Hawaii

Colorado

The Metabolic Surgical Weight Management unit-based team at the Franklin Medical Office is saving money and improving efficiency by reducing unnecessary lab tests for patients. The team researched current literature and discovered that its process was not adding value to patient care. As a result, the team went from 40 to 50 tests each day to 10 to 12 a day, saving more than $700,000 in one year. The project helped propel the team from a Level 1 to a Level 5 on the Path to Performance. The team won the UBT Value Compass Award for the first quarter of 2015.

Georgia

When the Georgia region sought to promote compliance initiatives while engaging frontline workers, it copied an idea from an existing regional program. “We already have workplace safety champions, so we mirrored what they did to birth this little baby,” says Kim King, fraud control, privacy and security officer. As of December 2014, each of Georgia’s 30 medical centers and its medical records facility boast a compliance champion on site. The goal is to increase under-standing of possible compliance lapses, such as an unlocked door or allowing an unknown person into restricted areas. “Frontline staff—and the majority are union representatives—raise awareness and do monthly walkthroughs of the facilities,” says King.

Hawaii

After she helped set up a network of safety champions at the Moanalua Medical Center and medical offices in the Hawaii region, registered nurse Christy Borton won the individual award for Creating a Safer Workplace at Kaiser Permanente’s Workplace Safety Summit in late February. Borton, the workplace safety co-lead and a member of HNA OPEIU Local 50, is mobilizing colleagues around the region’s renewed focus on safety conversations and safety walk-arounds. Frontline staff share safety tips via a weekly safety newsletter. She also is working with the Safe Patient Handling Committee to spread the use of HoverMatts, which help prevent injuries to both patients and employees.

Mid-Atlantic States

Workplace safety leaders in the Mid-Atlantic States region are committed to investigating incidents in partnership. Ensuring that a labor representative can meet soon after an employee injury was a key to the boost seen over the last several months. In January, 89 percent of incident investigations were performed in partnership, a 10 percent increase over December and significantly better than in October, when fewer than 70 percent were investigated in partnership. Another improvement is that incidents were reported in an average of four days in January compared to an average of eight days in December. “If we don’t keep ourselves and each other safe, we won’t be there for our patients to provide the care they deserve,” says Samantha D. Unkelbach, RN, the labor lead for Workplace Safety/Integrated Disability Management for the Baltimore area and a member of UFCW Local 27.

Northern California

Before moving to a new facility in San Leandro, members of the Pulmonary Sleep Services Center in Hayward took action to raise their patient satisfaction scores from the bottom third to upper third. They asked patients what needed to improve and even visited some members at home. By listening, the unit-based team identified nearly 50 points of confusion patients face from the moment they arrive for treatment to when they go home. From February to August 2014, the UBT began letting patients return diagnostic equipment at their own convenience and staggered lunch breaks to ensure that patients could receive respiratory therapy around the clock. These changes helped transform the team from a Level 1 to a Level 4 on the Path to Performance.

Northwest

Building on the region’s success in exceeding the goal of 75 percent completion of the Total Health Assessment in 2014, Total Health leaders are taking more steps to create a culture of wellness. Cynthia Beaulieu, the region’s Total Health labor lead and an OFNHP member, along with her management partner Lauren Whyte, employee wellness consultant, work with unit-based teams to celebrate team approaches to health. They round on teams with leaders to acknowledge and learn from team efforts. One fun project was collecting “healthy selfies” to showcase on the region’s internet site. Beaulieu and Whyte are encouraging the more than 300 employees who submitted photos to share them on social media using the hashtag #KPHealthie.

Southern California

The region is adding a new dimension to its popular and effective reward and recognition program for inpatient Medical/Surgical and Maternal Child Health unit-based teams: a special award for teams that sustain their strong service scores for an entire year. For the performance year that recently ended, winners were Anaheim Medical Center for Maternal Child Health and Woodland Hills 4 West for Med-Surg. After celebrating their achievements, the teams are expected to help spread their successful practices to their peers at their own facilities and region-wide. Strategies they are considering are a one-day conference with presentations by the winning teams, hosting visits from other UBT co-leads, and monthly webinars.

Colorado

The Colorado region is improving patient care and saving millions by providing high-risk patients extra attention after discharge, leading to a reduction in readmission rates. In the Post Acute Care Transitions (PACT) program, nurse practitioners visit patients in their homes after discharge from a hospital or skilled nursing facility, giving them a chance to alter the patient’s care plan if needed. The PACT team has visited approximately 4,200 high-risk patients since the program began in January 2013. At that time, 22 percent of high-risk patients were readmitted within 30 days, at a cost of $11.7 million. The PACT team has reduced readmission rates by 50 percent, saving Kaiser Permanente approximately $6 million since the program began.

Georgia

To make sure no good deed goes uncopied, the Georgia region launched a Spread and Sustain system to move best practices throughout the region—and showed off the results to KP’s board of directors at a UBT fair early last summer. Georgia took a spread blueprint from the Southern California region and fine-tuned it to meet its needs. Now its unit-based teams, sponsors and regional leaders identify projects with good spread potential, determine other locations where the new process could work, share the practice and check back to see how they’re being sustained. Several projects have been successfully spread region-wide—addressing such issues as hypertension, HPV vaccinations and lab specimen collection.

Hawaii

Hawaii is a beautiful place to live, but Kaiser Permanente members who live on the less-populated islands sometimes find it challenging to get the care they need. To address that, KP offers a special benefit called Travel Concierge Service. If health plan members need medical care that isn’t available on their island, KP assists them in traveling to the Moanalua Medical Center in Oahu or to a specialty care medical office. KP makes the travel arrangements and picks up the tab for travel, including airfare, shuttle service and discounted hotel rates. For minors who need specialty care, KP also pays for companion travel. “Our members love this service,” says Lori Nanone, a sales and account manager in the region.

Mid-Atlantic States

For several years, co-leads in the Mid-Atlantic States have compiled monthly reports of their UBT activities, goals and progress using Microsoft Word and Excel. Now, the region is rolling out a dashboard that automatically compiles the same information from UBT Tracker into an easy-to-reference SharePoint site, Kaiser Permanente’s new online social collaboration tool. The new dashboard will encourage more frequent updates to UBT Tracker and eliminate the need for co-leads to create separate documents, says Jennifer Walker, lead UBT consultant and improvement advisor. “Now the information we get is more timely and easier to assess,” Walker says. “Before, the information was up to a month old.”

Northern California

The Santa Rosa Medical Center Diversity Design committee is equipping employees with tools to help them provide better service to Spanish-speaking patients. The group, composed of labor and management, has been piloting a handout featuring a list of common Spanish phrases, such as ¿Necesita un intérprete? (“Do you need an interpreter?”), as well as instructions on using the phone interpreter system. The idea came from a Spanish-speaking patient on the facility’s Latino patient advisory committee, who recalled the time she was lost in the facility and no one could direct her in Spanish. The Spanish language flier is the latest in the committee’s work to help ensure all patients receive the same optimal service and care.

Northwest

Unit-based teams in the Continuing Care Services department are focusing on improving the experience for some of Kaiser Permanente’s most vulnerable members: those in skilled nursing facilities or receiving home health, hospice or palliative care. Teams are focusing on ensuring better transitions for patients as they go from inpatient to ambulatory care. By identifying issues before they become problems, labor and management hope to coordinate care more effectively, reduce emergency department visits and cut down on outside medical costs.

Southern California

Harmony comes easily when you use the tools of partnership. Just ask the Biohazards, a band of union members and a manager that uses partnership principles to guide performances. “We call ourselves an LMP project,” says Mary Anne Umekubo, a clinical laboratory scientist and Regional Laboratory assistant director who sings and plays percussion and guitar. She is among six band members who represent a variety of departments, shifts and unions, including SEIU-UHW and UFCW Local 770. Performing for friends and colleagues, band members use consensus decision making to choose songs, interest-based problem solving to fix mistakes and the Rapid Improvement Model to tweak performances. “We’re from different departments,” says drummer Eric Cuarez, a regional courier driver and SEIU-UHW member. “We come together to play music.”

Colorado

Unit-based teams are hitting their stride, with 190 out of 261 teams reaching a Level 4 or 5 on the five-point Path to Performance. Teams are engaged in several types of projects, including those that save the organization money. The region will see a financial savings of $1.85 million this year through the 175 affordability projects of UBTs. The five UBT consultants in the region are coaching teams impacted by regional restructuring and helping those teams rebound quickly. Teams also are focusing on workplace safety, patient safety and HEDIS measures (Healthcare Effectiveness Data and Information Set).

Georgia

Starting in May and running through December 2015, Georgia medical centers are conducting an experiment. This region-wide test involves using greeters to usher in members. During the trial period, 15 greeters will make the member feel welcomed and convey the message they are important to Kaiser Permanente. Greeters also will answer questions, escort members to their appointments, maintain waiting rooms, ensure wheelchairs are available and welcome members with a smile. “They will provide a concierge-type member experience,” says Elizabeth Ramsey, the Georgia region’s senior manager of loyalty and retention.

Hawaii

The Hawaii region recently re-set its 57 unit-based teams’ scores on the Path to Performance to Level 1. Three consultants—two also are registered nurses and one is a project manager—will help teams quickly advance as they meet such core requirements as sponsor training. The region is unique in that, for now, one union (Hawaii Nurses Association/OPEIU Local 50) is in the Coalition of Kaiser Permanente Unions, while other unions are not. Although that can be challenging, consultants say teams still focus on the patient and want to do improvement work. “We help each other work through obstacles with our teams and understand the data,” says Lisa Kane, UBT consultant and project manager.

Mid-Atlantic States

In February, when home health orders came in to Health Information Management Services Northern Virginia, the average turnaround time was 4.4 days. By creating red folders for the orders, adding a cover sheet that says “stat” and date stamping the order as soon as it arrives, the team cut turnaround time to three days by April 2015—even as the number of orders went up from 673 in February to 747 in April. “This was important to the workflow, because when home health agencies called to follow up on the orders it interrupted our work,” says LaShawnda Powell, a senior health information management assistant in Woodbridge, Virginia, and member of OPEIU Local 2. “We have determined that our new process is successful and we’ve adopted it.” 

Northern California

Last year, unit-based team consultants and union partnership representatives formed a regional UBT to work on issues related to consistency and accountability for Northern California’s 1,300 frontline teams. Now the group has established three subgroups to review the 2015 National Agreement, which includes new provisions for UBTs. Each subgroup has a distinct focus area: sponsorship, UBT validation and assessment, and tools to support contract expectations. The subgroups will develop recommendations for review by a committee of labor members and management representatives. The regional co-leads will submit final recommendations to the regional LMP Leadership Council by year’s end.

Northwest

UBT Resource Team members have been busy refining the region’s new process for assessing teams on the Path to Performance. Co-leads and sponsors of 415 unit-based teams in the Northwest work with their consultant to ensure each team advances or sustains high performance throughout the year. Improvement Advisors help co-leads create action plans and provide direct training to move teams along or refer them to the appropriate subject matter experts. A majority of teams at Levels 2 and 3 will advance to high performance within the next 90 days due in large part to the work of the UBT Resource Team.

Southern California

Playing games at work usually is considered taboo. But that’s exactly how a group of regional UBT staff members spent a recent afternoon when they learned to play the “Leading Innovation Game.” Created by Kaiser Permanente’s Innovation and Advanced Technology team, the board game is designed to help employees overcome challenges that can doom the best ideas. Starting this fall, regional UBT staff will train team co-leads and sponsors, who will share the game with unit-based teams at their facilities. “Most teams come up with great ideas but they aren’t always aware of potential pitfalls,” says Rosalyn Evans, UBT practice leader for Southern California. “This board game gives them hands-on experience to develop innovation in a risk-free environment.”

“The idea came from our manager, when one of our young, alert patients fell and got an injury. We were all upset,” says Jenalyn Andres, RN, one of the union co-leads for her department’s UBT.

That incident spurred nurses on the 4 East-Malama West unit-based team at Moanalua Medical Center in Hawaii to set a goal to cut the number of falls in half within 12 months—from 18 in 2013 to nine or fewer by the end of 2014. The team exceeded its goal and had only six patient falls in 2014.

Steps to success

Team members adopted the No One Walks Alone falls prevention program, pioneered at the San Diego Medical Center, to help them reach their goal. The team set up a standard process to ensure success. Some of the elements of the plan included:

• checking that all bed alarms are on at the start of shift and during the shift
• having alarm pads for chairs readily available in rooms, ready for patients who get out of bed and into a chair
• placing nonskid socks on patients’ feet
• positioning call lights within reach
• using walkers to help patients become mobile

Andres, a member of Hawaii Nurses Association, OPEIU Local 50, says the team educated patients and families by sharing literature with them that included tips on preventing falls and information about the No One Walks Alone protocol. The protocol starts with the assumption that all patients are fall risks, instead of nurses trying to identify which patients are at risk. Patients are accompanied every time they get up, especially to and from the bathroom, which is when most falls occur.

Troubleshooting “hot spots”

As part of the team’s process improvement, it identified “hot spots”—things that could happen that could prevent success. For example, the team quickly discovered that it had different types of patient beds on the unit, with different bed alarms. Some of those alarms weren’t wired into the nurse call system, so staff members had to follow the sound of the alarm to figure out which patient needed assistance—which meant it took longer to get to the patient.

The UBT worked to get the issue fixed, and as a result, “a project was opened with facility maintenance and beds have been switched to a universal cord, which resolves the problem,” says Manlee Velasco, the unit’s manager and management co-lead. “In the few cases where the cord wasn’t compatible, new beds have been ordered.”

The team has had five falls so far this year, which came before the cord issue was resolved. 

Spreading a successful practice

The overall success of the prototcol has been noticed by other teams and “all of the inpatient units at the Moanalua Medical Center are now using the program," says Kim Lu, RN, the 4-East unit’s other UBT union co-lead and also a Hawaii Nurses Association member. 

The practice is a great example of spread for another reason: The “No One Walks Alone” slogan and program was created by a San Diego Medical Center UBT in Southern California that was involved in a Joint Commission pilot in 2012.

For the first five years after the Permanente Foundation Health Plan opened to the public, there were no separate regions. Three hospitals—two in Northern California and one at the Fontana steel mill in Southern California—served the new members.

Northern California

The Oakland hospital opened on Aug. 21, 1942, and the Richmond hospital opened nine days later. Once the plan went public, the International Longshoremen and Warehousemen’s Union and other unions were prominent among the early member groups. Oakland city employees, union typographers, street car drivers and carpenters also embraced the plan. In 1953, state-of-the-art hospitals opened in San Francisco and Walnut Creek, as well as Los Angeles. Today, three union locals in Northern California belong to the Coalition of Kaiser Permanente Unions: SEIU-UHW (28,800 members), OPEIU Local 29 (2,400 members) and IFPTE Local 20 (1,300 members).

Southern California

Harry Bridges, the ILWU president, wanted a hospital in the San Pedro area in 1949, and it was his promise of a large and stable membership that convinced health plan leaders to expand. He proved as good as his word, and KP became the sole supplier of medical care to ILWU’s 6,000 West Coast members. The Southern California Permanente Group was established in 1950. In 1951, the 15,000 members of the Retail Clerks Union Local 770 in Los Angeles, at the time the largest local in the country, joined the plan. Today, there are 13 coalition locals in Southern California: SEIU-UHW (18,000 members); UNAC/UHCP (16,000); United Steelworkers Local 7600 (6,000); OPEIU Local 30 (4,000); UFCW locals 770 (a descendant of the clerks union), 324, 135, 1428, 1442 and 1167 (3,860 total); Teamsters Local 166 (500); KPNAA (350); and SEIU Local 121RN (200).

Northwest

Health plan enrollment opened to the community in 1947 with the opening of an outpatient facility across the Columbia River from the closed Kaiser shipyards. It became a region in 1951 and has been at the forefront of several innovative practices. In 1964, it launched the Center for Health Research to advance evidence-based medicine. In 1974, it became the only KP region to provide prepaid dental services. In 1991, the Northwest started Kaiser-on-the-Job, a workers’ compensation program that has since spread to all regions. Coalition locals in the Northwest are: OFNHP/ONA (3,400), SEIU Local 49 (3,900), UFCW Local 555 (900) and ILWU Local 28 (65).

Hawaii

Hawaii opened in 1958—before the territory became a state—with strong support from the building and construction trades, which benefited strongly from Henry Kaiser’s hotel and housing projects. It was the last region to join the partnership, in 2009. The Hawaii Nurses Association, OPEIU Local 50 (800 members), belongs to the coalition.

Ohio

The Ohio region was the first organizational expansion of the health plan outside the western United States. The Community Health Foundation in Cleveland—which had been established by the Meatcutters and Retail Store Employees Union and had a structure similar to KP’s—merged with Kaiser Permanente in 1969 to form the Kaiser Community Health Foundation. The region left KP in 2013.

Colorado

Colorado also joined Kaiser Permanente in 1969, after requests from a group of labor, medical, university and government leaders. The United Mine Workers had regional headquarters in Denver, and Kaiser Permanente had longstanding relations with UMW through the Kabat Kaiser Institute in Vallejo, later known as the Kaiser Foundation Rehabilitation Center, where injured miners were treated. Today, SEIU Local 105 (3,500 members), UFCW Local 7 (1,800) and IUOE Local 1 (23) belong to the union coalition.

Mid-Atlantic States

In 1980, KP acquired the failing Georgetown Community Health Plan and, through the use of existing community hospitals, began to operate profitably within two years. Kaiser Permanente believed locating in the Washington, D.C., area would provide high visibility regarding health care legislation. The effort was successful: In 1992, Jim Doherty, president of the Group Health Association of America, the professional organization for HMOs, remarked that the move “did more for the HMO movement than any single act since the HMO Act of 1973.” In 1984, the region opened its first pharmacy and changed its name to Kaiser Foundation Health Plan of the Mid-Atlantic States. In 1996, it acquired Humana Group Health Inc., one of the country’s oldest HMOs. OPEIU Local 2 (3,800 members) and UFCW locals 400 and 27 (1,600 total) belong to the coalition.

Georgia

The Georgia region opened in 1985. Its first medical director was Harper Gaston, MD,
a Northern California physician and Georgia native who was proud to return home and serve the initial 265 members. In 1988, the region experienced dramatic growth when the state of Georgia came aboard as a major account and Kaiser Permanente acquired the financially ailing Maxicare Georgia HMO; within a year, the region celebrated its 100,000th member milestone. UFCW Local 1996 (1,800 members) is part of the Coalition of Kaiser Permanente Unions.

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