When the internal medicine UBT at the Los Angeles Medical Center decided to focus its efforts on African Americans with hypertension, not all team members initially were comfortable with targeting patients by race for special outreach. “We worried about how patients would react,” says union co-lead Marilyn Lansangan.  

However, when they invited African-American patients to a special clinic, they were thrilled with the results. Not only did patients show up, the team made progress toward its goal of closing the gap between African-American patients with their hypertension under control and those of other races. “The barrier was not the patients. The barrier was us,” says Lansangan.

Closing care gaps

Nationwide, nearly 45 percent of African Americans suffer from high blood pressure—a rate much higher than other racial and ethnic groups. The condition tends to develop earlier in life and is likely to be more severe for them. There is some recent research from the National Institutes of Health that suggests genetics may play a part. Such social and economic factors as discrimination and poverty also may contribute. Whatever the reason, health care organizations—including Kaiser Permanente—are working to reduce the disparity.

When Jose Saavedra, M.D., the physician champion on hypertension at LAMC , heard that colleagues at Downey Medical Center held a special outreach clinic for African-American members with high blood pressure, he encouraged the internal medicine UBT to try it as well.

Targeted outreach

Team members generated a list of their African-American patients with a certain threshold of uncontrolled hypertension. LVNs and social workers called patients every day, inviting them to the special clinic. The success of the outreach calls surprised everyone. “Even when we just left a message, people would come to our clinic,” said Elenita Petrache, assistant administrator and one of the management co-leads.

At the event, clinicians educate patients about hypertension, then take their blood pressure. Depending on the results, patients queue up for a short chat with either a doctor or a nurse, who can adjust their prescription or schedule a more in-depth appointment. Patients who successfully control their blood pressure get a certificate. Everyone gets a swag bag containing an apple, bottle of water, DVD about hypertension, and information about diet and sodium.

Improving teamwork

Gayle McDow, who attended the clinic in late April, says it make sense for KP to reach out to African-American patients. "The numbers suggest that this issue is more prevalent in our community," she says.

The project also built cohesion among UBT members who work on different floors, says Petrache. “It helped two parts of the department develop a better relationship because we have common goal,” she says. “There is communication between the teams. It’s a beautiful thing.”

Bryant Terry is a vegan chef, author and advocate for food justice. His new cookbook, Afro-Vegan, will be published next year. Terry will whip up a batch of citrus collards with raisins for the Union Delegates Conference and share how to use cooking and urban gardening as a tool for social change. He recently spoke with Laureen Lazarovici of LMP Communications.

What was your journey?

My entree into this work was as a grassroots activist in low-income communities of color. I was living in New York City, going to cooking school, and seeing the disparity in the types of food available and the impact that had on the health of communities. When I learned about the risk of a shorter lifespan for our youth, that made me want to help young people be leaders to solve this problem. So I founded b-healthy!, which stands for Build Healthy Eating and Lifestyles to Help Youth.

I realized it was their parents making the purchases, so we had to figure out how to bring parents in, how to raise their food IQ. I saw how little time people have to cook. Cooking is this lost art. People don’t even know how to make a stir fry with vegetables. It is easy to cook meat. It is a lot harder to tease out the flavors and textures just using fruits, vegetables and grains. You’ll have negative connotations of vegetables if you’ve grown up eating vegetables from a can. Those don’t taste that good.

I’ve gone from omnivore to vegetarian to vegan. But it was not a linear path for me. We are all on a journey. There is no room for judgment. My mission is not to convert people into vegans or vegetarians. I am looking to improve public health through cookbooks.

What obstacles have you encountered and how did you overcome them?

When we start talking about what people eat, folks might say, ‘It’s my decision.’ But it is important to realize we are influenced to eat things that are unhealthy by marketing. Yes, we have some autonomy. But there are forces influencing us. I want to provide a counter-narrative. We are in a beautiful moment when people are more open to things like meatless Mondays. These diets are a tool; they are not the tool, to address the crisis.

What role can Kaiser Permanente and its workforce play?

I come from a family of health care providers. They tell me all the ways the current health care system does not provide tools to them to help their clients. They are taught to respond to crises and to give pharmaceuticals. So, the first thing I would say to health care workers is: it is important to take care of yourselves. I’m referring to diet, exercise, and stress reduction, especially since you all work such long hours. The people who are working to heal people can heal themselves.

I am impressed by how Kaiser Permanente is taking the lead in prevention. Kaiser Permanente is part of that counter-narrative. And I love the farmers’ markets at hospitals. That is brilliant.

What is your favorite recipe?

I do like the citrus collards with raisins. It is symbol of my embracing the African-American community. That community is so heavily impacted. If we can make a change there, we can change the whole system.

At 10:30 a.m. sharp, South Bay Medical Center appointment clerk Carolina Meza removes her telephone headset. She fires up what looks like the world’s tiniest iPod, attached to a portable speaker that’s not much bigger. She gathers four of her co-workers in a patch of open space near the coffee room. They do some neck rolls, march in place and then do a move Meza calls “the incredible hulk”—a shoulder stretch that brings welcome relief to those facing a computer screen for most of their day.

“When we go back to our stations, we feel refreshed,” says Meza, a member of SEIU UHW.

It’s called Instant Recess, and it’s the brainchild of Toni Yancey, MD, co-director of the UCLA Kaiser Permanente Center for Health Equity. It involves a quick, daily group exercise and is aimed at incorporating physical activity into a normal workday. It comes at a time when research is showing that workplace fitness initiatives targeting individual behavior (such as counseling and gym memberships) aren’t working. An organization’s whole infrastructure needs to be addressed, says Yancey. 

That’s what makes Instant Recess so appealing. It demonstrates KP’s commitment to Total Health—including for a healthy and safe work life for KP employees as well as the members and communities we serve. It’s consistent with KP’s Healthy Workforce push, and also seems to help reduce workplace injuries and improve attendance.

At the South Bay call center, for instance, annualized sick days fell almost one full day per full-time equivalent between 2010 and 2011, when the department began Instant Recess. The number of ergonomic injuries went from three to zero.  

Overcoming obstacles

While they are seeing results now, team members were wary when senior leaders at their medical center approached them about trying Instant Recess. “I was very skeptical,” says Darlene Zelaya, operations manager. “We can’t prevent the calls from coming in.” In fact, hold times for patients did go up when the team first implemented Instant Recess.

The unit-based team worked together with project manager Tiffany Creighton to adapt Instant Recess to their members’ needs. For instance, before calling a recess, team members check the reader board to assess how many agents can be off the phones at one time. They hold many small exercise bursts throughout the day instead of one or two longer ones. And they keep the music turned down low to avoid disturbing agents on the phone with patients.

Making it work locally

In the South Bay lab, Instant Recess looks and sounds totally different—but is getting similarly promising results. That department blasts a boom box for 10 full minutes during the Instant Recesses it incorporates into its huddles at shift change twice a day. Clinical lab scientist Nora Soriano steps away from her microscope to join in. She’s lost 43 pounds recently, and she partly credits Instant Recess. Soriano, a member of UFCW Local 770, says the initiative inspired her to exercise more at home. “My son got me an Xbox,” she says. “I don’t stop for half an hour, sometimes 45 minutes.”

Not all of Soriano’s co-workers were so enthused when they first heard about Instant Recess. “I was kind of negative,” admits Julia Ann Scrivens, a lab assistant and UHW member. “I thought, ‘I am so busy. You want me to do what?’ ” Area lab manager Dennis Edora says, “It was a shock. No one knew what to expect.” But the lab’s staff had just been through some stressful changes—including getting new equipment and moving to a new floor—and team members were hungry for something that would help rebuild morale.

“We collaborated with all the different job codes,” says Edora. “Everyone added their different flavor,” she says, noting that employees rotate as a leader, some choosing Hawaiian dance moves, others yoga-inspired stretches. “Instant Recess really got us together. It wasn’t just exercise.” Moreover, it was helping reduce injuries: the lab reported only one repetitive motion injury in 2011, after beginning Instant Recess in April. There were five such injuries in 2010.   

And Scrivens is sold as well. “It is fun,” she says. “It makes me happy.”