Permanente Impact Spring 2021

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Building a culture of wellness

A Publication of Washington Permanente Medical Group

HOW I THRIVE: Seattle Ob/Gyn Dr. Adrianne Wesol tends her garden

CEO letter


fter a relentless year battling COVID-19, reinventing how we deliver care virtually, and responding to our patients’ evolving needs, many of us find ourselves running on empty at the end of the day. It can be difficult to find the resilience and balance that fuels our work. Even before COVID-19 emerged, clinician burnout was a pandemic in the health care industry. In 2011, an AMA and Mayo Clinic survey found 45% of U.S. physicians displayed indicators of burnout, and three years later that number was 54%. Further, U.S. physicians had the highest suicide rate of any profession including the military in 2018 and the pressure to perform has only increased with the onset of COVID-19. As healers, we tend to put others’ well-being above our own, and that can have serious consequences. Although some progress has been made to address burnout in our industry, more needs to be done to ensure that “caring for the caregiver” remains front and center to protect our clinicians, our patients, and our communities. As practitioners of Permanente Medicine, we are better positioned than most to do that. The Permanente medical groups have prioritized clinician wellness with the “Quadruple Aim,” which adds the well-being of clinicians to the more commonly known Triple Aim of health of populations, enhanced care experience for individuals, and reduced per-capita cost of care. Here at WPMG, I continue to be grateful to Mary Wierusz, MD, for accepting the role of Health & Wellness program clinician lead last June. Mary and her team have been working hard to prioritize wellness and implement her program. She’s making a difference, and I’m sure she would be happy to hear from you. I invite you to take a few moments to sit down, enjoy a few deep breaths, and peruse some of the useful and restorative stories in this issue of Permanente Impact. Like the many wellness resources that you’ll read about, this e-magazine’s goal is to deepen our community of practice so we can all connect and thrive, making WPMG the best place not just to get care, but to give care.

Permanente Impact Spring 2021 Letter from the CEO COVID-19 Progress Intro to Wellness Efficacy of Practice A Culture of Wellness Personal Resilience Wellness Resources Letter from the CFO



Why clinician wellness?

Table of contents

4-5 6 7 8-9 10 11 12

EID Progress




WPMG University


On the cover Many thanks to Adrianne Wesol, MD, for sharing a look at her gardening hobby with us as an example of wellness. As WPMG’s medical director for patient safety, she reviews our patient safety practices to ensure we have the tools and resources we need to deliver safe care to our patients during every interaction.

All my best,

Paul Minardi, MD President and Chief Executive Officer



COVID-19 Progress

COVID-19 Progress

Progress in the pandemic

Aiming for equity in vaccine distribution

Over the last year, we’ve tested more than 183,000 members, treated those in need, and

As COVID-19 continues to evolve, so do our efforts to equitably distribute the vaccine.

delivered more than 141,300 vaccinations to people across the state. Our work in this pandemic is far from done. We’ve gathered a selection of stories that highlight a few of

Using data dashboards, we’re tracking vaccinations through many lenses including race and ethnicity, languages spoken, age, and geographic factors such as the Social Vulnerability Index.

your successes and outline some of our equity efforts. If you’ve not yet volunteered to assist in a vaccination clinic, we invite you to sign up using the links below.

Quick response saved 1,600 doses of COVID-19 vaccine KP Washington COVID-19 Command Center leadership averted the loss of more than 1,600 doses of COVID-19 vaccine in January by reaching out to the local community and identifying health systems that were able to quickly mobilize large-scale vaccine clinics. The team transferred the vaccine and all the necessary supplies to two locations that had the shots in the arms of eager Washingtonians in less than 12 hours; the final dose was given at about 4 a.m. The quick response demonstrates that “we’re a powerful collective of individuals that can change the trajectory of the pandemic together,” says Jennifer Graves, VP, Quality and Safety, and regional chief nursing executive. Read the full story – including the invaluable learnings from the experience – in the Perm Pulse.

KPWA employee receives a Pfizer/BioNTech vaccination at a KPWA vaccine clinic

King County partnership expands vaccination clinic reach KP Washington, in collaboration with the King County Vaccination Partnership Network, launched a new vaccination site at the KPWA Administrative Campus in early March. This additional clinic increases KP Washington’s vaccination reach by serving about 1,000 people every day of operation. “This is the right thing to do for our patients, our staff, and our community,” says Brandy Reed, clinical quality consultant for Primary and Specialty Care. Another collaborative effort is underway with the Washington Office of Superintendent of Public Instruction to provide vaccines across the state to school employees. Read the full story – including safety precautions and volunteer reflections.

Vaccine clinics still need you

KPWA is partnering with South King County and Snohomish County public health entities, which have expertise in engaging with communities in the greatest need through a variety of outreach methods. The Renton Administrative Campus vaccine clinic targets South King County, where the disease burden has been most severe. Public Health Snohomish County is focusing on older adults and those with tech barriers. More equityspecific clinics are on the horizon as conversations with Pierce, Thurston, Kitsap, and Spokane counties continue. We’re also working to increase equity by providing multiple ways for patients to get appropriate information in their own language at vaccine clinics. Materials are currently translated into the top 10 most frequently used languages and translations for the next 10 languages are underway. Live video remote interpreters (VRI) are also available on iPads for members so they can walk through the entire vaccination process with a real person answering questions and guiding their experience.

Clinical and non-clinical staff are still needed for the COVID-19 vaccination clinics. To sign up, go to the vaccine clinic shift schedule to look for open locations and shifts (read descriptions of staff roles) and complete the staff sign-up intake form to be included on the schedule.

Capitol Hill medical staff pack up the vaccine and other supplies before transfer



Mary Wierusz, MD Health & Wellness Lead


y passion for wellness comes from previous experience receiving care and my drive to build a sustainable practice for myself and my colleagues—all of you. As a mid-career physician, many of you are now like family—I’ve known some of you since residency, medical school, and even college. We studied for the MCATs together, shared an anatomy lab cadaver, traveled the world, and supported each other through life’s biggest moments. Now, you care for my children, elderly parents, extended family—and you care for me.


Medical Informatics: Increase your efficiency Medical Informatics is a team of clinicians who support their colleagues in becoming more efficient and effective in the way they use medical technology. The result is better patient care and more clinician satisfaction. In 2020, Informatics Champions provided more than 297 consultations—and feedback showed 80% of those who participated felt they could save over 5 minutes an hour using the skills they learned.

What I want for all of us is a meaningful, sustainable practice—the kind we envisioned as idealistic trainees. That’s why I’m proud to lead WPMG’s Health & Wellness program. Together with Trisha Harris, Training & Development Specialist, I’m working to ensure that the Health & Wellness program addresses our biggest wellness challenges—the cultural and systemic changes that must happen at an organizational level. I feel obligated and privileged to help WPMG embed wellness and belonging into our culture.

You, too, can gain back time by scheduling a 1:1 efficiency consultation with an Informatics Champion from your region in either specialty or primary care. Or consider taking the Pathway to Proficiency (P2P) course. Either alternative will help you optimize and personalize your HealthConnect experience, with hands-on time and support to build key tools into your current clinical workflow. Both options are CME eligible.

To focus our work, we use the Stanford WellMD Professional Fulfillment Model. This robust model balances a culture of wellness with practice efficiency and personal resilience, while addressing the larger systemic issues that enhance alignment and work-life integration. We know that to be the best place to get care, we must be the best place to give care.

Soon surgeons, anesthesiologists, and proceduralists will be able to register for HealthConnect “OpTime”. This new Medical Informatics course integrates perioperative documentation across the organization.

We hope you find the following pages on WPMG’s Health & Wellness program both inspiring and useful. 6


ith the right workplace systems, processes, and practices, we can promote safety, quality, effectiveness, and positive patient and colleague interactions. The result is better work-life balance that benefits everyone.

Whatever your comfort level with medical technology, Andrew DerksenSchrock, MD, Informatics Primary Care Lead, has a few tips to help you be more efficient and effective:

Intro to

It was a great class, one of the best. I think I’ll take it annually! – Erica Bottai, PA-C Family Practice

• • • • •

Notice what disrupts your daily flow and address those issues Use QuickActions to manage InBasket items with fewer clicks Use Speed Buttons for progress notes and patient instructions Expand shorthand text with User Dictionary Use the Preference List and Order Panels to have orders appear individually or in groups without having to add or edit items



orming a culture of wellness means identifying and supporting shared values, behaviors, and leadership qualities that prioritize personal and professional growth, community, and compassion for self and others. To truly move the needle toward wellness, we must continually and consistently tackle systemic boulders. While we keep an eye on the big goals, we also know that many small things done simultaneously can improve your workday.


Open mics and open minds Speaking up isn’t always easy and we’re grateful to all those who continue to use their voices to support the health and wellness of our community of practice by showing up at Open Mic, our virtual rounding initiative. Open Mic is proving to be a valuable way for us to hear and understand your concerns at the local level and help resolve them. Some of the important issues you surfaced include: •

Before COVID-19 admissions peaked last year, hospitalists at multiple sites recommended preparing for a fall surge. Their voices helped us be more efficient, respond thoughtfully to increased admissions, and responsibly manage our resources. Clinicians in Spokane shared complications faced by some of their Idaho patients who travel to Washington for KP care. Drs. Ward and Minardi worked together to obtain emergency licenses for Spokane clinicians from the Idaho Medical Board in 24 hours. Clinical staffing challenges are mentioned more than any other issue at Open Mic. In response, Dr. Minardi is working with KFHP to report staffing issues more transparently through a new dashboard for vacancies, recruitment, and fill rate.

Throughout 2020, about a thousand of our WPMG coworkers spoke up through our three primary bi-directional communication platforms: Talk to Paul, Permanente Voice Box (anonymous), and Open Mic. Together, your opinions and insights helped form our 2021 work plan. Please continue speaking up. Your questions and concerns help to make our community of practice stronger and healthier. 8

My story of well-being Helen Shaha, MD Family Medicine

WPMG’s Well-Being Program is like that tool in your back pocket you didn’t know you needed. Now that I’m connected, just knowing it’s available helps keep the anxiety away. You know someone’s there for you. I first learned about program during my onboarding in 2010. Since I’ve always had some anxiety and germophobia—you can imagine I struggled at the beginning of the pandemic—I recently needed to use it. Anxiety can be debilitating. In spring, 2020, I reached out, got a call back that same day, and was set up with someone in the area—although with the pandemic, all visits are video. I had six of those video visits over the next couple of months, which proved incredibly helpful by normalizing my experience through conversation. The well-being team meets you where you are, in whatever space you need them to be in, formal or informal. Talking and good questions can lead to a mindset shift—it’s cognitive behavioral therapy. It can be just a conversation—but then you feel better. They helped me learn to rethink and reframe how to do things and ‘organize my anxiety’—really, how to better organize my day. We did some breathing exercises but there wasn’t any ‘homework.’ Later in the fall, when I struggled more generally with the state of the world, I reached out again and

I was able to boost my wellbeing with a phone conversation. I learned a couple of little things to reframe my viewpoint, like changing my expectations, focusing on what’s livable and decent, and being more mindful of my own thinking patterns. It helped me get back to doing what I need to do. Now when I need a “tune up” I know who to call, which is very reassuring. Key wellness definitions Burnout: Emotional exhaustion, depersonalization, and low sense of personal accomplishment Resilience: Ability to recover and bounce back from adversity—an early warning system for burnout; includes activation and decompression Engagement: Emotional attachment and commitment to an organization Alignment: The extent to which clinicians feel a strong connection with leadership and a shared vision to execute the mission and vision 9


hile organizational wellness requires ongoing systemic change, developing personal resilience is a valuable contribution to growing a healthy community. The individual skills, behaviors, and attitudes that contribute to physical, emotional, and professional well-being are vital not just for the well-being of individuals but for the health of the collective.



Personal resilience: What wellness means to me

WPMG’s Well-Being program The WPMG Well-Being program provides services and resources to help you manage demanding responsibilities, whether its finding the right support for personal or professional concerns, or accessing your own inner wisdom. The program is confidential and voluntary and is part of your benefit package.

Emily Prazak, MD

Family Medicine: Mindfulness

I loved the Mindfulness-based Stress Reduction (MSBR) class. I signed up to get an extra tool in my toolbox to help with the stressors of being a primary care doctor. Having never done formal meditation, I was skeptical going in, but then loved the class and looked forward to Tuesday nights immensely. Because this was during the pandemic, class was held via Zoom—and I was pleasantly surprised by how much of a community we were able to develop. Three months after the class, I still meditate most days before clinic; I find it very centering and helpful through the day. 10

Birgit Grimlund, MD Family Medicine: LitMed

I’ve always loved reading and thought a structured group might help me read more regularly when immediate tasks seem to take precedence over reading. Although the impact wasn’t immediate, reflecting on 2 years of attending LitMed workshops (in-person and now virtually), I realize how they’ve helped me focus on purpose and meaning in medicine. The wisdom of so many others—both the authors we’ve read and my KP colleagues—helps me access the big picture view more frequently and move beyond daily frustrations and constant time pressure. It’s not a panacea but it’s one way I’ve kept medicine purposeful for myself.

Practice efficiency resources

Alvin Cabrera, MD

Radiation Oncology: LitMed

Medicine is full of meaning, but sometimes, as we run from patient room to patient room, we forget the meaning underlying the work we do. I joined LitMed to have a more disciplined way to reconnect with meaning in medicine through literature and community. It has been a privilege to get to know more of my colleagues in this setting. We have so many wonderful providers at Kaiser Permanente, and as I’ve gotten to know more people across multiple specialties, I’ve become only more impressed at the breadth and depth of talent and thought in our medical group.

• • •

Addressing burnout WPMG leadership knows the scope of burnout and that it’s a crisis issue, especially for women and especially since the pandemic began. We’re dedicated to establishing clear definitions and a shared agreement about the causes of burnout so that we can make progress together. We must address burnout broadly without pointing to personal resilience as the only antidote. This recent study about women physician runners emphasizes the need for better work-life integration because individual self-care and exercise often aren’t enough to avoid burnout.

Informatics resources: chair-sides, classes (Pathway to Proficiency) WPMG U: education for leaders and frontline about wellness, burnout, and leadership American Conference on Physician Health/ International Conference on Physician Health participation: resources and networking about the latest research and innovations about systemic and organizational programs that influence wellness

Personal resilience resources • •

WPMG’s Well-Being program (includes ComPsych Guidance Resources) Virtual Wellness Series (meditation, Literature & Medicine, Narrative Medicine, Balint, Medical Improv); MBSR /Mindfulness for Healthcare Professionals with Mindfulness Northwest, offered twice yearly in 2021 Physical health: Peloton, Calm app 11

Letter from the CFO

EID Progress Each region is facing its own financial pressures, and each is working to create affordability through quality care. Quality is our True North and is the hallmark of Permanente Medicine. We must—and we will—provide access to medical excellence at a price that is affordable. In the Washington region, 2021 started with membership shortfalls. To meet our financial obligations, we need to identify between $60M to $100M in additional savings opportunities this year. Our Path to Profitability begins with Permanente Medicine at the forefront of our strategies. Whether it’s internalization of surgical services, infusion, medical specialties, or inpatient care, our goal is to bring more patients to our internal delivery system where we have the means to deliver care that creates quality outcomes.

How profitability paves the way to affordable, accessible medical excellence As a finance leader I’m often asked why Kaiser Permanente, as a non-profit, needs to generate a profit margin. The answer is all around us. When we have money above and beyond meeting our expenses, we can build surgical centers and expand medical offices. We use it to invest in our IT systems, and we give back to our communities through our community health efforts (eg safety net funding for the COVID-19 vaccine, Equity Institute impact, and supporting 11 FQHCs). Since becoming part of KP in 2017, KPWA has been incurring planned losses. This was intentional because we were a new region that needed to invest in buildings, clinical programs, and the capabilities to bring more members into our internal delivery system. Now is our time to fully utilize the investments that we’ve made over the last four years and increase the pace of our Path to Profitability. Each of our fellow KP regions is on the same path, sharing similar pressures: economic shifts, aggressive competitors, and numerous legislative changes.

In parallel, we’re using technology to provide more choices for patients to receive care from us, like CareChat, Telederm, and OnDemand Video. Creating sustainable and efficient practices for our clinicians also supports affordability. That’s why improvements in back office support will continue this year, including tools and training to improve workflows. Every member deserves the quality and excellence that you are working so hard to create. We must get our care and our costs within reach of those who need us most. In my time here I have seen your ability to embrace change and engage in innovative thinking despite the challenges of a pandemic. It hasn’t been easy, but your resilience is undeniable. A million thanks to those of you who have worked in vaccine clinics or have gone the extra mile to help Southern California KP colleagues in their time of need. This is the time when we all come together to meet the needs of our members and our teams. With admiration,

Equity, Inclusion & Diversity: What’s next Equity, inclusion, and diversity is integral to our organizational wellness. To foster our continued growth and build on the changes and challenges we addressed in 2020, the EID team is working with leadership to actively remove barriers to full inclusion in our programs and practices. We know that diverse organizations are more successful, and that people are happier when they’re valued for who they are, feel like they belong, can safely speak up, and use their strengths to fulfill their professional goals. Here’s what we’re working on: •

• Cindi Johnson CFO, VP of Strategy, interim COO • •


Piloting a Racial Equity Communications Toolkit to support you when you experience racist, sexist, homophobic, or other offenses from patients or colleagues. These interactions can be hurtful, stressful, and demoralizing. Being prepared with language to engage in those difficult interactions can be helpful; this toolkit will help. Developing an incident reporting tool to be used for incidents of harassment, bias, unfair treatment, or to share any concerns you may have at work. The tool will allow for confidential reporting with the option to be anonymous. Because it can be difficult to speak up, we know it’s essential that you have a safe place to share your experience. Better understanding the stratified data to reveal disparities by race, ethnicity, language, and other factors beyond the current metrics we measure. These data filters are being embedded in dashboards across care delivery. Creating a new Labor Management Partnership Equity Committee. This new committee brings WPMG together with Kaiser Foundation Health Plan’s represented and non-represented staff to make meaningful change within the organization, fostering a culture of inclusion. Launching Belong@KP, a new program, in partnership with KP National. Belong@KP is a required new transformative program to help individuals be more inclusive and combat racism. We’ll learn to recognize our own biases in thinking and actions, cultivate belonging, and gain tools to be more inclusive. This program will guide us as we delve deep to re-imagine policies, practices, and processes—including hiring and retention. Hosting a second listening session in early April to gain your insights on how to live our equity value and use it to transparently make decisions. (The first was held during Wellness Week; thanks to those who participated.) 13

WPMG University


WPMG University

WPMG Board of Directors establishes new Equity Governance Collaborative Last year, the WPMG Board solicited broad internal feedback, seeking input on how to address racism and health inequities throughout our organization. This feedback, coupled with listening sessions and health disparity data, led to a strategic plan outlining our path to becoming an anti-racist organization. We’ve created a board committee to focus specifically on this work: The Board Equity Governance Collaborative (EGC).

Grace Kim, MD Board Member

Jenny Pang, MD BOD Committee Rep.

Sarah Philp, MD Board Member

Deb Gore, MD Board Member

All WPMG clinicians are leaders in patient care. Grow your communication and leadership skills through interactive courses alongside clinician colleagues at upcoming courses this summer and fall. • • •

Foundational Leadership Series – Calling all new and future leaders! Join us for two half-day sessions covering leadership essentials including decision making, running meetings and inclusivity. Coaching for Success – Coaching is a powerful way to empower others around you whether you are a formal or informal leader. Learn key coaching skills and have time to practice them with colleagues. Leveraging Feedback for Success – We receive feedback all the time, but it can be challenging to sort through critical or challenging feedback. In this short course we’ll dive into the latest research on feedback, plus practical tools for receiving and responding to feedback. Find these and many more programs at WPMG University.

Ali Thomas, MD, MPH Pipeline Medical Director

Mabel Bongmba, MD EID Rep

Dalph Watson VP, Human Resources

Paula Lozano, MD BRG Executive Sponsor

The board approved the EGC at the January board meeting, with 8 representatives and members (pictured above). The EGC kicks off in April and expects to recruit at-large members in late spring from both clinical and administrative teams. This is the first time a board committee will include members from our greater community and we invite you to watch for that announcement and consider joining us.



A Publication of Washington Permanente Medical Group

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