Taken with total health - a focus on prevention and proactive management

Following on from my visit to the Garfield Innovation Center in Oakland, I was just as lucky to have chance to see the Kaiser Permanente Center for Total Health in Washington last month.

Whereas the Garfield Center had all the feel of a practical 'trying things out' sort of space, with innovations being built and tested in situ, the Kaiser Permanente Center for Total Health was very different. A space for policy makers, the public and health care leaders to imagine a future that puts the maintenance of health ahead of the treatment of disease, the Center showcases, provokes and explains in equal measure. If the concept of ‘total health’ – characterised by a focus on prevention and proactive management – had an quasi-religious feel, the Center was definitely the cathedral!

A large, open, well lit-space, it immediately opened up your mind. An 80 foot long interactive flat screen told the story of Kaiser Permanente (KP) and its achievements and ambitions across the US, not chronologically but geographically, coast to coast, allowing you to stand in front of all the most famous US landmarks!

The Center was populated with a series of interactive demonstrations that either imagined what was possible, showed how current KP services were working to promote health or provided a wealth of talking heads to help you stand in the shoes of members (people who have a health plan with KP) and professionals. Walking around with Ted Eytan (Medical Director of the Center for Total Health) and Suzie Bailey from Monitor felt like being on a cerebral roller coaster. Not just because of Ted’s passion in describing their philosophy and practice, but also because of the sheer quality of the demonstrations. If I was a KP employee or a member, I would really be left feeling that I mattered. Really mattered.

Four things stood out in terms of the KP approach and ambition.

Firstly, their commitment to creating and telling a narrative to engage and explain what they were doing. Improving health was a mission and the energising displays captured both hearts and minds in achieving this. Why doesn't the NHS, an institution that is held up by all as one of the greatest achievements of the 20th century, have places where we can celebrate and explore its purpose and potential?

Next, the principle of understanding people's individual needs and aspirations for their own health. The concept of ‘total health’ is grounded in recognising what is possible for the individual concerned, what matters to them and how KP can support them to achieve it. Throughout the Center, videos of members talking about what health means to them focus the mind on reaching the goal of total health rather than delivering a health care process.

Third is the vision of taking care to the members. Like the Garfield Center, there was an emphasis on providing care where and when people needed it rather than at the convenience of the professionals.

A truly transformational shift has been the introduction of physician to patient email communication. Can you imagine what it would be like if every one of your patients could email you whenever they wanted? The clinicians at KP were equally daunted by the prospect but as near as 100% of the 17,000 physicians and 49,000 nurses now have access to it and 50% of appointments are now ‘virtual’. Clinicians say that this change has increased their job satisfaction, feeling that they are now actually able to help people when they need it.

And lastly, making every contact count. KP see their responsibility as being for the health of the whole person. This means that whoever you are – clinical and non-clinical – when you come into contact with a member you can see information about their health status and service profile. A receptionist in a dermatology department can see whether a woman is due for a mammogram, an orthopaedic surgeon would know if someone smokes. But it isn't just knowing, they all feel a responsibility to act on the information. KP is caring for the whole person, not just a set of disconnected physiological systems.

As I walked round there was something that just felt too good to be true. The energy, the vision and the commitment to health filled the space. Rarely do I come across leaders articulating the same ambition in the NHS. I kept wondering why that was. Why, when we have a system that provides universal and comprehensive coverage, do we so easily forget what a privilege it is?

The next morning, a thought came to me. Kaiser Permanente is founded by very similar principles to the NHS. But it sits in a system where many people are unable to access the same comprehensive care. Where sometimes clinical decision making is driven by profit rather than need. Where the payment system incentivises people to fix poor health care rather than preserve good health. Working in such a system can't be very comfortable.

Perhaps as we travel to work each day in the NHS we should imagine what it would be like if our clinic, our service, our ward was the only one in the locality that was committed to providing comprehensive care. How proud would that make us feel? And how committed to make the maximum difference for patients?

Jo is Director of Strategy at the Health Foundation, www.twitter.com/JoBibbyTHF