Los Angeles Medical Center

Going Green

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video_VID-41_GoingGreen
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At Kaiser Permanente's Los Angeles Medical Center, 350 environmental services workers are putting the green training they received through ant educational trust to work. The result: Lower operating costs, improved patient and workplace safety and happier employees.

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Non-LMP
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Ben Hudnall Memorial Trust can now be found online at: bhmt.org (instead of benhudnallmem...etc).
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VID-41_GoingGreen/VID-41_GoingGreen.zip
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Kaiser Permanente and two Workforce Planning and Development trusts are training frontline workers in green practices. At Los Angeles Medical Center, 350 Environmental Services workers represented by SEIU-UHW are putting that training to work. The result: lower operating costs, improved workplace safety and happier employees. 

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Reducing Health Disparities With Outreach

Submitted by Julie on Tue, 05/06/2014 - 16:05
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sty_LAMC_hypertension outreach
Long Teaser

An internal medicine UBT at the Los Angeles Medical Center had success inviting African-American patients to a special hypertension clinic and made progress toward its goal of closing the gap between African-American patients with their hypertension under control and those of other races.

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Laureen Lazarovici
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Spreading the Word

Knowledge is power, and when you give patients good information it empowers them to take charge of their health.

Here are some ideas to get the word out.

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Members of a Los Angeles Medical Center UBT are surprised by positive response from patients
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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.”

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Early Detection: Encourage Patients to Get Screened

Submitted by Laureen Lazarovici on Tue, 02/25/2014 - 17:03
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Early Detection: Encourage Patients to Get Screened
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Team improves rate of needed cancer tests

The staff at the Radiation Oncology department at the Los Angeles Medical Center knew well the importance of identifying cancer early.

It was part of their clinical routine, and when necessary, they knew patients could begin treatment and slow the spread of the disease.

“We see what happens when you don’t screen regularly,” says Sandra Miller, the department administrator and the UBT’s management co-lead.

So, the UBT was determined to deliver on Kaiser Permanente’s promise of preventive care and leverage the Proactive Office Encounter to increase the percentage of regularly scheduled mammograms, colorectal and Pap screenings by December 2013. 

“With Proactive Office Encounter, we are treating the whole member,” says Maria Caceres, an assistant department administrator who was involved with the improvement project.

But the team also had to overcome resistance from patients.

“I think most of our patients that come to us do not want to deal with [one more test],” says union co-lead and medical assistant Monica Villanueva, SEIU UHW. “However, the more we reinforce the importance of having it done, they are more willing.”

Electronic reminders on KP HealthConnect helped ensure patients were getting their screenings, but the team also used a process map to examine its own workflow.

They put color-coded sheets on providers’ keyboards in exam rooms as visual alerts to indicate a patient is due for a screening (pink for mammogram, orange for colorectal test, green for Pap test) and created a pending order in KP HealthConnect.

Medical assistants checked the Proactive Office Encounter before each appointment to alert physicians when screenings were needed, and to check results and make reminder calls to patients.

They gave staff access to the radiology department’s appointment system so appointments could be made for patients while they were in the office, and provided training by laboratory colleagues on how to instruct patients on using the Fecal Immunochemical Test (FIT) kits.

“We had to sit down and break down every step,” Miller says. “We would ask, ‘Where were we not taking advantage of an opportunity to communicate with the doctor or the patient?’ Our process really changed after that.”

As a result colorectal screenings improved by 25 percentage points, Pap smears got a 12-point bump and mammograms increased by 46 points.

And when results for two patients showed they had additional health issues, the physicians, employees and managers were convinced.

“They could see the value and the impact of their hard work,” Caceres says.

For more ideas to share with your team and spark performance improvement ideas, download a poster, a tip sheet or read what an allergy unit did.

 

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By combining effective workflows with the power of HealthConnect, all departments can focus on early detection.
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pdsa_LAMC_POE
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Long Teaser

A Radiation Oncology UBT harnesses the power of the Proactive Office Encounter to ensure its patients get needed screenings.

Communicator (reporters)
Laureen Lazarovici
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Management co-lead(s)

Sandra Miller, Sandra.C.Miller@kp.org, 323-783-2558

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The Sponsorship Dilemma

Submitted by cassandra.braun on Thu, 11/08/2012 - 23:08
Hank
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sty_hank33_sponsors
Long Teaser

A look at UBT sponsorship, the challenges it faces, and the key role it plays in the success of teams.

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Non-LMP
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Tyra Ferlatte
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Gena Bailey, a service area director and UBT sponsor in the Northwest, and Melissa Garan, a medical assistant and SEIU Local 49 member
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The sponsorship dilemma
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Active sponsors drive high-performing teams. Can partnership overcome the short supply?
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If you ask Los Angeles Medical Center sponsors Ilda Luna and Sanjit Sodhi for the secret to successful sponsorship, they’ll agree it boils down to investment—of time, trust and respect—in each other, in their teams and in the collaborative work process.

Luna, a family medicine receptionist, and Sodhi, the chief financial officer for LAMC, didn’t know each other when they were asked to co-sponsor the Health Information Management, Admitting and Patient Revenue, and the local business office teams—teams that were failing to meet performance goals and were entrenched in mistrust between labor and management.

“Sanjit said, ‘Tell me what I need to do to get us up and running,’ ” recalls Luna, a member of SEIU-UHW. “I said, ‘You need to meet with your teams. If you invest time in labor, you’ll get huge dividends.”

Like most investments, success didn’t happen overnight—and it wasn’t guaranteed. But after a year and a half of perseverance, dedicating time and hard work to supporting the work of those teams, the pair has watched the departments go from being in the red in most metrics to seeing huge improvements in areas like attendance and co-pay collection.

“We’re taking on types of projects that we could never have dreamed of a year ago,” Sodhi says. “And when you work though relationship issues and put the focus back on partnership and performance improvement, it’s highly satisfying.”

What’s so special about sponsors?

A 2011 study by Johns Hopkins University, Rutgers University and Kaiser Permanente identified five key characteristics of high-performing teams, including “consistent, aligned and visible sponsorship.” It confirmed what has been seen throughout the organization—strong sponsorship and support from higher levels of leadership are key factors in a team’s success.

The reasons are straightforward. Many frontline workers say simply having leaders’ involvement and support gives their work validation, letting them know that what they’re working on is important, that their contributions matter. In addition:

  • Sponsors mentor unit-based teams and connect them with effective practices and other resources to help them do their work.
  • They help break down barriers and provide guidance on setting goals that line up with local and national performance goals.
  • They act as role models and advocates for working in partnership.

“There are teams that need both management and labor sponsors to model partnership behaviors, who can agree to disagree and who can have some healthy courageous conversations till they get to an outcome,” says Vicki Barkan, the UBT consultant at the Los Angeles Medical Center. “Sometimes teams and co-leads haven’t experienced that, so they need to see it. It really helps to further the team dynamics.”

Sodhi agrees.

“As sponsors,” she says, “we have the same common goals and mutual respect for each other” that team members should have. “It trickles down to the rest of the UBT.”

“Sponsorship is a way to help move UBTs forward,” says Diane Ochoa, the regional director for Medical Group Support Services in Northern California and a former San Jose Medical Center medical group administrator. “It’s just like having a mentor, somebody you can talk to, to help you with issues and celebrate with you, and be there to really acknowledge the work you’re doing.”

So, what’s the problem?

Yet sponsorship is still a developing area in the partnership structure, even though many regions find that without active union and management sponsors, UBTs’ performance improvement work stalls.

Several challenges get in the way, and chief among those is time. Sponsors repeatedly cite the difficulty of finding time in their regular work to mentor teams. Labor sponsors face the added challenge of needing to cover their duties when they’re away from their usual post, lest those duties fall to colleagues.

Even with a commitment from facility and department leadership to backfill her position when her sponsorship work takes her away from her regular job, Luna, who is the union co-lead for the medical center’s LMP Council, says there isn’t enough time for everything she needs to do.

“But you have to make time,” she says. “I put in my own time, during lunch and after I clock out.”

Luna’s partner Sodhi agrees. The time challenge has to be reckoned with—but it’s a challenge worth solving.

“I’ve definitely made it a priority,” she says. “It was tiring devoting all that time, but I knew that I needed to do that to develop my relationships. In order to achieve any results, I knew I had to invest in time.”

“Capacity” is another word that surfaces when sponsors talk about challenges. Identifying people who can be strong sponsors and ensuring they have the tools and skills for the role is not easy. Labor bears the brunt of this barrier, in part because the unionized workforce typically has a smaller pool of leaders to draw from than management has. Many potential labor sponsors lack the consulting and facilitative skills required to mentor a team. As a result, union sponsors are in short supply, and those few become overwhelmed, with too many teams to support.

“I think that with labor, with so much work to do for our regular jobs, this is too much,” Luna explains. “So a lot of my peers didn’t want to do it. (Or) the ones who want to do it couldn’t get released because of operational needs. Patient care comes first, so operational need is a huge barrier.”

Solutions?

Some say successful sponsorship won’t happen until sponsors are held accountable, with their success tied to performance goals and financial compensation.

But in the meantime, many medical centers and regions are wrestling with finding other solutions to these issues. As a first step, some are revamping their training to clarify roles and responsibilities, which many sponsors—both labor and management alike—say have not been clear.

“It will be helpful for people to understand what they are supposed to do and see examples of how that’s done,” Ochoa says. “This is relatively new for some labor folks especially, and the more we can give them the tools to be a good sponsor, we need to do that.”

At the Los Angeles Medical Center, the facility’s LMP Council has made a series of changes in the last year it thinks will help shore up sponsorship. These include establishing criteria for becoming a sponsor, to make sure the right people are in the role and can model partnership and leadership behaviors; aggressively recruiting union co-leads of high-performing teams to become sponsors to increase the labor sponsor pool; and reassigning UBTs so a sponsor has no more than five teams.

Ultimately, time and commitment always will be challenges, but the potential rewards—the culture change and performance improvement work that come with high-performing teams—make the investment worthwhile. If sponsorship remains a barrier, there is a risk that teams will get discouraged.

As Luna says, “To be successful, we need successful sponsors and to build credibility with our teams. And we want to be successful.”

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Polish Your Skills, Save the Planet

Submitted by anjetta.thackeray on Tue, 10/30/2012 - 11:34
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Sty_wfd_greenjobs
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Learn how EVS frontline workers are advancing their careers--and making Kaiser Permanente greener.

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Non-LMP
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Leroy Alaman, operations manager for the EVS department at the Los Angeles Medical Center, demonstrates battery recharging.
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Additional resources

Ben Hudnall Memorial Trust: http://benhudnallmemorialtrust.org/

SEIU UHW-West and Joint Employer Education Fund: http://www.seiu-uhweduc.org/

Healthcare Initiatives: http://www.doleta.gov/brg/indprof/health.cfm

Collaborate (reporters)
Collaborate
Waste not
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Career Development Resources

Here are some tools to help you advance.

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Polish your skills, save the planet
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Southern California EVS teams go green with new certificate program
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Cutting waste and saving money for Kaiser Permanente members and patients is good. But 350 Environmental Service workers in Southern California are taking that mission a step further by tending to Mother Earth as well.

Kaiser Permanente and two Labor Management Partnership-funded workforce development trusts are among the health care partners nationwide that are training frontline workers and managers in improved recycling, waste disposal, energy conservation and other green practices. The U.S. Department of Labor and the Healthcare Career Advancement Program, a national partnership of unions and hospitals, are leading the effort.

“‘Carbon footprint’ is a phrase that’s thrown around a lot,” says Milford “Leroy” Alaman, EVS operations manager at the Los Angeles Medical Center. “Now our staff is able to understand that when you are talking about conserving energy, water and electricity, you are talking about looking at the resources we have in our facility and holding on to just what we need instead of creating more waste for us and the planet.”

Leading change at work

Along the way, these “green teams” also are reducing operating costs, enhancing employee skills and morale, and improving patient and workplace safety. 

For example, the EVS department is now using environmentally friendly microfiber mops to clean a single patient room. This has the benefit of not spreading infections between rooms and preventing lifting and straining injuries caused by wringing traditional mops and hauling buckets of water.

The department also has started a project that is reducing the cost and trouble of replacing the 500 D-cell batteries used in the hospital restrooms’ automatic towel dispensers. The traditional batteries wore out in a matter of weeks—costing about $3,000 a year to replace and adding some 6,000 batteries a year to local waste or reprocessing streams. Starting in February 2012, workers installed new rechargeable batteries. Overall, EVS' green projects, including the use of rechargeable batteries, are saving an estimated $12,000 a year.

Enhancing skills, raising sights

“I feel better having conversations with anyone…doctors, nurses, I can tell them how to be green,” says EVS attendant Jose Velasco, an SEIU UHW member and a recent graduate of a green certification course offered at West Los Angeles Community College.

The program also was piloted at KP Riverside Medical Center, where the EVS unit-based team is reaching out to others with its newfound expertise. Now an EVS member is embedded with the Operating Room UBT—with others to follow—to help tackle waste and hygiene problems there.

The SEIU UHW-West & Joint Employer Education Fund and the Ben Hudnall Memorial Trust have helped underwrite the cost of the training for Kaiser Permanente’s LMP-represented workers. Eventually, frontline workers may be able to use their certifications for higher pay and promotions as medical center “green leads,” a program that would be negotiated between KP and the unions.

But the training already is making a difference to workers as well as to KP and the community. “They have more tools, more knowledge, so they are able to catch things,” says Angel Pacheco, management co-lead of the EVS UBT at Riverside. “We talked about saving the environment for future generations.”

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