Over the course of the last 2 years, 4 center has focused on creating a culture of patient centered care. We developed a caritas plan that encouraged all members of our team to engage in the process of being authentically present and using every part of who we are as caregivers to create a caring environment. We are trying to establish a lasting ethic that allows us incorporate our caritas principles into our patient care experience (HCAHPS).

1. Kaiser Permanente, Northern California
Caritas Consortium 2013
Bring the Team to the Core: Establishing an Ethic to Incorporate
Caritas into our Patient Care Experience
Caritas in Action
How Caring Science informs and inspires KP caregivers and affirms our commitment to provide our
patients and their families exceptional care

2. Bring the Team to the Core: Establishing an Ethic to
Incorporate Caritas into our Patient Care Experience
Intent to Contribute Statement:
Over the course of the last 2 years, 4 center has focused on creating a culture of patient centered care. We
developed a caritas plan that encouraged all members of our team to engage in the process of being authentically
present and using every part of who we are as caregivers to create a caring environment. We started paying
attention to the little things. Our unit leaders were focused on encouraging the frontline staff to take ownership of
the caritas plan. Our caritas champions set examples by celebrating the lives, interests and health of our patients.
The only problem = we weren’t getting consistent HCAHPS scores … We saw a large number of survey respondents
who rated our unit 8! We knew that people were satisfied with their care, but it wasn’t translating on our scorecard.
8 out of 10 should be flattering right? It was flattering to us! It’s was unflattering to our scores. The good news = we
realize that establishing a culture is a long process. 4 Center is not interested in rushing for results. If we rush and
introduce before assessing the potential outcomes, we may sacrifice the quality of our efforts. We are trying to
establish a lasting ethic that allows us incorporate our caritas principles into our patient care experience (HCAHPS).
We want to merry the two so that we can care for the patient as a whole and improve our scores without neglecting
one or the other. Our concept: Bring The Team To The Core

3. Bring the Team to the Core: Establishing an Ethic to
Incorporate Caritas into our Patient Care Experience
… Continued
1) Initiate a front line culture that enables our staff to care for patients using their whole and authentic selves. We
spent almost 2 years doing this and presented at the last consortium with this concept.
2) Develop a culture within our unit leadership team that exhibits the following principles:
a) Open mindedness - Without open minds, we may be inhibiting our staffs desire to act naturally or raise crucial
concerns.
b) Open Doors - Keeping the “doors open” is a metaphoric example of how leaders should be available to staff always! Nothing says “I care” more than absolute presence. The idea is that leadership visibility creates a more
cohesive team and a cohesive team is better equipped to care for patients!
3) Identify the areas of the patient care experience that can be married to some caritas principles. The hospital is a
busy place and it can become overwhelming when you consider the multitude of responsibilities we all have. We felt
like these 2 areas are equal parts of a coin: On one side are the tangible aspects of our care experience actions like
hourly rounding and sending thank you cards and the other side is depicted by the way in which we perform these
activities.
4) Maintain the things that are working and modify/change/erase the things that don’t. As a unit, we look at the
scores and celebrate our successes.

4. Bring the Team to the Core: Establishing an Ethic to
Incorporate Caritas into our Patient Care Experience
… Continued
We want to know what our HCAHPS scores look like and we want to discuss our strengths and weaknesses in
relation to the score. Unit leaders are giving staff surveys and encouraging use of the anonymous suggestion box.
Unit leaders meet frequently to address each other’s concerns as well. There should be an ongoing dialog about the
things we do right and the things that need change. This is the dialog that writes the cultural rules of our unit. The
idea is to treat the concerns of everyone involved in patient care equally. How does the concept look?
1) We developed a culture that affirms patient centered in approximately 2 years
2) Unit leaders openly acknowledge faults and huddle with staff that there is no retaliation for expressing ideas for
change or to enhance unit leadership performance. This is ongoing . We want to use positive language and become
less punitive and more constructive
3) Align / combine the concepts of patient care experience and Caritas principles to improve HCAHPS. We are using
HCAHPS as a way to quantify the more expressive caritas concepts. Patient care and experience is enhanced through
consistent and diligent care details. These details start with the moment a patient arrives on the unit. Nursing staff
should be warm and welcoming. The care givers should be consistent because authenticity comes from building
relationships. We make consistent staff assignments. We assign our ANM’s to round on, send thank you cards, and
make phone calls to the same patients every day and every time. We are attentive to any special requests or needs
a patient or their family have.

5. Bring the Team to the Core: Establishing an Ethic to
Incorporate Caritas into our Patient Care Experience
… Continued
We have formed two committees within our unit council that focus on the patient care experience. It is basic
because we have made it a priority to deliver consistently. 4 Center has been in the green (HCAHPS score above
target) for 5 months straight. We plan on developing a special requests team who will be responsible for obtaining or
creating unique moments for patients. This will be in addition to everything mentioned above. We want to be
creative and find interesting ways to show our patients that they are in our thoughts. As our HCAHPS scores have
shown it is not one big thing that makes a difference, it’s all the little things.
4) We are maintaining all of this through frequent huddle/feedback conversations, HCAHPS, and peoples pulse. As
mentioned above, this has to become an ethic in order to work.
5) We don’t rush things. We are striving for a quality of outcomes and are willing to sacrifice quick results for
sustainability.
Page 5

6. Bring the Team to the Core: Establishing an Ethic to
Incorporate Caritas into our Patient Care Experience
Inspired Contributor(s) 1 :

Bryce Albright

Michelle Gail Cusi

Jed Rigor
-----Service Area: San Francisco
Medical Center: SFO
Affiliation: PCS
-----Year Shared: 2013
Venue: Caritas Consortium
Format: PowerPoint
ID #: n/a
1
Names as listed in Lotus Notes, otherwise personal e-mails indicated
Page 6
Keyword TAGs:
Identifier
 Consortium2013-July, San
Francisco, Podium, Patient Care
Services
 Hospital Initiatives, Culture,
Caritas Leadership, Team,
Patients/Families
Descriptor
 Workflow, HCAHPS, Rounding

7. Page 7

8. Ethic:
RATIONAL, OPTIMAL AND APPROPRIATE DECISIONS MADE
ON THE BASIS OF COMMON SENSE. THE BEST SOLUTION
OF THE GIVEN OPTIONS…
CULTURE: The way we do things

9. HCAHPS
(JAN. 2010 –JAN.
2012)
65%= OUR OVERALL
RATING BEFORE
LAUNCHING OUR
INITIATIVES

10. We wanted to do better

11. 2 years ago
we came up
with a
concept to
create a
patient
centered
culture.
The idea was to infuse teamwork into
our culture, WHICH WOULD RESULT IN
better PATIENT CARE.

12. WE DRAFTED 4 CENTER’S FIRST MISSION
STATEMENT AND CREATED A SLOGAN THAT
EXEMPLIFIES TEAM WORK…

13. We divided hourly rounding

14. We focused on call light responsiveness..
In July of 2012, we started thinking about ways to answer
call lights more efficiently. We were able to get an average
time of 9 seconds. The rule: Call lights are everyone's
responsibility!
Staff responsiveness scores creeping
up…

15. We kept consistent break relievers
In order to provide the
best care possible, we kept
consistent break relievers .
We wanted our break staff
to be friendly, clinically
strong, and competent in
the role. We chose nurses
who were excellent team
players because we
wanted to distribute the
team energy across the
widest field.
Consistency breeds
mastery !

16. THE PATIENTS NOTICED!
2 of those break relief nurses won
the daisy award in the same month!

17. HCAHPS (JAN. 2012 – OCT.
2012)
72%
OUR OVERALL
RATING AFTER INITIATING A
TEAM FOCUSED CULTURE
=

18. 18% OF OUR SCORES WERE 8’S
8=0
WE WANT OUR PATIENTS TO
LOVE THE CARE WE GIVE! 8 IS
AN AWESOME SCORE AND WE
ARE FLATTERED! WE WANTED
TO DO BETTER…

19. 10%=less
than 8
18%=8’s
72% = 9’s
and 10’s

20. 10%=7or less
18%=8’s
72% = 9’s
and 10’s

21. OPEN MINDS – OPEN DOORS

22. Visibility is a staple

23. Consistent Personalized Relationships

24. HCAHPS(OCT.2012– APRIL. 2013)
82%
OUR OVERALL
RATING SINCE INITIATING A
TEAM FOCUSED CULTURE
=

25. HCAHPS
FROM 65% TO 82%
=
17% INCREASE
OVER 2 YEARS

26. OUR CARING INITIATIVES HAVE BROUGHT
ABOUT SOME MAINTAINABLE CHANGES.

27. The use of word cloud to understand the values of
our patient population

28. Share file: Fingertips
4
2

29. Creating a unit vision