for my family anyway,” says Johnson. At home, “We’ve changed our habits because of high blood pressure. I prepare this food with love because I’m preparing it for both of my families: my family at home and my family at work.” 

About 15 to 20 people participate in the club each week, up from 10 when it first began in May 2010. In addition to its health benefits, the club has helped her department be more productive and collegial, says Johnson.

“It’s going strong,” adds Mendez. “It brings us together.”