Building the case for Prevention through Design presentation--Kaiser Permanente.

Good afternoon. When I see all of these engineers, architects, etc., who manage their process so carefully, then compare it to health care, our industry seems to be a lot more chaotic. I will give you a little background on our scale. We operate in nine states and the District of Columbia within eight regions, Northern California, Southern California, Colorado, Georgia, Hawaii, the Mid-Atlantic States, Ohio, and Oregon/Washington. In some regions, Kaiser Permanente (KP) owns and operates hospitals. In others, we work with facilities operated by other organizations. We are investing $24 billion in a capital improvement plan. We are in a current building program where the 2,700 people in my group are managing billions of dollars in projects, and we try to design these projects from the standpoint of safety. We are very serious about our designs. We actually talk to architects, frontline workers, infection control personnel, and safety people. We conduct in-depth panels of all of the detailed processes of a hospital, and we're trying to incorporate a lot of information into the designs. If you want to design an exam room, our teams go through and see how a room is supposed to work. Then we use that as a model we share with all of our partners. We believe this is rare for health care. We spend a lot of time looking for products that are environment -, patient-, and worker-safe. We try to find the sweet spot in that balance. We're impassioned about worker health and safety because of our history; we were founded as industrial safety advisors for Kaiser Steel. In addition to that, we've been passionate about keeping people at work. They say the difference in our designs is that we focus more on workplace safety than any other health care organization. With our labor management partnership (our working with the unions), one of the main focuses is to make KP a safe place to work. Of the 14 industries with the highest numbers of occupational injuries/illnesses, three are in health care. Hospitals have the greatest number of occupational injuries/illnesses. Nursing and residential care facilities are number two (Bureau of Labor Statistics, 2006). We at KP have a way of thinking about safety by design. One of the interesting things about the health care industry is that you cannot motivate our workers to put their own safety above patient safety. It's a testament to the caliber of people who work in health care, but it also means that a 150 lb. nurse will injure herself trying to stop a 300 lb. patient from falling. You cannot motivate someone in health care to put their safety above the patient safety. And that's all right. We found that if you put the things together in context you can do both. You have to motivate the workers that their health and safety is part of the overall goal of healing. We are motivating people to change processes, equipment, layout, etc., to reduce clinical error; reduce fatigue; reduce infections; reduce slips, trips, and falls; reduce toxic materials; and reduce moving injuries. We try to create a business case for something that reduces injuries. For expensive equipment, such as ceiling lifts installed in patient rooms, getting the business case through was difficult. As we come forward with recommendations like that, we found that if you evaluate all the benefits, the workforce injury reductions can pay for it. For some changes the only way we can come up with the economic argument is to look at benefits to all three groups (patients, employees, and the environment). For instance, using digital radiology rather than the traditional silver film, results in benefits for patients, employees, and the environment. It saves water, it saves money, and it's better for people. The initial costs for implementing digital radiology are high. Computer terminals, imaging equipment, and staff training are expensive, but the long-term savings can justify the initial outlay (Freiherr, 1996). Patients benefit from the elimination of repeat films, which reduces their exposure to and dose of radiation. The radiology technologist becomes more productive and efficient by being able to easily produce a quality film that has optimal contrast and density, includes all anatomical