Presentation given to the Kaiser Permanente Labor Management Partnership all hands meeting, December 2, 2014, in San Francisco, California. "The Labor Management Partnership (LMP) is the largest and longest-lasting partnership of its kind in the country. Created in 1997, it is based on a series of agreements between the Coalition of Kaiser Permanente Unions, made up of 27 union locals, Kaiser Permanente and the Permanente medical groups in each region. Today, it covers almost 100,000 union members and tens of thousands of managers and physicians."

1. #transformKP: Total Health and Social Innovation
Labor-Management Partnership all-hands
December 2, 2014 • San Francisco, CA USA
Ted Eytan, MD, MS, MPH • The Permanente Federation, LLC • @tedeytan
© 2014 The Permanente Federation, LLC
Photo: Ted Eytan : http://www.flickr.com/photos/22526649@N03/15038274933

2. Disclosure & Language
Disclosure
– I  Kaiser Permanente!
– Personality type: amiable/amiable
Language
– From “frontline”
– To: “member facing”
– Avoid “trenches,” “triage”
– We are at peace with our members
“Double Rainbow”
Medicine and Management, Colorado Springs, July, 2012
Photo: Dina Piccoli, The Permanente Federation

3. Hi. I’m Ted.
I’m a social innovator
(also a family doctor,
a Permanente physician,
a Kaiser Permanente member,
a Washington, DC resident)
Build Your Best Life Total Health Festival, with Capital Pride, Washington, DC • Kaiser Permanente 2014 Gold Sponsor

4. Health Activist
Advocate
Catalyst
Change agent
Agitator
purple heart!
“Out there”
Humanist
Kristin Beck, Northern Virgina LGBTQ Pride, October 5, 2014
photo: m.v. jantzen: https://flic.kr/p/pxpr2D

5. We’re from the future
Keith Montgomery, Yen Greene, Erin Meade
Kaiser Permanente Center for Total Health, Washington, DC • @KPTotalHealth
photo: Ted Eytan, http://www.flickr.com/photos/22526649@N03/13855285073

6. We’re from the future
Louise (Lu) Casa, MSN, CRNP, CTTS
Kaiser Permanente Capitol Hill Medical Center • @KPMidAtlantic

7. …so are you
Real Life Rosie the Riveters, Yen Greene, Keith Montgomery, Karen Blair (foreground)
Center for Total Health, Washington, DC, April 1, 2014
Photo: Erin Meade • https://www.flickr.com/photos/taedc/13568895794

8. Real Life Rosie the Riveters
Center for Total Health, Washington, DC, April 1, 2014
Photo: Ted Eytan • https://flic.kr/p/mF37b3

10. #activetransportation
Source: Ted Eytan, MD, Star Magazine,September 23, 2013, Partnership for Active Transportation
New York Citibike; Jeff Olson, Founder Alta Bikeshare
New York City and Center for Total Health, Washington, DC, March 6, 2014
Photos: Ted Eytan (L and R only)

11. End of WW II
Great Depression
1st Surgeon
General’s report
Annual Adult per Capita Cigarette Consumption and
Major Smoking and Health Events – US 1900-1998
1st smoking
cancer concern
Year
Thousands per year
Broadcast advertising ban
Nicotine medications
Available over
the counter
Surgeon
General’s
report on
environmental
Tobacco smoke
Federal cigarette
tax doubles
Fairness
Doctrine
messages on
TV and radio
Nonsmoker’s
rights
movement
begins
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990
Master
settlement
agreement
1st World Conference
on smoking and health
1998
1st Great
American smokeout
Is this our our generation’s 1968?
Source: http://www.iom.edu/~/media/Files/Activity%20Files/Nutrition/Obesity-Roundtable/1_Dietz.pdf

12. Source: Bikesharing Trip Visualizer: http://mvjantzen.com/tools/visualizer/

13. Source: Bikesharing Trip Visualizer: http://mvjantzen.com/tools/visualizer/

14. © 2012 The Permanente Source: Commun Fietdyera Htione, aLLlCth Needs Assessment http://chna.org

15. Candlelight vigil for Marion Barry, Jr., Anacostia, Washington, DC, November 23, 2014
Photo: Ted Eytan, http://www.flickr.com/photos/22526649@N03/15678160529

16. KP Mid-Atlantic States HR all-hands
Center for Total Health, Washington, DC, July 10, 2014
Photo: Ted Eytan • https://www.flickr.com/photos/22526649@N03/14468838850

17. National Health IT Collaborative for the Underserved
Center for Total Health, Washington, DC, September 17, 2014
Photo: Ted Eytan • https://www.flickr.com/photos/22526649@N03/15111579629

19. The secret: Leadership
Mary Gonzalez, Kaiser Permanente Care Stories Blog: http://kp.org/carestories

20. The secret: Leadership
Susan, Kaiser Permanente Center for Total Health Digital Display

21. Social Innovation
“Saving Lives: One at a Time”
Kaiser Permanente Regional Headquarters, Pasadena, CA USA • March 30, 2011

22. The secret: Leadership
John August, Kaiser Permanente Center for Total Health Digital Display

23. Innovation System: Kaiser Permanente
social
innovation

24. Garfield Center: Ideate and Test
The Conference Board Council on Innovation
Garfield Innovation Center, San Leandro, CA, September 22, 2014

25. Center for Total Health: Social Innovation
Walk with a Doc, Bike with a Doc
Center for Total Health, Washington, DC, February 8, 2013
photo: Ted Eytan, http://www.flickr.com/photos/22526649@N03/8457305113

26. Center for Total Health: Social Innovation
Generation Y “UnFocus” Group : Jennifer Liebermann, Ashley Brown, Emelina Choi
Center for Total Health, Washington, DC, September 25, 2014
photo: Ted Eytan

27. …and some ideation :)
Wearables in Health Care Design Sprint
Center for Total Health, Washington, DC, October 17, 2014
photo: Ted Eytan, http://www.flickr.com/photos/22526649@N03/15373453770

28. “Vast amounts of money are
spent by business on
innovation to meet both real
and imagined consumer
demands … but far less to
more systematically develop
innovative solutions to
common needs.”
Involves the “bees and the
trees”
Businessweek, November 2014
Social Innovation
Mulgan G, Tucker S, Ali R, Sanders B. Social innovation: what it
is, why it matters & how it can be accelerated.; 2007. Available
at: http://www.sbs.ox.ac.uk/ideas-impact/skoll/research/social-innovation-
reports-resources/social-innovation-what-it-why-it-matters-
how-it-can-be-accelerated;

29. Characteristics: “sheer persistence,
a kind of benign ruthlessness,
clutching onto an idea beyond the
bitter end, always taking no as a
question.”
Enter Harry Bridges: “It was a
marriage with great potential. Bridges
needed a health plan for his
members and Henry Kaiser needed
health plan members. Instant
symbiosis.”
Social Innovators
Harry Bridges: Young Seaman
https://depts.washington.edu/labpics2/repository/main.php?g2_itemId=5081; Social
innovation: What it is, Why it matters and how it can be accelerated; Mulgan G, Tucker S,
Ali R, Sanders B. Social innovation: what it is, why it matters & how it can be accelerated.;
2007. Available at: http://www.sbs.ox.ac.uk/ideas-impact/skoll/research/social-innovation-reports-
resources/social-innovation-what-it-why-it-matters-how-it-can-be-accelerated;
http://kaiserpermanentehistory.org/latest/harry-bridges-and-sidney-garfield-synergistic-collaboration/

30. Desert Center, 1933
#transformKP: Total Health and Social Innovation
Labor-Management Partnership all-hands
December 2, 2014 • San Francisco, CA USA
Ted Eytan, MD, MS, MPH • The Permanente Federation, LLC • @tedeytan
When any human being is hurt, or sick and full of toxins and down
with energy at ebb tide - then of all times the surroundings should
be most beautiful, most gentle.” - Sidney Garfield, MD
© 2014 The Permanente Federation, LLC

31. Washington, 2014

32. San Leandro, 2015
Future gender neutral restroom
Garfield Innovation Center, San Leandro, CA, September 22, 2014
photo: Ted Eytan, http://www.flickr.com/photos/22526649@N03/15144080399, https://
twitter.com/DCHumanRights/status/481816762355564544

33. #KPLantern2015 : Innovation Consultancy
Kaiser Permanente Permanente Executive Leadership Summit, Dana Point, California, June, 2014
Photo: Ted Eytan, https://www.flickr.com/photos/taedc/14205479277

34. Listening/Empathy
University of Arizona College of Medicine 1967, 2014
Images courtesy University of Arizona Health Sciences Library

35. “As gay young people, we are marginalized. As young people who are HIV-positive
and have AIDS, we are totally written off.” – Pedro Zamora, 1972 -1994

36. Failure to Listen
“I am comparing the current
situation to that we faced 15 years
ago when we addressed HIV. If we
look back at how we initially handled
the issue, we would be
embarrassed.”
- Ingrid Hoven, Executive Director, World
Bank, Germany, 2014
Source: http://habdessamad.com/2014/04/08/wbg/

37. Listening saves lives
http://www.midstaffs.nhs.uk, April, 2013

38. Listening saves lives
http://www.midstaffs.nhs.uk, December 2014

39. http://www.mirror.co.uk/news/uk-news/stafford-hospital-1200-patients-died-1589186, http://www.dailymail.co.uk/news/
article-1253438/Mid-Staffordshire-NHS-hospital-routinely-neglected-patients.html

40. Listening: Just 6 more seconds needed
length of time before
patients were interrupted by
their physician
“…asking “Anything else?”
repeatedly until a complete
agenda has been identified
appears to take 6 seconds
longer than interviews in
which the patient’s agenda
is interrupted.”
study year
Sources: Beckman, HB The Effect of Physician Behavior on the Collection of Data. Ann. Intern. Med. 1984;101(5):692. Available at:
http://annals.org/article.aspx?articleid=699136 [Accessed November 18, 2014]; 1. Marvel MK, Epstein RM, Flowers K, Beckman HB.
Soliciting the Patient’s Agenda: Have We Improved? Jama. 1999;281(3):283–287. Available at: http://jama.ama-assn.org/cgi/content/
abstract/281/3/283.

41. Listen
Kaiser Permanente Innovation Retreat, Denver, CO, May 30, 2013
Photo: Barry Gutierrez, http://www.flickr.com/photos/22526649@N03/8953724015

42. Another Great Susan (Mahler, Ph.D)
Source: http://youtu.be/oJZZDPjXfxM

43. Another Great Susan (Mahler, Ph.D)
“I felt in my heart that there could
be a school without a principal and
support staff - there could never be
a school without a teacher.
However, while saying that............ I
felt my role and the role of the
support staff was to enhance,
inspire, support those teachers in
every single way possible. Only
then can the child be the winner.
In your health world - the
physicians and nurses are the most
critical variables...........thus making
the patient the winner.” - 11/13/14
Personal Communication, November 13, 2014
Blog post: Ted Eytan, http://www.tedeytan.com/2014/08/13/17683

44. Listen
Shadowing Abtin (“Abi”) Foroohar, MD, Kaiser Permanente South Bay Medical Center, June 26, 2014
Photo: Ted Eytan, http://www.flickr.com/photos/22526649@N03/14546602059

45. Listen
Shadowing Elsa Torres, Kaiser Permanente Barranca Medical Office, March 28, 2011
Photo: Ted Eytan

46. Listen Sos Mboijana, MD and Yoalanda, Eliminating Health Disparities
Center for Total Health, Washington, DC, November 19, 2014
Photo: Ted Eytan, http://www.flickr.com/photos/22526649@N03/15829430435

47. Listen to eliminate bias
Question assumptions: The Illusion of objectivity
Create: The “tell me more” culture
Kaiser Permanente Los Angeles Medical Center, May 2, 2014
Photos: Ted Eytan, http://www.flickr.com/photos/22526649@N03/14088671614

48. A world learning to love better
University of Central Florida School of Medicine, Lake Nona Medical City, FL, July 31, 2013
Photo: Ted Eytan, http://www.flickr.com/photos/22526649@N03/9415091583

49. Leverage contagion
http://instagram.com/p/t08v17OPno/?modal=true

50. Integrate compassion
Hug Timer & Hug Tour
Kaiser Permanente Capitol Hill Medical Center;
Center for Total Health, 2011-2014

51. Love People
Ruby Jade Corado and Mayor Vince Gray, Corado-Walker Wedding, Washington, DC, October 18, 2014
Photo: Ted Eytan, http://www.flickr.com/photos/22526649@N03/15392978950

52. Follow the leaders
with Kapriece Williams, Corado-Walker Wedding, Washington, DC, October 18, 2014
Photo: Lane Hudson, http://www.flickr.com/photos/22526649@N03/15392654087

53. “Crisis of Faith” - All in the Family (CBS)
“Edith’s Crisis of Faith,” All in the Family, air date 12/25/1977
https://www.youtube.com/watch?v=xDY_S8YO5QY

54. “Breckin and Jeff” - Undercover Boss (CBS)
Source: https://www.youtube.com/watch?v=44ghpWc5qrI (air date 3/15/2014)

55. Listening • Involvement • Inclusion • Innovation
“American mothers and
sisters, like these
women at the Douglas
Aircraft Company, give
important help in
producing dependable
planes for their men at
the front, Long Beach,
Calif.”
Source: http://www.flickr.com/photos/
library_of_congress/2179921774/in/
set-72157603671370361/

56. We’re from from the future
Thank you.
Kaiser Permanente Center for Total Health,Washington, DC • @KPTotalHealth