A Breath of Fresh Air for Health Care

“Optimistic” may be about the last word you’d choose to describe the health care industry. Or maybe “innovative.” But the work now being undertaken by Kaiser Permanente, the nation’s largest not-for-profit health plan, would make you gravitate toward those descriptors. Kaiser’s collaborative, institution-wide effort known as KP Innovation could revolutionize health care for the whole industry.

Over the past few years, I’ve noticed that there was something very different about the way Kaiser communicated its brand. Their “Thrive” campaign, created by Campbell-Ewald, posits Kaiser less as a medical/institutional service than a lifestyle. Both in print and on TV, the ads are visually compelling (clever puns, blueberries elevated to high art) and emotionally engaging (online medical records not only streamline procedures, they save trees and the planet), with voiceovers by the appealing Allison Janney, formerly of “The West Wing.” The intended message is not how well Kaiser will care for you when you’re sick, but rather how Kaiser helps deliver wellness and can enhance the quality of your life.

It would be easy to dismiss “Thrive” as a great piece of ad work, one likely masking larger institutional deficiencies. But the thing is, Kaiser has invested an incredible amount of its resources to align itself with the brand message conveyed by “Thrive.” Their efforts to improve the patient experience touch all facets, from designing greener, healthier buildings to increasing the amount of time nurses spend at bedside. And they are helping resuscitate an industry that’s never been more in need of fresh air.

I’ve written here about how even the most seemingly innocuous details of the health care environment — a dead potted plant in a doctor’s reception room, an ill-fitting hospital gown, a blaring television — can contribute to an unpleasant, at times even devastating experience. Recognizing that reality, Kaiser’s National Facilities Services (N.F.S.) group has, since 2007, been working on the Total Health Environment, a program that is applying design thinking to every aspect of Kaiser’s operations, from medical records to medication administration, color palettes to carpet.

“Total health” becomes a principle on which to build new facilities and remodel existing ones. Though certainly not the first health care provider to improve its facilities and service (an exemplar is the Mayo Clinic), Kaiser Permanente may be the first to reach so many people. KP has nearly 9 million members spread from Washington, D.C., to Hawaii, a team of 14,000 physicians and a workforce of 167,000.

Early on, N.F.S. team members began touring several of Kaiser’s facilities, taking note of all aspects that were distinctly “not thriving.” They visited both competing institutions and analogous places (like cafés, hotels and retail establishments). They interviewed all relevant stakeholders, from orderlies to patients’ family members, about their experiences, and anyone who has ever visited doctors’ offices and hospitals would nod in agreement with many of the Kaiser team’s findings.

Some of what the team learned (quotes in parentheses are from interviews): People can’t find entrances, or parking, or where they need to go (“There are so many signs! All the buildings look alike!”). Grand lobbies instill anxiety rather than awe. Waiting rooms are dreadful, time-wasting, uncomfortable (“Why are these magazines so old?”; “I hope I don’t catch anything”). Cafeterias = inedible food + unpleasant environment (“Is this café clean?”). Examination and hospital rooms are impersonal, isolating and not family-friendly (“I hope nobody walks in without knocking”; “I am so bored”; “Can my daughter sit with me?”). People need more information, more connection, more control.

The collaborative team designated 22 key experiences that together add up to what they call a “Total Health Journey.” These touch on each moment of the patient’s experience, from the approach to the facility to the route down the corridor to any stop made along the way, whether at check-in, in an exam room, or at the cafeteria, pharmacy or bathroom. The design solutions that emerged include things as seemingly obvious as clearly marked signage; stairwells that might actually encourage people to take the stairs (and remove the fear that anyone who does so might end up locked in between floors); the creation of outdoor spaces that provide escape and respite, not to mention natural light; transforming typically unwelcoming cafeterias to more people-friendly cafés; and an exam room that emphasizes comfort, privacy and personal control.

Key Experience #13, for example, addressed the waiting room, which traditionally features linear seating arrangements. Kaiser eschews the typical “bus station seating” for comfortable chairs, with brighter color palettes, and the more flexible seating allows for situation- or needs-based configurations.

Key Experience #19 focuses on the patient room. A multi-disciplinary, multi-regional panel of experts (nurses, infection-control specialists, Kaiser members, brand consultants and others) developed a template flexible enough to work for a variety of patient populations across all Kaiser facilities. They addressed problems including harsh lighting, lack of storage, a surplus of “hard” spaces (with few softer ones) and the intimidating amount of equipment and technology a patient was confronted with from the entryway and from the bed.

The redesigned room was divided into five distinct zones:

Innovations include more effective and attractive receptacles for waste management and soiled linen, increased storage space, better equipment organization and more readable patient care information in the nurse zone; and greater privacy and more comfortable furniture in the family zone.

Something as simple as redesigning the headwall into a more efficient, modular headboard saved a whopping $2,369 per room — and is far more comfortable to boot. Language was rethought as well: this new room is a “guest room,” not a “patient room,” part of a larger move toward thinking about health and wellness rather than sickness.

Integral to the Total Health endeavor has been its embrace of sustainable materials, systems and technology, from denim insulation for walls to the introduction of farmers markets at 30 facilities in six states. (Other hospitals are embracing similar food and farm innovations. San Francisco’s newly rebuilt Laguna Honda Hospital will feature a therapeutic farm and garden for patients.) The move toward sustainability can be credited in large part to committed KP leadership. But of course much of the cost-saving is possible because of Kaiser’s size, which gives them incredible buying power.

In 2000, for example, they launched a national campaign to remove polyvinyl chloride (PVC) from products and building materials, including carpets. At the time, PVC was ubiquitous in health care settings, even though the material is a major source of dioxin, a known human carcinogen. Working with the carpet manufacturer Collins and Aikman (now known as Tandus), KP helped create a new type of carpet backing that is PVC-free (it’s made from recycled safety glass from car windshields), while also meeting performance requirements for health care settings. Four years later, the new carpet was on the market. Since 2004, approximately 10 million square feet of this carpet has been installed in Kaiser Permanente facilities — and it is also available to the health care industry at large.

Though hospitals will end up looking better, these efforts aren’t about decorating, they’re about outcomes. Numerous studies point to the benefits of the design strategies and environmental interventions KP has proposed and implemented. Factors like the quality and intensity of light, access to natural light, the noise level in a room, the privacy afforded by single-patient rooms — all of these affect patient health, satisfaction, soundness of sleep and speed of healing. Views of nature have been shown to decrease depression, pain, stress and even length of hospital stays. Floor plans that are designed to help health care workers do their work more effectively (as well as increase privacy and comfort of patients) can reduce falls, improve patient communication and lessen stress for all.

I can’t help thinking of the enormous opportunity for other large corporations and institutions to take a cue from Kaiser’s efforts. There is no reason why schools and banks, as well as major homebuilders and office, hospitality and retail developers can’t make similar demands of their vendors and contractors. Wal-Mart, for example, has mandated the goals of using only renewable energy, producing zero waste and selling only sustainable products (now, if they’d only provide Kaiser-like health care for all employees). Why aren’t builders demanding that makers of vinyl siding develop a more sustainable alternative? Or require that buildings generate some percentage of their own electricity from alternative energy? Why not save money, heal the planet and improve quality of life for workers, residents, students and customers?

Kaiser has made a commitment to share their research, from process to product, for free. As Denton says, “We are intent on sharing everything that we do. We’re doing it for the benefit of everyone in health care. We are trying to make human-centered design and designing for emotions as meaningful for the patient as possible and as doable for health care organizations as possible.”

That others might take notice — finally — might help steer us all toward thriving rather than just surviving.