Leadership at the Southern California region of the managed-healthcare giant Kaiser Permanente decided that outpatients could prevent more illness if the orga-nization used a teamwork approach to managing their health. Following the Complete Care program, doctors have been instructed to perceive themselves as part of a team, supported by a group of nurses, physician as-sistants, nurse practitioners, and other staff who help reach out to patients.Kaiser relied on its electronic medical records sys-tem to identify patients who were overdue for preven-tive care. One year, the data revealed that more than 47,000 members were overdue for a mammogram, and 10,530 overdue for blood-sugar tests. These data led to the heart of the system, a proactive office- encounter program to identify and target patients with chronic medical conditions and encourage them to be active participants in their own care. A computer-based en-counter checklist is used to record which screenings and lab work need to be performed.The Complete Care program uses all members of the clinical care team in a coordinated and collabora-tive effort to engage, encourage, and support patient health. The information and tools provided have helped to increase preventive screening and to support patient health. Examples of the improvement in health care in-clude a higher percentage of patients with hypertension whose blood pressure is now under control, and also a higher percentage of patients who have had colon can-cer screenings. Furthermore, many patients who were urged to get mammograms had breast cancer detected early enough to prevent the spread of the disease.Before a patient arrives at Kaiser for an appoint-ment, staffers identify missing lab work and send patients instructions before the visit. During the visit, staff members take vital signs, get missing tests ac-complished, and identify other health-screening needs. Even call-center agents are part of the team, by re-minding patients if they are overdue for a screening. Before the beginning of the Complete Care program (or Proactive Office Encounter), departments rarely co-ordinated care with each other, or paid much attention to patient problems outside their own specialty. As a result, patients were often overdue for recommended screenings.Kaiser also uses rewards and other motivational techniques for staffers, including a monthly “Guinness World Record Meeting” to celebrate patient success stories. One woman was literally chased down the hall by a nurse to inform her she was overdue for a mam-mogram. The overdue biopsy revealed the patient had cancer. After radiation and chemotherapy treatments, the patient became cancer free.

QUESTIONS

1. Why might the Complete Care program be better than the traditional approach to outpatient medical care?

2. What impact do you think the Complete Care program might have on the job satisfaction of staff members? Explain your reasoning.