Navigating a Changing Continuum of Care With Heart

BACKGROUND: The 2010 Patient Protection and Affordable Care Act (ACA) is the most significant change in healthcare since the implementation of Medicare. In the face of reductions in reimbursement, healthcare organizations are seeking creative ways to reduce the cost of care delivery. The Kaiser Permanente Northern California (KPNC) mission is to provide high-quality, affordable healthcare and to improve the health of the members and the communities it serves. In alignment with this work, KPNC values the importance of excellence in care as well as the nurturing of the mind and spirit. The continuum of care, including home health and hospice services, are at the center of the evolving environment. Uncertainties and fast-paced innovations create tension and stress for home care leaders responsible for responding to and implementing change. Meeting these challenges requires incredible creativity and resilience. The framework that best meets these diverse needs is CaritasHeart.(1) CaritasHeart brings together the philosophy, theory and framework of Watson's Caring Science,(2) the “heart” of Caritas, and the scientifically validated methods of HeartMath.(3) METHODS: To support the cultural change inherent in CaritasHeart, education was provided to management and staff in Caring Science and HeartMath. The management teams participated in a four-part “Leading with Care” series. Managers also participated with staff in half-day sessions that introduced the philosophy, theory, and framework of the Caring Science as well as self-care practices. The 7-hour HeartMath “Revitalizing Care” program was provided to 200 managers and staff members to enhance self-care, creativity, ease, and resilience and the understanding of how to be authentically present when providing care. Personal outcomes of participants were measured assessed using the HeartMath validated Personal and Organizational Quality Assessment-R2 (POQA) instrument. Participants completed the initial POQA self-assessment during part 1 and 2 weeks later during part II of the Revitalizing Care program. Reference values for the POQA are results from 5900 healthcare workers. Member satisfaction with care was measured using the Home Health Consumer Assessment of Healthcare Providers & Services (HH-CAHPS) percent “rate agency 9 or 10” score and the Family Evaluation of Hospice Services (FEHS) “Overall, how would you rate the care the patient received while under the care of hospice?” percent “excellent” score. RESULTS: POQA results demonstrated each of the positive characteristics were above average at baseline and significantly improved in three areas: positive outlook (P < .001), gratitude (P < .01) and motivation (P < .001). Each of the six stress-related measures were below average at baseline and significantly improved (P < .001) and above average following 2 weeks of HeartMath use. HH-CAHPS “rate agency 9 or 10” scores improved 1.7 percentage points to 83.6%. FEHS scores for the period were not yet available at the time of this report. CONCLUSION: CaritasHeart was an effective leadership strategy to support the continuum and its staff within a constantly evolving healthcare environment.