Working to Achieve the Quadruple Aim - Kaiser Permanente 2020 National Quality Conference


Nancy Gin, MD; Patrick Courneya, MD

E-pub: 03/13/2020

Kaiser Permanente 2020 National Quality Conference


Quality improvement activities are essential to achieving the Institute for Healthcare Improvement’s Quadruple Aim of improving the health of our patients and members, enhancing members’ care experiences, reducing costs, and attaining joy and meaning for our physicians and care teams in the workplace. These activities are also essential in creating a learning health care system.

For more than a decade, the Kaiser Permanente National Quality Conference has been our premier national forum on quality. The conference brings together diverse stakeholders—from physicians and frontline staff to senior executive leaders, patients, and strategic partners—to connect, collaborate, accelerate learning, and spread the work of our colleagues to achieve the Quadruple Aim. The leading-edge work presented each year reflects the interdisciplinary contributions and breadth and depth of work necessary to deliver on the mission of Kaiser Permanente to bring quality, cutting-edge, and person-centered health care to its patients.

This is the fourth year we have partnered with The Permanente Journal to share learnings from the conference with those who are unable to attend and with the broader, international journal readership. Through the more than 40 abstracts chosen from more than 120 submissions on the basis of scientific rigor, interest, and opportunity for spread, we demonstrate the important work being done in quality (safe, timely, effective, efficient, equitable, and person centered); affordability; joy in the workplace; and tools (evaluation, analytics, and informatics). Publishing quality improvement activities has considerable value, encourages precise adherence, and helps facilitate greater willingness to share improvement opportunities. We hope the readers of The Permanente Journal find this work thought provoking and a source of continued learning. 

Author Affiliations

1 The Permanente Federation, Oakland, CA

2 Kaiser Foundation Health Plan and Hospitals, Oakland, CA

Corresponding Author

Nancy Gin, MD (


20.046The Preparedness Assessment for the Transition Home (PATH): A Data-Driven Approach for Addressing Gaps in Caregiver Readiness and Capacity
Michelle Camicia, PhD, MSN, CRRN, CCM, NEA-BC, FARN, FAHA; Carrie Robertshaw, DNP, MSN, FNP, CRRN; Deborah Raymond, MSN, MBA, RN, NEA-BC; Brian Theodore, PhD


Northern California to Hawaii—Health Achieved through Lifestyle Transformation (HALT)
Hyewon Jun, MD, MPH; Mae Lynne Swoboda, MPH, CHES; Rajiv Misquitta MD, FACP, PT (NASM), RYT 200; Lisa Edwards MBA, RD


Effective Patient Advisory Councils: Make Sure the Gang’s All There!
Kerry Litman MD, CPPS; Linda Fahey, RN, NP, MSN; Diana Palma, MHA; Nancy Gin, MD; Susan Mahler, MSE, PhD; com Mike Adamson; Alice Rademacher, MS


Elevating Care through Patient Engagement: Practical Strategies for Embedding the Member Perspective into Our Work
Rebecca Skiles, MHS; Stephanie Lotane; Cathy Fragola; Krista Rosa


Breathing Life into Data: Estimating Lives Positively Impacted by Chronic Disease Prevention and Control Programs at Kaiser Permanente Georgia between 2008 and 2018
Alan Bienvenida, MPH; Jacqueline Hensley, MPH; Kate Koplan, MD, MPH; Felipe Lobelo, MD, PhD, FAHA


Reducing Cesarean Section Surgical Site Infections: Multidisciplinary Implementation of a Novel Bundle within an Integrated Health Care System
Neeru Gupta, MD; Eric Hunt, MD,PhD; Mary Kay Ausenhus, RN, MSN; Franklin Keathley, RN, MBA; Samantha Delehant, MBA, DPT, CMPT; Frederick Cabasa, MS


A Multidisciplinary Approach to Improving Medicare Medication Adherence
Beth Barham, PharmD; Carole Gardner, MD, AGSF; Debbi Baker, PharmD, BCPS


Drug Dealer, MD, Meets The Pain Management Rehabilitation Program
Karen Peters, PhD; Barbara Gawehn, RN, LAc; Dhiruj Kirpalani, MD; Maureen Wenski, PT, DPT and Kimthy Pham, PharmD


Autism Services Transformation: A Triple Aim Approach to Applied Behavior Analysis
Lisa Denike, MD; Sarah McGee, RNC, MSN; Charlene Weaving, RN, MSN; Krystle Alligood, MS; Matt O’Connell, MPH; Kristen Morris, MA


Care Experience: The Redwood City (3-Year) Journey of HCAHPS Star Rating Improvement
Barbara Hounslow; Amy Young, RN, MBA; Ashu Goyal, MD; Poonam Kapadia, MD


Skilled Nursing Facility Transitions of Care (Vohs/Lawrence Single Site Finalist 2020)
Yvonne B. Rice, PharmD; Hannah M. Austin, MBA; Preston Peterson, MD; Jose G. Benuzillo; David M Mosen


Creating Healthy Work Environments: “I am living in mine”
Laure Lisk, RN, MS, CPHQ, CPHRM; Elizabeth Scruth PhD, MPH, RN, CNS, CCNS, CCRN, FCCM, FCNS, CPHQ; Bronwyn Cox, MSN, RN; Vilma Cadiz, MSN, MBA, RN; Vanessa A Martinez, MSN, MHA, RN; Kristine Wilson, RN, MSN, CPHQ; Jacqueline (Jacquie) Buckley, RN MBA, MSN, CCRN-K, CPHQ; Maria Galletto, MSN, RN, CNL, CPHQ


Implementing a Digital Mental Health Ecosystem—Getting to Scale
Trina Histon, PHD, Han-Chun Liang, MD , FACHE, Tina S Han, Scott Heisler, RN, MBA


Multidisciplinary Patient-Centered Support of Opioid Tapering
Katherine Reese, PharmD; Traci Hamer, PharmD, MAT; Elizabeth Bentley, PharmD, MSJ; Andrew Vidaurreta; Bryan Ing, PharmD; Christopher Matthews, DO; Darlene Marsh, PharmD; Jeannette Zimmer, PharmD; Johanna Heymann, LCSW; JJ Johnson, PharmD; Mindee Dewitt, PharmD; Sara Westby, PharmD; Steven Piscoran


Chronic Kidney Disease Moonshot: Interregional Nephrology Chronic Kidney Disease Management Program to Delay Progression to End-Stage Renal Disease
Sijie Zheng, MD, PhD, FASN; Mark Rutkowski, MD; Alvina Sundang, MBA


Way Ahead of the Curve: Leading the Nation in Increasing the Rate of Peritoneal Dialysis
Sijie Zheng, MD, PhD, FASN; Leonid Pravoverov, MD; Alan S Go, MD


Mid-Atlantic States Hospital Patient Day Rate Reduction for Extended Length of Stay Patients
Claire Pagano, MHA; Pam Galley; Farzaneh Sabi, MD; Jean Langley, RN; Tracye Brewer, LCSW-C


Transitional Care Center: A Center for Medical and Nonmedical Excellence
Nkem Chukwumerije, MD, MPH; Parnika Kodali, MHA


The Impact of Unit-Based Teams’ Engagement with Employee Well-being: Findings from Kaiser Permanente’s 2019 C Everett Koop Award Application
Ben Simons, MA; Leslie Pole, MA; Nicole VanderHorst, MA; Kelli Woods; Michelle Mancuso, MPH; Karen Stoeffler, MPH; Maria Dee; Kathy Gerwig, MBA; Dave Schweppe, MPH, CPHIMS


Diagnostic Excellence—Getting it Right at the Right Time: Building Cultural Awareness
Ronald Loo, MD; Nancy Gin, MD; Michael Kanter, MD; Mimi Hugh, MA, MPH; Maricruz Arteaga-Garavito


A Multidisciplinary Perioperative Optimization Program for High Risk Elderly Patients improves Surgical Quality and Utilization Outcomes
Letitia T. Bridges, MD, MBA Jonathan Lipana, MD Terri Williams, RN


Healthy Balance: Impact and Lessons Learned from an Evidence-Based Weight Management and Diabetes Prevention Program
Sean Hashmi, MD; Jimmy Wannares, MPH; Danielle Altman, MA; Guangxi Zheng; Anna Marie Salvador, MPH; Chris Rapp, MHA; Faith Ruperto-Ramirez; Denice Waters


The “Perfect Pee” Keeps Young Girls Antibiotic Free
Poonam Kaushal, MD


Beyond the Baby Blues: Improving Psychosocial Screening and Follow up Care for Obstetrics Patients
Lawrence Lurvey, MD; Lyn Yasumura, MD; Melanie Pitts, MPH; Liza Eshillian Oates, MD


Screening and Intervention for Adverse Childhood Experiences (ACEs) at Pediatric Well-Child Visits
Mercie Digangi, DO; Liza Eshilian-Oates, MD


Caring for Hawaii’s People Like Family, One Call at a Time
Stacy Layco, MA; Ronny Fujimoto; Andrew Fong, MD; Samir Patel, MD; Sally Lee, MSN; Mark Linscott


Variations on a Theme: Improving Communication of Safety Information
Karen Birmingham, PharmD, CPPS, CPHQ; Tina Ghia, MD Verna Honda, CPhT; Lili Hozakowska, MHA; Norah Meyerson, MPH; Alex Truchot; Adrianne Wesol, MD


Peer Mentors Matter: Patients Supporting Patients through Healthcare Journeys
“Dexter” Janet Borrowman; Judey Miller; Marlene Zuehlsdorff, MS; Sara Flores; Julia M Gregory, RN; Claudia DeYoung, MD; Veronica Shim, MD; Andrew Tan, MD


Designing Excellence in Cancer Care
Zachary Szukala; Jonathan Bullock, MBA; Jeff Convissar, MD; Aubrey Kraft, MS; Michele Lagana, MPA; Michele Le, MPH; Karen Libby, MBA, MHA; Varnee Murugan, MPH; Tiago Pinto, MBA; Violeta Rabrenovich, MHA


Home Based Cardiac Rehabilitation (HBCR)—A virtual program to improve members’ lives.
Columbus D Batiste, MD, FACC, FSCAI; Christine M Ruygrok, RN MBA; Debora A Lahti, MSN, RNP; Soraya Arango, MSW, LCSW, Steven T Craffey, Tadashi T Funahashi, MD, FAAOS, FAOA


Developing an Acute Care for the Elderly Framework—Becoming an Age-Friendly Health System
Letitia Bridges, MD; Karineh Moradian, MHA; Shant Bairian, MPA


My Medications Matter: Improving patient experience through evidence-based communication to educate patients on new medications
Heather Brown, PT; Mary Linda Rivera, RN; Ashu Goyal, MD; Barbara Hounslow; Megan Mira, MSN, CNL, RN; Doug O’Brien, PharmD; Julia Loughlin; Stephanie Muci, MBA, MPH; Sarah Lahidji, MHA


Better Together: Performance Improvement and Human-Centered Design—Creative Problem Solving for Health Impact
Scott Heisler MBA, RN; Jeffrey K Hall, MFA; Jennifer Cunha, MBA; Jenn Cheung, MPH


High-Quality Outcomes for Transplant Patients: The National Transplant Services Quality Program and Collaboration with Transplant Centers
Rebecca La Londe, MPH, RN; Geri LiBetti, MSN, FABC; Dana Weisshaar, MD, FACC; Laura O’Neill; Allison Tomimatsu; Ronald Potts, MD


The National Safety Committee, the Odyssey Begins ...
Patrick Courneya, MD; Nancy Gin, MD; Joan Gelrud, MSN, CPHQ; Scott Young, MD , NSC; ;Jeff Convissar, MD, CPHRM; Julie Vilardi, MS, NP; Kathleen Music MSHSA, JD, CPHRM, CPPS, Dot Snow MPH


Deprescribing Tools and Processes to Assist with Performance on Polypharmacy Measures
Marti Groeneweg, PharmD, BCPS; Sunshine Sommers, MS, RPh


Designated Decision Maker: Making Life Care Planning a Part of Routine Health Care
Ruma Kumar, MD; Uma Zamvar, MD; Zoe Sutton, MSN, PNP


The aging bundle—a strategic approach to improve wellness, outcomes, and affordability
Sheldon Lewin, LCSW; Hassan Movahedi, MD, PhD


The Kaiser Permanente Northern California Gastric/Esophageal Program—A New Model of Multidisciplinary Cancer Care Delivery
Yan Li, MD, PhD; I-Yeh Gong, MD; Ellie Chan, MD; Sirisha Karri, MD; Hoa Le, MD; Edmond Schmulbach, MD; Tilak Sundaresan, MD; Swee Teh, MD; Simon Ashiku, MD; Brian Missett, MD; James Morris, MD


Operational Excellence: Catheter Associated Urinary Tract Infection (CAUTI) Prevention and KP Rounding Illustrate the Journey to Becoming a Highly Reliable Organization
Kim Horn; Greg Adams; Joan Gelrud, MSN, CPHQ; Ellen Lee; Kathleen Music, MSHSA, JD, CPHRM, CPPS; Dot Snow, MPH, CPPS, CPHQ; Celine Gray, MBA; Abigail Mulhern, MHA, RN, CPPS; Dang Nguyen, MPH, MBA, CSP, CIH; Tawny Belleau, RN, BSN, CIC, CPHQ; Jodie Torena


Impact of a Fully Integrated Regional Antibiotic Stewardship Program and Penicillin Allergy Delabeling on Antibiotic Utilization, Clinical Outcomes, and Costs
Eric Macy, MD, MS; Katie Sharff, MD; Tracy Barton, PharmD; Steve Spindel, MD; Andrew Leitz, MD, PhD; Jodi Longueil, PharmD


The Enhanced Recovery After Surgery Common Pathway: Fewer Postoperative Complications and Reduced Opioid Exposure Across Northern California
Derrick Lee, MD; Vivian Reyes, MD; Shirley Paulson, DNP, MPA, RN, NEA-BC; Danielle Lerer, MPH; Jessica Galin, MPH; Bryan Philips, MPH; Vincent Liu, MD


Every Moment Matters: Strength in Standards
Hans Donkersloot, MBA, MSHA, Evelyn Nodal, MPH CPXP, Sara Flores


Keywords: affordability in medical care, improving health care, joy in the workplace, Quadruple Aim, quality


Click here to join the eTOC list or text ETOC to 22828. You will receive an email notice with the Table of Contents of The Permanente Journal.


2 million page views of TPJ articles in PubMed from a broad international readership.


Indexed in MEDLINE, PubMed Central, EMBASE, EBSCO Academic Search Complete, and CrossRef.




ISSN 1552-5775 Copyright © 2021

All Rights Reserved