Presentation: Walls, Ceilings, Closet Doors (Things Worth Shattering): Total Health and Social Innovation

This is a 2015 Update on the Kaiser Permanente Center for Total Health (@KPTotalHealth)  the Social Innovation Center of Kaiser Permanente.

There’s a short description of social innovation and examples of social movements and interventions that have been born or amplified since 2011.

It has been an impactful 4 years! Come by for a tour, and arrive by #activetransportation please. There’s now a Capital Bikeshare (@bikeshare) station right in front for your convenience 🙂 .

Enjoy, let me know what you think in the comments.

Infographics: How health care can strengthen the food system

These are great, because as I have previously pointed out, the health system and the food system appear at times (much of the time?) to be at odds with each other (see: Comparing the stats: The US Food System and US Health Care System | Ted Eytan, MD).

There’s a way out. Thanks to Health Care Without Harm (@HCWithoutHarm) and Kaiser Permanente (@KPShare) for producing these. H/T Kaiser Permanente Institute for Health Policy (@KPIHP)

Health Care Food Purchasing Power

Hospitals As Anchor Institutions

Healthier Hospital Food Service

Sustainable Food Scorecard Creates a Healthier Supply Chain| Kaiser Permanente Share

Kaiser Permanente Share | Sustainable Food Scorecard Aims to Create a Healthier Supply Chain.

Kaiser Permanente created the industry’s first Sustainable Food Scorecard, which allows the organization to rate suppliers and vendors and select the vendors who can best support the organization’s sustainable food purchasing initiatives. 

Great job, Kathleen Reed and team, in working to create a healthier food system for all.

“Kaiser Permanente spends approximately $52 million on food each year,” explains Reed. “So we want to use our purchasing power to begin shifting the supply chain towards more sustainable food options. And the Sustainable Food Scorecard is critical to that process.”

Sustainable Food Scorecard Infographic

Women’s Wednesday: Capital Area Gay and Lesbian Chamber of Commerce, Washington, DC

A pleasure to host a healthy and productive women’s community at the Center for Total Health (@KPTotalHealth) in conjunction with The Chamber (@DCLGBTBIZ). The courage of Rosie the Riveter and her colleagues continue to inspire (see: Photo Friday: Yes they could shatter glass ceilings. Meeting the women of the Kaiser shipyards | Ted Eytan, MD to read about their amazing visit to us this year)

The Healthy Meeting Revolution continues – what it looks like 2 years later

By now, most people know about the walking meeting revolution. This is the companion revolution, that’s been under way at the Center for Total Health (@KPTotalHealth) for over 2 years (!): Idea for the Obesity prevention Code-A-Thon: a healthier meeting revolution | Ted Eytan, MD

Whether or not you like going to meetings (or hosting them), the fact of life is that they happen and people spend a lot of time at them. The corollary fact is that a lot of health can, over time, is determined in the gatherings you go to, so it is incumbent that a philosophy of total health environments include the meeting environment.

I’ve been to enough events where it feels like the hosts either didn’t spend time thinking about whether health would be improved or degraded when the meeting was over, or that the caterer made the default decision that unhealthy would garner more positive reviews.

Our experience has defied this assumption – as I tell people, the number of attendees who approach us spontaneously thanking us for being mindful of their health (including dietary restrictions) is more than we ever expected. People don’t want to feel that they are held hostage when they are in an environment that they have less control over.

I would say this extends to the workplace in general, where the choices given as the default can have a huge impact over the span of a career. Why not expend the same energy to think about the choices?

This week, the Center for Total Health hosted the Association of Meeting Planners (@AMPSdc) to show how a meeting can be healthy, with help from Ridgewells (@RidgewellsDC) and curated by Erin Meade (@erinm81).

The photos are meant to show that healthy meetings are a choice that’s worth making. One day this will be the default, and there will be “meetings” and “unheathy meetings.” Until then, the Center for Total Health will continue to accelerate this social innovation. Feel free to access the Center’s healthy menus here, and comment/post/tweet about your healthy meeting experiences. Just like walking meetings, once you go to one, you’ll never be the same.

The People of Washington, DC’s Anacostia are Building a Culture of Health

The last time I was in Anacostia, Ward 8 of Washington, DC, was almost exactly 2 years ago (!) when I walked with Kait Roe (@Fuse_Kait) and Pierre Vigilance, MD (@PierreVigilance) (see: My #walkwithadoc and patient, exploring the determinants of health in Washington, DC Ward 8 | Ted Eytan, MD). Well actually, I was *near* Anacostia when I walked the future 11th Street bridge (@DCBridgePark) (Photo Friday: Walk With a Doc over a future, beautiful park over water, in Washington, DC, USA | Ted Eytan, MD).

On the ride back to much-less-obese Ward 2 in 2012, I remember asking Pierre about the determinants of the social determinants of health in Ward 8. If people didn’t want to die any earlier in Ward 8 than in Ward 2, how did they want to live? There was so much in the media about dog parks, bike lanes, and food deserts at the time, what was the answer?

It’s now 2 years later, and this time, I didn’t go to Anacostia to go see Anacostia, I was invited, along with my friend Lane (@tlanehudson), to meet Khadijah Tribble (@tribbleme), who is a person who lives in Anacostia. We chatted in the brand newish NURISH Anacostia (@NurishAnacostia) cafe, one of only 3 sit down restaurants in the Ward, one of which has a sign on the door that says, “Please have your shirts on.”

Khadijah used to be over 300 pounds. She’s now at 208 and she let us know that she’s working to create a culture of health in Anacostia, because when she looked for one, it wasn’t there.

“Culture of Health” were her exact words – she said she picked the phrase up from the Robert Wood Johnson Foundation’s newest initiative. Hey I know some people that know a little something about that @RWJF :).

The Maps

Thanks to the still awesome Community Commons platform (@CommunityCommon) I ran some maps of Washington, DC with data on food access, poverty, and high school education. Poverty plus high school education gives you a vulnerability index.

It doesn’t matter which map you look at, you can tell which parts of the city are most in need. The Northwest part of Washington, DC is the least obese, has the greatest income gradient, lowest poverty rate, highest educational attainment, highest access to healthy food. The Southeast part of the city, across the river, where Ward 8 is, the opposite:

The county level obesity data is not useful, as you can tell, and actually tends toward being harmful, because it implies that Washington, DC is in the top quartile of obesity status and that there isn’t a problem. I’ve explored this in a previous blog post – you have to look at sub-county level data (Do national numbers inaccurately represent Washington, DC’s obesity condition? what electronic and personal health records can do to help | Ted Eytan, MD). There is a problem. There are impressive disparities in this city.

I ran a comparison of San Francisco, CA on the food access data, which shows that even the less vulnerable parts of Washington, DC are more challenged in food access than in San Francisco.

The Walk

Khadijah took us on a walk down Martin Luther King, Jr. Ave SE, past “The other U Street” (Southeast, we inhabit U Street NW, which a generation ago was strikingly deprived itself). We passed the largest chair ever made (“The Big Chair”), rededicated as a sign of hope for this community in 2006. The convenience store that I visited in 2012 didn’t seem to be open this time.

I took photos. See if these images are the signs of a healthy community:

I was so lucky that I got to meet The Advoc8te (@TheAdvoc8te), fellow blog writer of the I’ve-been-following Congress Heights on the Rise Blog. She’s in the photo with myself and Khadijah. It was a cool moment for me 🙂 . I also got to meet Dr. Lisa Fitzpatrick (@askdrfitz), who’s currently enrolled at the Harvard Kennedy School mid-summer program.

The Culture (of Health)

Lisa and Khadijah are part of (founded?) The Community Wellness Collective (@comemovenlearn) which is based at the Anacostia Arts Center (@AnacostiaArts), where NURISH is also housed. So where I left Ward 8 2 years ago with a lot of questions, this time I left with a lot of ideas, that are not from me. Those are the best kinds of ideas.

As Khadijah explained, there isn’t yet a sense of “comfort” for women in the community who want to exercise. A lot of messaging (and the assumptions that go along with them) are not appropriate for this audience. Here’s a great example of that: How Low-Income Commuters View Cycling – CityLab. People don’t know how to use health services well, and they don’t know how to shop healthy within their immediate environment, based on what’s available. These add up to challenges that need to be solved at many different levels, because as the data shows, there are large disparities.

The Community Wellness Collective is working toward this, with exercise classes and food instruction. I hope to attend some of these, because all I know is that I don’t know about what’s needed.

Our Cities are Changing

The new Ward 8 7-11 looks a whole lot like this Ward 2 7-11 from 2012, and that’s a healthy thing View on Flickr.com

I just noticed this post on CHOTR: Congress Heights on the Rise: Anacostia welcomes it’s 1st national retailer to the neighborhood!, which is about the first 7-11 opening up in Ward 8. And guess what. The photographs of the Ward 8 7-11 show a similarity to the photographs I took of the Ward 2 7-11 in 2012, right down to the fresh fruits and vegetables..

She writes:

As we were exiting I noticed that several discount stores on Good Hope Rd had undertaken a little upgrade of their own. The shop directly across from 7-11 was sporting some freshly cleaned windows (possibly a first in the 6 years I’ve been in the neighborhood) and a newly organized window display. It seems consumers aren’t the only ones taking notice of the new kid on the block. 😉 Here is to hoping the upgrades continue.

I came to Anacostia for the same reason my generation came to health care – we are not satisfied with the status quo, we love the places that we live in, and we’re here to change everything. Yes, here is to hoping the upgrades continue, because, to quote community leader Ruby Corado (@CasaRubyDC):

Embracing Curiosity: Google Glass DC and Future Health meetup

GlassDC and Future Health meetup at @kptotalhealth (view on Flickr.com)

We have never hosted a meetup event at the Center for Total Health (@kptotalhealth) until last night, when we partnered with the team at Silica Labs (@silicalabs) to host last night’s event “Google Glass and Future Health“. It was, of course, a ton of fun.

After the terrific demo (on his birthday) by Antonio Zugaldia (@zugaldia) of the Google Glass device ( @ProjectGlass ), we broke into small interest groups to network around future uses of the device. I think there was more Glass per capita in the room than anywhere in the universe last evening.

The physicians in the room, myself, Amit Shah, MD, and Rebecca Coelius, MD (@RebeccaCoelius), gathered a small group in the protoype exam room in the Center and had the most interesting conversation with our guests (You can see Amit in action in this series of photos captured by the Silica Labs team). It was less about the device, I think, and more about the ways we could collaborate together to improve health care efficiency, quality, cost, and ultimately health itself (well, not ultimately health, life). Should we work at the level of the physician or other health professionals? The level of the patient? Which part of health – prevention? illness? With what data and how do we get it?

I believe the same types of conversations were happening throughout the Center in the areas of public health, neuroscience, patient empowerment, innovation. All stimulated by a new device that we’ve never had the opportunity to work with before.

I haven’t really thought of new technology like this as a bonding and magnetic force, bringing people together inside and outside of the health industry, to solve important problems in health. Then again, I haven’t really seen a new technology launch like this before – different than iPhone in that it’s a new paradigm, with development tools available on day 1. For igniting curiosity about what health is going to be, and who we’re going to produce it with, the meetup was a smashing success.

I would also like to point out the catering finesse of Center for Total Health’s Erin Meade (@erinm81) who also made this the healthiest meetup on the planet (see the Silica Labs photos). Total Health includes everything in the environment.

One of the themes that appealed to me so much in the exam room conversation was about the idea of Glass or technology in general to bring patients and physicians closer together, by getting out of the way, while introducing important data to improve caring and compassion. The could be during a visit with a patient and family providing dementia care (thanks @sterlingHIT !), it could be during a visit with a person from a vulnerable population (such as a trans person or LGBT).

#ifihadglass it would use it to introduce more cultural humility into the patient physician interaction, to promote respect and celebrate the abilities of people to produce health for themselves and those around them. The Center for Total Health’s pair will be picked up on July 12, 2013. Come innovate :).

Idea for the Obesity prevention Code-A-Thon: a healthier meeting revolution

When you take the time to be mindful – View on flickr.com

How does it feel when you are at an all day or multi-day event either as an attendee or staff, and you feel trapped by the food choices that are provided for you? Oh, I just gave away the answer. It doesn’t feel good. The recent Weight of the Nation documentary showed that this is actually dangerous, because in situations like these where we are not in normal environment and/or working long hours, stress hormones go up, and disregard for caloric quality goes down. Is there a way out? I found out, there is. Read on….

I have been meaning to write this post since about January, but really since about 2010, when I learned that we can stop this. I alluded to this first in a post on healthy food in health care (see: #greenhealthcare Part 3: Better food in health care makes a difference | Ted Eytan, MD ).

I’m giving it its own post now because the Obesity prevention code-a-thon is just 2 short days away (are you coming?). 

I learned when shadowing event planners, and a specifically gastronomically tuned one at Kaiser Permanente, Kimberly Stansell, who showed me how she works with hotel chefs and caterers to change their default menus to menus that are healthy. The most important finding is that is is possible to work with them to change menus – it isn’t “what you see is what you get.” 

I first picked up on this because I noticed a qualitative difference in the type, quality, and healthiness of food at events planned by Kaiser Permanente staff. I actually heard a rumor that there was a “Thrive” menu that venues in and around Kaiser Permanente facilities were using to cater events, and that this menu was actually being requested by other organizations for their events, too.

I found out from watching Kimberly, that there is definitely pre-work involved, there is definitely a dialogue involved, and it is definitely important to make it known that people want healthier choices. As I learned at the Bipartisan Policy Center in February, it is not that the hospitality industry doesn’t want guests to be healthy, it is that they don’t know what guests want. This is where a knowledgeable event planner with the right tools changes the course of health history, for a lot of people.

I found out there is no “Thrive” menu, per se, but there is a helpful, publicly available healthy meeting guide that’s designed for meeting planners, and it’s here: Do-it-yourself programs – Workforce health | Kaiser Permanente BusinessNet California.

In it is a healthy meetings checklist, a nutritional meeting guide, even a sample e-mail that you can send to meeting planners to take advantage of this resource (here’s the direct link to that).

Materials are one thing, leadership is another

The development and availability of these tools was announced back in 2011. What I am emphasizing here is the difference it makes for a meeting planner to visit with a chef or a caterer before an event, empowered and informed by data and the desire to keep people healthy. I have seen how Kimberly attends to this work with extreme care, because she is caring for hundreds of people when she does what she does. I would say what she does on is as valuable to a group of people as having an AED in the facility, if not more, because she’s helping prevent the need for the AED in the first place.

Is there an app for that? I’m not sure. Could a mobile accessible healthy meeting planner be created? Would it be standalone or would it be part of a caterer/hospitality venue’s mobile offering? An app can’t replace leadership, but it can certainly enable it. There are a ton of other ideas for this week’s Code-a-Thon that people posted on the Massive Health + Massive Ideas for Health Innovation – feel free to bring those, too.

Take a look at some of the tasty and healthy bites at the January, 2012, Care Innovations Summit, don’t they lower your stress level?

That URL again is… Welcome to Kaiser Permanente BusinessNet California – Healthy Meetings

And it’s true, I do like to photograph food. Don’t hold it against me. With thanks to Kimberly and the experts at Kaiser Permanente HealthWorks Exercise and Nutrition for taking the time to teach me.

Map of Food Access and Predominant Race/Ethnicity in Washington, DC – What’s your massive idea for health innovation?

I posted previously that there are a lot of interesting correlations between health/unhealth and location as seen in maps of Washington, DC (see: Quantified Community: Visualizing the health and illness of Washington, DC through open data and art).

This is a new starter map from communitycommons.org that includes Access to Healthy Food and Predominant Race/Ethnicity:

This map includes block group-level data showing the dominant race/ethnicity from the 2010 Census. The map also includes locations of Farmers’ Markets and SNAP-Authorized Retailer Locations from the USDA.

Using the Layer and Label controls you can turn on additional layers that have been added to this map including: USDA Food Desert Census Tracts and the CDC’s Modified Retail Food Environment Index.

This map shows similarities to the maps in that post around features of wards 5, 7, and 8 (on the right and lower right of the District map), but also some differences. What do can we do with this information to understand why people may want to choose the best behaviors but don’t have the right choice architecture?

I’m not sure, I’m not that smart, and my ideas are not that unique, so I am going to the Obesity Prevention Code-A-Thon on June 2-3, at the Kaiser Permanente Center for Total Health to connect with others. I’ve also posted a massive idea for health innovation, and you should too. The prize is a Massive Health ( @MassiveHealth ) T-shirt. I already have one, it’s high quality cotton and the art definitely starts conversations about health – highly recommended.

I’m specifically looking to connect with people who are interested in upstream causes (or “the causes of the causes” ) of health inequalities and using data to create productive collaboration. Washington, DC, is not in England, where the health care and social care systems are more connected – we need to be more creative. Fortunately, we’re good at that. This is Washington, DC, after all :).

Oh, and before you look at the map and say to yourself, “race/ethnicity is correlated with poor food access,” make sure you read the article Place, not race: disparities dissipate when blacks and whites live under similar conditions – this study demonstrates that health inequalities are a function of location, not race. Check it out.

What I learned at HealthFoo 2012

This post is patterned on a similar post penned by Susannah Fox ( @SusannahFox ) after the first HealthFoo in 2011. She lays out the origin of the event and the meaning of its name so I won’t repeat that here. I’m going to be honest and say that I was intrigued when I read the post then. A year later when I had the chance to actually attend, in Cambridge, MA, I was still intrigued.

And here’s what I learned.

All the photographs below are creative commons licensed, you can access the collection on Flickr at this link.

We all have “imposter syndrome”

Don’t know what that means? There’s an extreme definition on Wikipedia that you can reference. In the medical profession though, it’s a commonly discussed concept. Am I good enough to be here? Do I deserve the trust I’ve been given? Do I know all that I need to know for this case?

I walked in knowing a few people and maybe a little uncomfortable, and eventually discussed having imposter syndrome with several colleagues. The way to deal with imposter syndrome is to recognize that you have it, that everyone around you has it, and use it to provide humility and open leadership. No one deserves to be in that room, and everyone deserves to be in that room. Whoever are there are the right people. This event is not about a moment in time, I think it is about learning to learn, and preparing for the next experience, to include more people who will embrace imposter syndrome with you.

Hot topics for me: Less Tech, more people, more Food, more Quantified Self (“Prevention is the new HIT’)

In comparing my experience to Susannah’s last year, it is interesting that my experience was one of a shift away from health information technology and into prevention, social determinants, and behavior change.  This could be my selective attention based on what interests me.

This year brought experts in food systems, where I learned about an industry outside of health care that is struggling with transparency. There is no GTFS standard for food like there is for transit.  The food databases in our mobile apps can be incomplete or inaccurate, which has downstream effects on our behavior. The manufacturing processes of food, which affects the sustainability of our cities and rural areas, are also opaque, which disproportionately impacts people across the social spectrum. Note the USDA publication: “Are Healthy Foods Really More Expensive? It Depends on How You Measure the Price.”

I also received some insight into my obsession, I mean interest in, the data locked away in grocery club card databases. As I blogged previously (See: “R.I.P. Safeway FoodFlex“) , Safeway had previously made this information transparent, and then made it opaque again in 2011 (why, Safeway?). There is a company, Gojee, that has established a connection to a grocery’s consumer’s database for the purpose of providing information about recipes. Would they like to work with the health system?

I had a great conversation with Alan Greene ( @DrGreene ) and others about the first 33 months of an infant’s life, and what it can mean for obesity prevention. What a pregnant woman eats in her last 2 trimester is what her baby eats, and it has a profound impact on what they see as tasty throughout their lives. I’m bringing my intrigue to the Obesity Prevention Code-a-Thon on June 2-3, 2012 that’s part of DC Health Data and Innovation Week ( @DCHealthWeek )

This was very timely in the era of “Weight of the Nation,” which aired just last week.

Quantified Self  ( @QuantifiedSelf ) was also a topic of discussion. At this point, I am learning just what quantified self is – how does it fit with population health, communities, and systems of behavior change. It is more than just having a device, more than just tracking for health. Alex Carmichael ( @accarmichael ) exposed me to the three prime questions:

  1. What did you do?
  2. How did you do it?
  3. What did you learn?

That really changes things for me. Instead of wondering about which device has what data that connects to what care experience, it makes me think that our care system could just ask people/patients/members to ask these questions and provide the answer, that’s it.

On the topic of people, the role of pathologists came up from two different perspectives: first, from Regina Holiday, who is concerned about the rate of autopsies in the United States, and the profession’s ability to stay competent in this procedure. Second, from Mark Boguski, MD, who cleverly titled his topic “The fallacy of $1000 genome sequencing in cancer,” and described another view of the pathology specialty, which is one working to adapt to the future of tumor treatment by DNA.

Going all in, hacking with The Regina, Cambridge

One thing I liked about the atmosphere was that there was the open agenda which was timed, and then a flow into the evening. There was an immersive component to the experience – you wanted to hang around and meet one more person, and maybe write a blog post or paint late into the night. There is something to having a 24/7 environment available.

On the last evening there were a series of Ignite presentations. Regina Holliday ( @ReginaHolliday ) and I had talked about signing up for one before we went, but we decided that we wouldn’t have time to put one together. Well, as the first presentation of the night started, we decided to go ahead and create one on the spot. I thought the patient story was a great cap on the meeting, and brought me new resolve about what and who we are doing things for.

I have to make one note about Cambridge. I haven’t been there in a long time, but as I walk through the town, it feels like nothing less than the re-engineering of the human species is happening in the labs and tech hubs of this place.

In conclusion..

As I review the above, I realize the feeling I took away is very similar to Susannah’s from last year, we are learning to learn differently, which means in environments of greater diversity, humility, and embracing our vulnerabilities. There are many opportunities in cities all across the country to interact with new people in meet ups, health camps, code-a-thons. Many of these events don’t last  as long as this one, so I hope this post provides ideas about the possibilities that can come from these alternate learning environments, and what you can bring to them. It’s worth it.

Thanks a ton to Tim O’Reilly and the team at O’Reilly Media, The Robert Wood Johnson Foundation, and Microsoft for being courageous, open hosts.