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Transforming and Sustaining the Care Environment

Background: Caring Science Theory and Practices have been part of the Kaiser Permanente's Strategic Priority for Kaiser Permanente Northern Region since 2010. Their goal is to ensure the continued spread across the medical center of practices guided by the Caring Sciences framework that fosters caring-healing environments and that reinforce helping-trusting relationships between caregivers and between caregivers and patients. Methods: Gaining senior-level leader sponsorship is an essential element to integrate and sustain a program in our culture and obtain successful outcomes. The senior level leader sponsorship for HeartMath consists of Chris Boyd, senior vice-president/area manager; Sue G. Murphy, chief operating officer; Anne M. Goldfisher, chief nursing officer; and Barbara Hounslow, care experience leader. Effectively selecting the HeartMath Trainers was essential in helping ensure that the program outcomes were obtained. The four key elements determined in the trainer selection process were (1) trainers selected in contextual alignment with our strategic goals; (2) leveraged key leader/RN staff relationships in trainer selection; (3) trainers committed to advance culture of Caring Science with HeartMath; the chief nursing officer becoming a trainer, emphasizing consistent leadership support. In planning and implementing the training program, an infrastructure was set up to focus on specific units and service lines. This included developing a “pull” message addressing the aspects of staffing realities and the training process. As lessons were learned, adjustments were made in process to suit the culture. A plan was constructed to support the staff on the units to sustain their practice after the training. Outcomes: During a 12-month period, more than 400 nurses, leaders, and other support staff trained. The response was overwhelmingly positive. The participant perceptions at program completion are described in the Results section. Other benefits included improved relationships between nursing staff and leaders. The trainers reported being deeply impacted on both professional and personal levels. Results: Of the 400 participants trained from June 2011 to June 2012, 263 completed both the pre and post surveys. Eight of the 14 metrics showed statistically significant changes. They were work attitude, goal clarity, communication effectiveness, time pressure, intention to quit, strategic understanding, and productivity. Improvements were also noted in well-being, quality of life, impacts on patient satisfaction, safety, and reduction of absenteeism.