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Blue Zone Project

Texas Health Resources is looking beyond hospital rooms and patient charts and working to make Fort Worth one of the healthiest cities in the country. As the primary sponsor of Blue Zones Project®, Fort Worth, the regional health system is leading the community-wide well-being improvement movement. With 23,000 employees and more than 400 points of access throughout North Texas, Texas Health is the nation’s largest employer and health system to become Blue Zones Project Approved™, demonstrating how employers can play a significant role in promoting longer, better lives.

Blue Zones Project works with selected cities, including Fort Worth, to transform environments and daily routines in ways that make healthy choices easier. From moving naturally and eating with a plant slant to having a sense of purpose and downshifting to relieve stress, principles are patterned after lifestyles in Blue Zones® areas—pockets of the world where people are most likely to reach age 100 and beyond.

Texas Health helped bring Blue Zones Project to Fort Worth in 2014 and continues to back implementation of the initiative, including improvements to its worksite environment and award-winning Be Healthy program to help employees improve their personal well-being.

“Blue Zones Project is a major priority for our organization, and it reflects the value each member of the Texas Health family places on well-being,” said Barclay Berdan, FACHE, CEO of Texas Health Resources. “We are dedicated to creating a workplace that promotes health and longevity for our employees and providing the people we serve with the care, support, and tools they need to live their best lives.”

Each of the Texas Health’s wholly owned locations completed the Blue Zones Worksite® Pledge—establishing walking paths at all locations, encouraging employees to take “microbreaks” to stretch and move, creating Blue Zones parking spaces, hosting on-site purpose workshops and health screenings, and supporting volunteerism, among other efforts.

“Texas Health Resources is an example of an organization that truly walks the walk,” said Fort Worth Mayor Betsy Price. “Through Blue Zones Project, Texas Health is transforming the well-being of its employees and our entire community. Its vision and innovative leadership are helping Fort Worth become one of the healthiest cities in the nation, and Texas Health stands as a model for employers across the country.”

The Blue Zones Worksite Pledge promotes evidence-based actions and lifestyle principles that help make the healthy choice the easiest choice for employees. This translates into increased productivity and a potential healthcare cost savings for employers. Across the country, more than 454 employers have taken the Blue Zones Worksite Pledge.

Blue Zones Project, Fort Worth currently counts 54 approved worksites, including all 18 locations for the City of Fort Worth. Texas Health is currently the largest employer and health system in the world to earn the designation.

“We spend a majority of our time at work, and whether a company has 50 employees or 5,000, employers can play a huge role in improving the overall health of a community,” said Matt Dufrene, vice president of Blue Zones Project, Fort Worth. “Texas Health is leading that charge here, by demonstrating that small changes can have a big impact—within their organization and beyond. That’s what Blue Zones Project is all about.”

In addition to worksites, Blue Zones Project, Fort Worth has 26 approved restaurants, four grocery stores, four schools, and two churches, plus 11 participating organizations—all of which have optimized their environments to make healthy choices easier. In addition, more than 18,000 people who live, work, and play in Fort Worth have taken the Blue Zones Personal Pledge. Once city-specific goals are met, Fort Worth will become a nationally certified Blue Zones Community®.

The Fort Worth Blue Zones Project® is a community-wide well-being initiative launched in 2015 that is all about making healthy options more available in every aspect of life. As well as being a key partner in this community project, Texas Health Resources set a goal to bring the Blue Zones Project® to all its worksite locations in 2016.

Texas Health officially became the largest Blue Zone ApprovedTM Worksite in the world in August 2016. We credit our enthusiastic employees as one of the reasons we could achieve the approval months ahead of our goal. Achieving the designation also helps advance our Mission to improve the health of the communities we serve, and reflects The THR PromiseSM Individuals Caring For Individuals, Together®.

Part of the worksite approval criteria included having at least 25 percent of our population pledge to incorporate the Power9 habits into their lives. Each of our Texas Health locations exceeded its 25 percent participation goal only six months into the project. As of February 2017, more than 7,500 employees have signed the Blue Zones Personal Pledge and made a commitment to improve their own well-being.

As a part of our award-winning Be Healthy program, we already had many sustainable environments in place to help employees live longer better live such as meditation gardens, downshift rooms, yoga classes, indoor and outdoor walking paths, and chances to give back. Our existing Community Time Off program supports volunteer opportunities in Fort Worth and surrounding areas so employees can give back to their community through BZP activities and other community initiatives and programs as needed.

As a culture, we have been providing a mindful moment to start our meetings well before we started the Blue Zones project. As a faith-based organization we embrace diversity and inclusion. Within this culture, we already encourage our employees to practice the Power9 habit of Belonging.

In 2016, we encouraged employees to form special walking groups within their departments called Moais. This is one of the healthy habits identified in Okinawa that incorporates natural movement and social connection with a Right Tribe during the work day. Like each of the Blue Zones areas identified in Dan Buettner’s study on longevity, this Blue Zone contains people who are living into their 100s by moving naturally and keeping lifelong social connections.

We also encouraged our employees to better well-being by providing a “state of the union” of our organizations’ health metrics posted on our dedicated wellness website. On this same website, we also provided easy to follow Blue Zones stretch breaks to help employees practice another Power9 habit, downshifting. Each Texas Health location now proudly boasts special Blue Zones parking spaces to encourage employees to park further away from work to add even more natural movement to their day. We also brought the Blue Zones Power9 habit, “Know Your Purpose” to our locations by holding onsite Purpose Workshops at Texas Health locations in 2016.

To continue sustainability of the Blue Zones Project in 2017, at our worksites, we are taking the philosophy of making the healthy choice the easy choice and applying it to the overall environment and food selections at our dining facilities with the goal of each location’s onsite dining café becoming a BZP approved restaurant.

Each of these initiatives and programs weave the Power9 principles of Blue Zones into the fabric of our organization, and our employees love it. Together we will improve the health and well-being of the communities we serve – starting with ourselves. The way we care about our employees and each other is one of the many reasons Texas Health is such a great place to work.

Making the Right Choice, the Easy Choice

As part of our journey to become a high reliability organization, Texas Health is working to consistently provide a safe, quality experience to our patients each time they visit any of our hospitals, wellness centers or physician offices. This work is intentional and strategic, requires extensive research and literature reviews to identify evidence-based best practices, and involves the expertise of our leaders, physicians, clinicians, staff, and safety and quality improvement teams across all Texas Health facilities.

When we follow evidence-based practices, we are most likely to get the expected result. When we can consistently provide the expected results to our patients, we build trust.


  • Patients: Benefit through improved safety and outcomes resulting from highly reliable delivery of care at every Texas Health location, every time.
  • Physicians: Can be confident that standard work will be delivered reliably, enabling them to focus on areas that require their unique perspective and expertise.
  • Employees: A consistent process eliminates unnecessary variability, and checklists prioritize and organize daily work for care team members. Improved critical thinking, team building and communication enhance employee and patient safety.
  • Texas Health: Improved and consistent quality and safety outcomes, enhanced reputation and value, reduced cost of care, and rapid identification of improvement opportunities. Real-time metrics also drive accountability and reliability.

Collaborative Rounding Reduces Length of Stay and Improves Patient Satisfaction

It’s common for nurses and physicians to round on their patients, stopping by throughout their shift to check patients’ vitals, test results and to discuss needs or treatment plans. Oftentimes, however, these clinicians work alone or in silos, which can negatively affect not only communication with patients and their caregivers, but also extend the length of patients’ stays within the hospital.

Extended hospital stays not only cost patients and health systems more money, they also increase the risk for patients to acquire an infection. Yet discharging patients too soon increases the likelihood of readmission.

To address this issue and increase communication among patients, physicians and clinical staff, Texas Health’s Clinical Nurse Leader Program proposed a collaboration rounding routine in which two Texas Health hospitals participated in 2016.

For three months, a physician, clinical nurse leader and the primary nurse made rounds together on select groups of patients and their families. They discovered that by collaborating, they got up to speed on each patient much faster and became better aligned on care plans. This, in turn, helped patients and their loved ones better understand the goals for the day, test results or treatment options. More importantly, having these conversations together significantly reduced patients’ length of stay and readmissions, and improved their overall satisfaction. Using this model as a blueprint, Texas Health will begin having clinical teams systemwide take this same approach to rounding in 2017.

Taking a Four Eyes, Four Hands Approach to Infection Control

Catheter-associated urinary tract infections (CAUTI) are one of the most commonly reported hospital-acquired conditions. These infections—which may affect the urethra, bladder, ureters or kidney—can lead to extended hospital stays, increased health care costs and even patient death. Therefore, catheters should be used only when medically necessary and removed once they are no longer needed.

At Texas Health, nurses began taking a four-eyes, four-hands approach to appropriate utilization of urinary catheters in 2016. We began requiring two staff members who are experienced in inserting urinary catheters to work together. They each verify that a catheter is medically necessary. Then, while one inserts the catheter, the other observes to make sure the catheter is inserted using an aseptic technique. Each day, nursing reviews the indications for the catheter and when the patient no longer needs it, it is promptly removed.

Standardizing Care to Reduce COPD Readmissions

Chronic Obstructive Pulmonary Disease (COPD) is a disease that occurs in the lungs and obstructs the airways. It’s the third leading cause of death and a leading cause of hospital readmissions in the U.S. In 2016, clinical nurse leaders at Texas Health Denton piloted an intervention to reduce readmission rates for patients with COPD. They discharged patients by giving them a care action plan and checklist, appropriate medications and instructions about following up with their primary care physician. In six months, readmission rates dropped from 22 percent to 17 percent.

Partnering with the reliable care blueprinting team, Texas Health is now implementing these evidence-based best practices—along with addressing root causes of readmission, providing other appropriate interventions and encouraging patients to ambulate four times a day—to reduce rates across the organization.

Southwestern Health Resources

Southwestern Health Resources is an integrated health network that combines about 1,200 primary care doctors and 600 advanced practitioners affiliated with Texas Health with about 1,500 specialists from UT Southwestern to help consumers receive more convenient and appropriate care—when they need it. The two organizations also are expanding medical education and research initiatives to identify the most effective health interventions and apply them to the people we serve.