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The Importance of Continual Learning in a Rapidly Changing Health Care Environment -- Abstracts from the Kaiser Permanente 2018 National Quality Conference


Michael H Kanter, MD; Patrick T Courneya, MD

Perm J 2018;22:18-071 [Full Citation]

E-pub: 04/25/2018

Abstracts from the Kaiser Permanente 2018 National Quality Conference

Changes in health care are rapid with increasing participation from nontraditional companies in technology, pharmacy, and others.1 Most recently, Chase, Berkshire Hathaway, and Amazon announced a joint health care initiative and the formation of an independent company to focus on technology solutions for simplified, high quality, and affordable health care.2 The announcement sent immediate ripples throughout the health care industry and beyond even though it included no material plans or concrete details.

With the increase of available technology, the promise of new and nontraditional means to access care, and the general trend toward consumerism in health care,3 patients and purchasers are demanding more value—including higher-quality services, improved access, and lower costs. Moreover, as health care becomes more global through the advent of cloud computing and mass customization, there is growing demand for health equity and the mitigation of health disparities. Kaiser Permanente (KP) is already making great strides in this area and were recently recognized by the Center for Medicare and Medicaid Services as the first recipient of their new Health Equity Award.4 

New technology is rapidly being applied to health care, leading to great advancements in how we treat and prevent illness. Although this innovation has led to mostly favorable results, some significant problems have surfaced, such as alleged fraud,5 that require vigilance on the part of health care organizations. These lessons are not new. Looking back on examples like the harm arising from relaxed use of opioids and the dramatic change in prescribing that came as we learned about risks of postmenopausal estrogen use, we learn repeatedly the importance of sound evidence and continuous vigilance as new evidence comes to us through research. There is also increasing recognition that one of the most common causes of harm are diagnostic errors, which may affect more than 12 million patients per year.6 Improvement efforts are challenging because of difficulties in measuring the problem and the gap in time that often occurs between the initial error and its detection. However, KP has closed many of the systemic gaps that contribute to diagnostic errors through our SureNet programs.7,8 

There is also great demand to begin measuring outcomes that matter to patients and that go beyond process measures and a limited set of intermediate outcomes measures. Although the work is still in its infancy, KP is leading the way in this area with demonstrated reductions in cardiovascular morbidity and mortality.9

Because KP has created effective solutions to many national challenges that affect the health care industry at large, we feel it is important to publish the results of our learning and improvement efforts in hopes of supporting health care improvement outside of our system. For the 15th year, KP is convening its National Quality Conference and will again publish the abstracts of presentations at the meeting to help spread new quality initiatives throughout the nation. The abstracts cover each of the National Academy of Medicine’s 6 aims or dimensions of quality (safe, timely, efficient, effective, equitable, and person-centered),10 which also form the framework for KP’s National Clinical Quality Strategy. We recognize that there are many health care quality conferences of high value offered by organizations such as the Institute for Healthcare Improvement, the National Patient Safety Foundation, and others. However, we believe that large health care organizations can and should participate in creating quality forums where practices are not only shared but also published.11

How to Cite this Article

Kanter MH, Courneya PT. The importance of continual learning in a rapidly changing health care environment. Perm J 2018;22:18-071. DOI: https://doi.org/10.7812/TPP/18-071

1.    Hwang J, Christensen CM. Disruptive innovation in health care delivery: A framework for business-model innovation. Heath Aff (Millwood) 2008 Sep-Oct;27(5):1329-35. DOI: https://doi.org/10.1377/hlthaff.27.5.1329.
2.    Amazon, Berkshire Hathaway and JP Morgan Chase & Co. to partner on U.S. employee healthcare [Internet]. New York, NY: Business Wire; 2018 Jan 30 [cited 2018 Apr 2]. Available from: www.businesswire.com/news/home/20180130005676/en/Amazon-Berkshire-Hathaway-JPMorgan-Chase-partner-U.S.
3.    Babu R, Jayashree K. A survey on the role of IoT and cloud in health care. International Journal of Science, Engineering and Technology Research 2015 May;4(12):2217-19.
4.    Kaiser Permanente named first CMS health equity award recipient [Internet]. Oakland, CA: PR Newswire; 2018 Feb 14 [cited 2018 Apr 2]. Available from: www.prnewswire.com/news-releases/kaiser-permanente-named-first-cms-health-equity-award-recipient-300599018.html.
5.    O’Brien SA. Theranos founder Elizabeth Holmes charged with massive fraud. New York, NY: CNN Money; 2018 Mar 14 [cited 2018 Apr 2]. Available from: http://money.cnn.com/2018/03/14/technology/theranos-fraud-scandal/index.html.
6.    Singh H, Meyer AN, Thomas EJ. The frequency of diagnostic errors in outpatient care: Estimations from three large observational studies involving US adult populations. BMJ Qual Saf 2014 Sep;23(9):727-31. DOI: https://doi.org/10.1136/bmjqs-2013-002627.
7.    Sim JJ, Rutkowski MP, Selevan DC, et al. Kaiser Permanente Creatinine Safety Program: A mechanism to ensure widespread detection and care for chronic kidney disease. Am J Med 2015 Nov;128(11):1204-11.e1. DOI: https://doi.org/10.1016/j.amjmed.2015.05.037.
8.    Danforth KN, Smith AE, Loo RK, Jacobsen SJ, Mittman BS, Kanter MH. Electronic clinical surveillance to improve outpatient care: Diverse applications within an integrated delivery system. EGEMS (Wash DC) 2014 Jun 24;2(1):1056. DOI: https://doi.org/10.13063/2327-9214.1056.
9.    Solomon MD, Leong TK, Rana JS, Xu Y, Go AS. Community-based trends in acute myocardial infarction from 2008 to 2014. J Am Coll Cardiol 2016 Aug 9;68(6):666-8. DOI: https://doi.org/10.1016/j.jacc.2016.03.607.
10.    Institute of Medicine: Committee on Quality Health Care in America. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press; 2001 Mar 1.
11.    Kanter M, Courneya PT. Perspective on publishing quality improvement efforts. Perm J 2017;21:17-140. DOI: https://doi.org/10.7812/TPP/17-140.

Abstracts from the Kaiser Permanente 2018 National Quality Conference

Quality improvement (QI) activities are essential to create a learning health care system. Publishing QI activities has great value, encourages greater rigor, and helps facilitate greater willingness to share improvement opportunities.

18 071X Project: Getting Grounded—How Project Chamai Is Poised to Serve Emotional Wellness Needs of Kaiser Permanente Members
Trina Histon, PhD; W Scott Heisler, RN, MBA; Herbert Ozer, LCSW; Paul Castaldo, LCSW

Depression Care Management—an Evidence-Based, Collaborative Care Approach to Treating Depression in a Primary Care Setting
Alisa Aunskul, MSHCM; Daniel Hackett, MD; Karen Coleman, PhD; Mark Dreskin, MD

Moving Upstream: Three Regions’ Approaches for Addressing Social Determinants and Needs to Improve Health Outcomes
Nicole Friedman, MS; Irene Alvarez-Zamzow, MPH; Adam Sharp, MD, MS; Ranu Pandey, MHA

The Community Action Poverty Simulation: A Powerful, Interactive Experience, Moving People to Make a Difference
Anna Khachikyan

The E-SCOPE Initiative: A Strategic Approach to Identify and Accelerate Implementation of Evidence-Based Best Practices
Joel Whittaker, MPH; Joanne Schottinger, MD; Michael H Kanter, MD; Marguerite Koster, LMFT, MA

Continuing Care Quality Management: Right Care, Right Time, Right Place Applied to Skilled Nursing Facility Care
Peter Khang, MD; Jennifer Cortez; Christine Jordan; Artem Aghourian

Changing Regional Surgical Practice to Improve Quality and Efficiency of Care
Charles Meltzer, MD

Sepsis Showdown: A Unified, Interregional Approach to Sepsis Diagnosis and Treatment
Cara Steinkeler, MD; Kenneth Robinson, MD

Preventing Unrecognized Deterioration and Honoring Patients’ Goals of Care by Embedding an Automated Early-Warning System in Hospital Workflows
Brian Dummett, MD; Shirley Paulson, RN, DNP; Elizabeth Scruth, RN, PhD; Julia Green, MPH; Theresa Villorente, MSN, RN; Liesel Buchner, RN, CCRN-K, CNML; Tamar Fendel, MPH; Vivian Reyes, MD; Gabriel J Escobar, MD

Using Lean Management to Drive Improvement at East Denver Medical Office
Kristin Banks, DrPH, MPH; Tom Kazutomi, MA, NRP; Mehul Gandhi, MD, MBA; Hanah Polotsky, MD, MBOE

Spreading the News: Prevention of Hospital-Acquired Pneumonia is Possible
Cristine Lacerna, RN, MPH, CIC; David Witt, MD, FIDSA; Lawrence Block, Quality Oversight Support; Donna Patey, RN, CNS, WOCN

Same-Day Bilateral Cataract Surgery: Providing More Value to Members and to Kaiser Permanente
Robin Cisneros; Neal Shorstein, MD; Alan Moreno

The Impact of Improving Access to Primary Care
David Glass, PhD; Michael H Kanter, MD; Paul Minardi, MD

Spreading and Scaling Kaiser Permanente’s Primary Care Plus: An Interdisciplinary, Person-Centered Primary Care Model
Tracy Ellen Lippard, MD; Sara Armijo; Amy Wolf, MD; Linda Donner, MHA

Imaging to Treatment: Leveraging Technology to Redesign Care for the Pulmonary Nodule Pathway
Ashish Patel, MD; Daniel Navarro, MD; Michael Rizzo, MD; Steven Levine, MD; Todd Osinski, MD

Bringing Hospital Care into the Home: Designing for Spread of AMCAH and SY@H
Bruce Cohn, MD; David Wong, MD; Zeth Ajemian, MA

National Total Joint Replacement Initiative: A Case Study for Accelerated Systemwide Spread and Learning
Jeff Convissar, MD; Kate Koplan, MD; Ronald Navarro, MD; Violeta Rabrenovich, MHA, CHIE

Care Without Delay
Serge Teplitsky, RN; Vivian Reyes, MD; Jennifer Misajet, RN; Catherine Winarsky, MPH, BSc (Pharm)

Optimal ESRD Starts: Moving Upstream Chronic Kidney Disease to Prevent or Delay End-Stage Renal Disease with Predictive Analytics
Sophie Taylor, RN; Alvina Sundang; Leonid Pravoverov, MD; Karen Ching, MD

Committee for Improvement of Performance Through People: Strengthening Influence Over Work and Engagement in Primary Care Clinical Pharmacy
Beverly Kroner, PharmD; Alex Block, PharmD

Deprescribing: A Graduation in Medicine
Christopher C Change, PharmD, BCGP, PMP; Lynn Deguzman, PharmD, BCGP; Maisha Draves, MD, MPH

Pharmacy and Care Management Collaboration to Improve Health Outcomes through Medication Reconciliation Program Expansion
Bryan Davis, PharmD

“There’s No Place Like Home”: Creating a Safe, Individualized, Transitional Care Pathway After a Skilled Nursing Facility Stay
Yvonne Rice, PharmD; Hannah Austin, MBA; Preston Peterson, MD

Collaborative Protocols between Physicians and Pharmacy Groups to Facilitate Opioid Reduction in the Napa-Solano Service Area
Jeff Chen, PharmD; Diparshi Mukherjee, DO

Improving Performance on Medicare Stars Medication Adherence Measures through Predictive Analytics
Heather Qian, MBA; Lynn Deguzman, PharmD, BDGP; Scott Jacobs; Kevin Chiang, PharmD; Chris Chang, PharmD, BCGP, PMP

A Successful Multimodal Initiative to Increase Access to Long-Acting Reversible Contraception Among Adolescents
Sharisse Arnold-Rehring, MD, FAAP; Jennifer Seidel, MD

Patient Partners Redesign kp.org Personal Action Plans
Hyewon Jun, MD, MPH; Gordon Ching, MBA; Julia Gregory, RN, BSN

Nothing About Patients Without Patients: Strategically Partnering with Leadership for Patient-Centered Outcomes
Linda Fahey, RN, NP, MSN; Kerry Litman, MD; Susie Becken; Barbara Lewis; Diana Palma, MHA

Human-Centered Design @ KP: Building Organizational Capacity in Innovation and Patient Engagement
Loulia Kachirskaia, PhD; Jeff Hall; Jonathan Bullock

Engaging with Members to Develop a Person-Centered Transgender Care Program
Felipe Dest, MHA; Erica Metz, MD; James Kelleher, RN; Stephanie Detlefsen, MD; Erin Waters

Putting the Patient First—Shared Decision Making at Kaiser Permanente
Andrew Felcher, MD; Matt Handley, MD

Improving the Culture of Safety: Workplace Safety Unit-Based Teams Interventions that Work
Barbara Zelinski, MBA; Leslie Pole, MA; Samantha Imada, MA

Leading Inclusively—Utilizing KP’s Seven Inclusive Attributes to Build Trust and Increase Engagement and Team Productivity
Susan Terrill; Laura Long, MBA

How Our Unique Multidisciplinary Care Model Leads to Superior Outcomes for Cardiac Surgery Patients
Yong Shin, MD; Brian Timm, PA-C; William Shely, MD; Thomas Lampros, MD; David Tse, MD; Josh Andrew, PA-C; Julie Faulk, PA-C; Piotr Starosta, PA-C; Victoria Brownlow, PA-C

May The Schwartz Be With You: Fostering Ethical Care Environments through Schwartz Rounds—A Live Demonstration
Paula Goodman-Crews, LCSW; Deborah Kasman, MA, MD; Felicia Cohn, PhD

Nurse-Led Strategies to Improve In-Hospital Code Blue Survival Rates
Rebecca Campbell, RN, CCRN; Patrice Chatterton, RNC, CPHQ; Christopher Cox, RN, CEN, CCRN; Anna Sandgren, RN

Workplace Violence Prevention
Robert Durand, CPP, CHEP, HEM, CHSS; Jeff Kostos, CSP

Pain Rounds: Implementing an Interdisciplinary Team-Based Approach to Pain Management for Inpatient Rehabilitation
Brian Theodore, PhD; Ryan Doan, MD

Optimizing Specialty Palliative Care: Five Key Strategic Initiatives
Dana Benton, RN, MS, CNS; Melissa Stern, MBA

Northern California Medi-Cal Onboarding: Upstream Engagement
Sarita Mohanty, MD; Bryan K Lee, MD; Molly Drebes, MS; Irene Alvarez-Zamzow, MPH

Embrace New Culture in Postacute Care: Shaking up the Status Quo
David Wong, MD; Karen Sirski-Martin, RN, MSN, CCRN, HACP; Cora Bailey, RN, MSN, PHN, CLNC

Effective Rounding for Quality and Safety
Maggie Robbins, MPH; Lizabeth Taghavi

Pursuing Health Equity: Our Journey to Improve Diabetes Control With Our Hispanic/Latino Population at Kaiser Permanente in Indio, California
Frank Flowers, MD; Jose Fernandez, MD; Robert Blair, MPH; Patrick Calasan, BSN RN MHA




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