I’m sitting by Conorado Beach, one of San Diego’s beautiful island areas. As I look out to the crashing waves and the pure white deserted sandy beach I consider the points in my Californian journey which have provided me with the best reflection time. Cycling across the iconic Golden Gate Bridge and along beach fronts in Monterey, Santa Barbara and Santa Monica, taking in the drama of the rugged Californian coastline, white sandy beaches, wildlife and surf have all inspired me to reflect most on this experience of a lifetime.
I am very grateful to Kaiser Permanente (KP) for hosting me during my visit to California and thank them and the Alzheimer Association Northern California for their kindness and generosity in sharing their experiences of supporting people with dementia and their families, and the improvement and leadership infrastructure which is supporting these efforts.
National Alzheimer Plan in Practice
During my visit I have had the privilege of seeing how the National Alzheimer Plan (which I heard about in Washington) is being applied in practice. I have met colleagues leading the dementia improvement programme at KP and shadowed the dementia team at Walnut Creek Medical Center, including attending a memory class for people worried about memory problems and witnessed multidisciplinary practice through individualised consultations at the memory clinic between physician, nurse, pharmacist and social worker. Dr Klingman’s vision for improving dementia care is inspiring and I have heard about how his team’s exciting work is transforming outcomes for people living with dementia and their family carers.
I’m excited to hear how KP are collaborating with Gunderson healthcare system to learn from their Respecting Choices Programme work and develop a new Life Care Planning Programme to support personalised planning, particularly for people with chronic conditions and people with advanced illness (including people with dementia). KP are also collaborating with the Dutch health system to support people with a diagnosis of Parkinson’s disease and considering how the learning from this work can be tailored for people with dementia. I hear about the value placed by KP on patient experience and I am interested to hear about the new Care Experience Standards ‘Care About Me’ which are being developed to support high quality person centred care.
Supporting diverse needs is a key theme during my visit and it’s great to hear from the Alzheimer’s Association about their innovative programmes and initiatives. I hear how the Association is raising awareness of dementia amongst diverse groups and about the ‘Open House’ programme to support the LGBT community. It is a busy day at the Alzheimer’s Association as they prepare for the forthcoming memory walks and it’s great to meet the staff and hear more about their work, campaigns and exciting new developments including an expert group to improve transitions between acute care and community. I am keen to keep in touch with developments.
I have the opportunity to visit the Diablo Center – an Adult Day Healthcare Centre where people with mid to late stage dementia are being supported to live well. This centre prides itself in personalised care planning and individualised multidisciplinary support. Whilst activities are delivered in a group setting, much careful planning is undertaken prior to and during the session to ensure appropriateness of activities and tailoring to individual needs and preferences. This includes the social worker visiting the person’s home to understand their requirements, and a tailored plan developed by the nurse, occupational therapist, physiotherapist and social worker, with input from a physician and speech and language therapist where required. Whilst at the centre I observe the compassion shown by staff, the tailored communication styles and the calm and happy environment created. I watch the smiles on the people’s faces as they take part in activities with the co-ordinator.
Responding to diverse needs are further emphasised as I pass through 2 other areas of the centre. These areas are not specifically for people with dementia. In one area is a support group for women who have immigrated from Afghanistan. Many of the women have post traumatic stress and I see the private prayer area created for them, the beautiful hand crafts they have made to send back to Afghanistan and then I meet the ladies in person. They are sitting in the shade of the Californian sun and are chatting and laughing together in their native language. They say hello and they smile when I tell them I have come from Scotland and how much I prefer the Californian weather to our rainy climate. As I further pass through the day centre I meet a group of people from Russia who are taking an exercise class and in the next room a group of elderly people who are also enjoying exercise to music with the physiotherapist.
During my time at KP I have had the privilege of meeting improvement colleagues. I feel right at home as many have undertaken the same Improvement Advisor course I have with the Institute for Healthcare Improvement (IHI) and using the same methodologies, approaches and measures. I hear about the exciting improvement initiatives and their advanced data systems. Similar topic areas are the focus of improvement efforts: flow, dementia, delirium, sepsis, healthcare acquired infection but to name a few. I hear about the links between inspection and improvement and I share our work in Scotland and offer to make connections. It is heartening that we share similar challenges around spread, scale and sustainability, demonstrating impact, initiative overload and data burden. I have the opportunity to spend time on the Professional Improvement Leaders course. This is an exciting course led by KP to build leadership capability and capacity amongst its quality improvement leaders and they are an inspiring group. I have the opportunity to share the work of Focus on Dementia, my experience of visiting dementia services in Japan and learn from their insights and experience.
I have had an inspiring time in California and so much to share in a single blog which only captures a fraction of my experience and learning. I hope this gives a flavour of the innovation at KP and Alzheimer’s Association and of the exciting developments taking place within such a diverse context.
Thank you to all at KP and Alzheimer’s Association for taking time to meet with me during my visit and share expertise and insights. In particular thank you to Barbara Crawford from KP and Ruth Gay from Alzheimer’s Association – two extraordinary leaders who have made my visit possible and inspiring.