Inspiring a Passion for Continuous Improvement

Kaiser Permanente’s 2016 Vohs and Lawrence Awards recognize innovation in enhancing quality and patient safety.

Feature Story
Veronica Monroy and her daughter

Veronica Monroy was elated after the birth of her daughter. “She was beautiful and I was happy, really happy,” she recalled.

But two months later, her mood took a turn. “I felt really sad all the time, and I didn’t feel like getting dressed,” she said. “It really scared me.”

Adding to her unhappiness were shame and embarrassment.

Monroy turned to Kaiser Permanente for help. She was diagnosed with perinatal depression and began seeing a therapist, participating in a group for other struggling moms and taking medication. Within six months, she began to feel like herself again.

“Knowing that they really cared for me helped me a lot,” she said.

Monroy’s story illustrates the value of Kaiser Permanente Northern California’s Universal Perinatal Depression Screening Program, one of three projects honored with the organization’s 2016 James A. Vohs Awards for Quality and David M. Lawrence, MD, Patient Safety Awards. The awards were presented by the Kaiser Foundation Health Plan, Inc. and Hospitals Boards of Directors on November 29.

Created to honor the contributions of two esteemed Kaiser Permanente leaders, the Vohs and Lawrence Awards recognize projects that exemplify the organization’s commitment to advancing the quality of care and improving patient safety. They’re presented annually to inspire a passion for continuous improvement while encouraging the spread of best practices.

Other 2016 winners include Systematic Screening of Abdominal Aortic Aneurysms, a collaborative effort between Kaiser Permanente’s Southern California and Northwest regions, and Northern California’s Enhanced Recovery After Surgery program.

Vohs Lawrence Award winners up close

More than baby blues

Twelve to 20 percent of mothers experience depression before or after the birth of a child, but many health care providers don’t screen for the condition.

“It’s a double whammy, because it affects not only the woman herself, in terms of her well-being and ability to function, but also the child,” said Tracy Flanagan, MD, director of Women’s Health for the Northern California Region.

Through the Universal Perinatal Depression Screening Program, all pregnant women are screened for depression in early and mid-pregnancy and soon after the baby’s birth. If the woman is diagnosed with depression, her obstetrician offers referrals for classes, support groups, counseling or prescription medication.

“Women in my group go from feeling like, ‘There’s something really wrong with me’ and ‘I’m defective’ to feeling like ‘I’m a capable mom who is providing for my baby and my family in a positive way,’” said Cosette Taillac, a licensed clinical social worker and Northern California’s assistant director for mental health.

Detecting aneurysms before it’s too late

An abdominal aortic aneurysm, or AAA, is a bulge in the largest artery in the abdomen that can be fatal if it enlarges to the point of rupture. The majority of AAAs cause no symptoms before rupture, resulting in a death rate of nearly 90 percent.

The Systematic Screening of Abdominal Aortic Aneurysms program uses data in Kaiser Permanente’s electronic health record to identify members who are at risk of AAA based on their age and smoking history. For patients who are at risk, physicians receive automated alerts reminding them to schedule screenings. If an aneurysm is found, treatment varies from watchful waiting to surgical repair.

That thorough, systematic approach proved to be a lifesaver for Richard Moody. After his ultrasound revealed an aneurysm, his vascular surgeon monitored his condition closely for nearly five years before it worsened to the point where intervention was necessary.

“My older brother died from a ruptured aneurysm,” said Moody, “so I was very glad they found mine and were able to do something noninvasive to fix it.”

Healing quickly, safely and comfortably

There was a time when patients recovering from hip fracture, knee replacement or colorectal surgeries could expect to spend a week or more in the hospital, feeling groggy and nauseated from painkillers. That’s no longer the norm at Kaiser Permanente in Northern California thanks to Enhanced Recovery After Surgery, or ERAS. By changing the way hospitals care for patients after select surgeries, the evidence-based program is helping people feel better, heal faster and return home sooner.

Since implementing ERAS in Northern California, Kaiser Permanente has seen a 17 to 13 percent reduction in the rate of post-surgical complications. “More importantly, it allows patients to feel better,” said surgeon Efren Rosas, MD. “It’s just night and day compared to what it used to be.”

ERAS is based on three core principles. “We’re trying to minimize the use of opioids in pain management, optimize nutrition both before and after surgery and help patients mobilize as early as possible,” said Mengfui Huang, MSc, regional ERAS director.

Because patients are given fewer opiates, “they have less nausea, so they’re able to eat sooner than they could in the past,” said Stephen M. Parodi, MD, associate executive director of The Permanente Medical Group. “They’re no longer delirious or sleepy after surgery, so they’re able to get up and walk sooner. As a result, they recover faster and are able to go home.”