Program-wide

Health care workers’ first obligation is “do no harm”— to see that the members and patients in our care suffer no injury or further illness. Unit-based teams across Kaiser Permanente launch hundreds of projects every year to improve patient safety. These tips can your guide your team in a patient safety improvement project and help ensure that KP is the safest place to get and to give care.

1. Wash your hands often, and in accordance with local policies and procedures.
2. Speak up if you observe a drift from safe practice. As the saying goes, “If you see something, say something!”
3. Make sure patients (or family members) understand their diagnosis and plan of care. Have them describe, in their own words, their condition, what they need to do next and why that’s important.
4. Label specimens accurately, completely and legibly.
5. When administering high-alert medications have two people separately check specific steps of the process. For example, a pharmacist calculates dosage, prepares a syringe and compares the product to the order; then a nurse independently does the same and compares the results.
6. Use tools such as SBAR (Situation, Background, Assessment, Recommendation) and clear language like “Safety Check” to identify a hazard, if someone is uncertain and does not feel it’s safe for the patient to proceed. 
7. Keep yourself free from injury so you can keep your patients free from harm.

Who hasn’t experienced the frustration of a long wait to get a prescription filled or a lab test done, or to see a physician who’s running behind schedule? To help keep Kaiser Permanente patients and members happy, many unit-based teams are tackling this issue and finding ways to reduce wait times.

1. Raise awareness of the problem by sharing data about the department’s wait times and patient satisfaction scores with unit-based team members.
2. Help your co-workers understand it is everyone’s responsibility to be attentive to members who have been waiting for long periods of time — and recognize co-workers who do this well.
3. Inform patients of delays by having the receptionist let them know if a physician is running late.
4. Provide members and patients who have been waiting for extended periods of time with individual attention and updated information by “rounding” in the waiting area.
5. Put a focus on wait times by posting patient arrival times on exam room doors or having pharmacists call out the wait time in the pharmacy.
6. Utilize an “all hands on deck” approach, so when wait times hit a certain threshold, all available staff members drop what they’re doing and help reduce long lines.
7. Consider shifting employees’ schedules to ensure adequate staffing during peak hours and at the start of the day, so you don't fall behind from the beginning.*
8. Promote alternatives to in-person visits such as prescription refills by mail or email, phone or video consultations with doctors.
9. Rethink who does what if part of the reason for long wait times is that only employees in particular job category are allowed to do a certain task.*
10. Create a quiet zone in pharmacies to reduce distractions for the primary filling technician.

*  Consult with local unions to ensure proposed changes are in line with the contracts.

All improvement requires making change — and change can be difficult. These practices are culled from Kaiser Permanente’s Organizational Effectiveness consultants and from unit-based teams that have moved through change successfully, developing new processes, transitioning to new leadership, etc. These tips are meant to support UBT co-leads and team members as they manage change — and the resistance that often comes with it.

For unit-based team co-leads and sponsors: Identify and manage resistance

• Clearly communicate reasons for the change.
• Make it safe to voice concerns throughout the change process.
• Identify team members mostly likely to resist the change and give them key roles.
• Involve naysayers as early and as often as possible to minimize grumbling.

For all UBT members: Assess the effects of the change and enlist support

• Develop a common understanding of the change, getting everyone’s point of view:  Ask, "What’s being done now and what will be done differently?"
• Engage everyone affected, including physicians, members of other departments and your team sponsor.
• Identify specific enablers and barriers to implementation — areas that will require greater attention.
• Allow team members to identify solutions and make decisions that affect them most.

Celebrate short-term successes — and acknowledge failures

• After each test of change, recognize and reward contributing team members at huddles and meetings. Use these small wins to increase credibility and keep the momentum going.
• Accept failures — and talk about what can be learned from them.

Our members and patients count on Kaiser Permanente for affordable, quality care — and more unit-based teams than ever are focusing on ways to improve efficiency as well as service and quality. In fact, service or quality care improvements often lead to more cost-effective care, which benefits KP, our workforce and, most of all, our members and patients. Use these tips to jump-start your team’s thinking about the financial impacts of your improvements.

1. Think about potential financial impact from the start of your project. This will help you identify early on the data to collect and monitor so the financial impact can be calculated later. Keeping the financial impact in mind can also help refine your SMART goal.
2. Get a good grasp of what you’re trying to improve. Then think about the cost associated with that thing. For instance, if your goal is to streamline scheduling, think about the potential costs, such as excessive overtime, associated with an inefficient schedule.
3. Have a clear understanding of your baseline metric. Once you know what your goal is, determine the associated costs before any changes are made. This will help you translate the improvement into money saved.
4. Work with your local finance team. If you don’t have a relationship with your local finance department, ask your UBT consultant or improvement advisor to connect you with the right person to help you determine the dollar value of a project.
5. Find out if there’s a team in your facility or service area that is working on something similar.
6. Another team may already have figured out ways to calculate the financial impact your project might have or may have different ideas for measuring its financial benefit.
7. Look beyond the hard dollar savings. “Soft dollars” can be equally important. These are avoided costs or improvements that don’t reduce the money spent but allow us to do more with the resources we have. Examples include improvements in re-admission rates, number of no-show appointments or time spent looking for supplies.
8. Value the financial impact of small improvements. If an improvement and its estimated financial impact seem small, remember to figure out the potential savings over time or add up what happens if the practice spreads to other departments or facilities.

Unit-based teams are getting results — and are finding ways to share their learning with their peers face to face, online or in print. Talk with your team about how to use these and other ideas to share your learning and spread success.

1. Track your progress. UBT Tracker is a web-based tool that helps unit-based teams and consultants collect and report information about their performance improvement work. Our UBT Tracker User Guide can help you make the most of your Tracker entries or search for model projects.
2. Tell your story. Storytelling is one of the best ways  to explain partnership and show others your results. Sign your team up for our storytelling training. 
3. Step right up. UBT fairs are a dynamic forum for spreading effective practices face to face. Hosting your own webinar online lets you reach beyond the walls  of your facility.
4. Lights…camera…take action. Kaiser Permanente’s Care Management Institute uses video ethnography— interviewing KP patients at the care site—to help teams share ideas and keep patients at the centerof performance improvement. To learn more, visit CMI’s Video Ethnography & Storytelling page [KP intranet].
5. Write all about it. Use fliers, posters and newsletters to keep others informed and engaged in your team’s projects. Post your results in the break room. Invite another unit to your huddle for a progress report. Use these templates to create your next newsletter.

Sponsors are the go-to people for UBT co-leads, providing resources, guidance and oversight for teams — and effective sponsorship is one of the most important ingredients for a high-performing unit-based team. If you’re a sponsor, provide your teams with the support they need to create an environment where UBT members are always learning, always improving, always innovating.

1. Make it a priority to be involved. Provide feedback and hold teams accountable for action plans.
2. Coach and mentor co-leads; connect them with opportunities to develop needed skills or knowledge. Developing strong team members will ease your work in the long run.
3. Take time for face time. Walk the floor with team members and occasionally attend UBT meetings.
4. Share expectations up front with your co-sponsor and team co-leads. Define how you’ll make decisions and how you’ll communicate and how often.
5. Help team members build their problem-solving skills by having them develop solutions, but if there are barriers outside the co-leads’ or team’s scope, get busy breaking them down.
6. Educate your teams about local work plans and regional performance priorities so they can work on the right projects. Be sure, too, that things team members care most about get addressed.
7. Celebrate and highlight successes, both large and small, by rewarding individuals and teams in a way that is meaningful to them — whether it’s an email, party, lunch or a parking spot for a month.
8. Secure the resources your teams need to get work done, such as time for regular trainings or meetings and access to data that will help benchmark their performance.
9. Establish a baseline Path to Performance rating. Assist teams in understanding the rating and connect them with resources or successful practices that will help them become high performing.
10. Ensure teams are documenting their work regularly, accurately and concisely in UBT Tracker.

Is your department’s supply room or cabinet cluttered with a mix of overstocked, understocked and out-of-date materials? Throughout Kaiser Permanente, unit-based teams are taking stock of their supplies and finding they can save time and money by designing better systems for organizing and ordering supplies. Reducing supply waste is one of many ways that teams are helping KP become more affordable for our members and patients.Sort your supplies to determine which ones to keep, which should be disposed of, and which you need more information about before deciding.

1. Create an opportunity for everyone in the department to give input about how often different supplies get used, so you don’t eliminate something the department needs.
2. Organize the supplies by figuring out where each item belongs and then labeling supplies and shelves. Also set “par” levels, figuring out the quantity the department should always have on hand.
3. Remember safety when organizing the supplies. Make sure people won’t have to bend too low, reach too far or lift something that’s too heavy.
4. Establish a signal for when supplies need to be re-ordered. For example, the signal might beflipping the bin upside down, filling out a re-order card or alerting whoever oversees ordering supplies. And have a system for alerting people when an item is getting close to its expiration date.
6. Routinize the new system by having a plan to make sure supplies stay sorted, in order and clean. For example, create a checklist to make sure the new procedures are followed or assign someone to sign off at the end of the day that the supplies are ready for the next day’s work.
7. Check in regularly with other team members to make sure the new system is working and to tweak it if it needs adjustments.
8. Consider approaching departments similar to yours that may order the same supplies. You may be able to consolidate orders. For example, many departments in the same medical facility order sutures.
9. Calculate how much money you’ve saved. Compare what you were spending before on supplies to what you’re spending now.
10. Take before and after pictures to help you communicate the story of how your department reduced waste.

When we help Kaiser Permanente membership grow, we help make KP stronger and our jobs more secure. One of the best ways to grow KP membership is to provide great service to every member we serve — especially to new members during their first interactions with Kaiser Permanente. Here are some ways to enhance the member experience and keep new members with KP for the long haul.Engage the entire unit-based team in providing a “wow” experience during a new member’s first visit.

1. Use tools like the New Member Identifier in Kaiser Permanente HealthConnect® to flag new members and give them a little extra TLC during their visit.
2. Provide new members with information packets (with, for example, important phone numbers, a facility map, pharmacy hours) that will help them access all of KP’s services.
3. Make every member’s visit special with a warm welcome. Take time to answer questions about KP, or even offer a mini-tour of the facility before or after an appointment.
4. Follow up on first visits with a thank-you card or survey to find out how the visit went and how it could be improved.
5. Sign members up for kp.org while they are waiting in the reception area or exam room. Take time to explain the benefits of using kp.org—for instance, the ability to refi prescriptions by mail or manage a child’s care online.
6. Create a friendly competition in your department to see how many members a staffer can get to try mail-order refill or KP.org.
7. Use service-improvement tools that help your team connect with members. Check with your UBT consultant or regional LMP Council for suggestions.
8. Improve access to KP services by working with your team to reduce the time members must wait for appointments.
9. Help new members get to know their care providers by providing a physician biography or a brief introduction about the nurse or pharmacist they will be seeing that day.

Managing in partnership is different from traditional management. You still have responsibility for managing employees’ performance, but when it comes to your department’s performance, the whole team plays a role in making the department a great place to work and to receive care. Frontline employees know where the problems are and have great ideas for solutions. Research shows that managers who engage their teams get better results, and team members are more enthusiastic about implementing the solution because they helped come up with it.

1. Be knowledgeable about the National Agreement. Download the National Agreement or get from your local human resources representative.
2. Get trained on the Labor Management Partnership. See your local learning and development website or our list of regional training contacts.
3. Proactively develop relationships with your union partners. Get to know your shop steward, union representative and other local labor leaders. Check in with them on a regular basis to share information and get their ideas.
4. Model partnership with your union partner. Treat each other with mutual respect. Attend LMP trainings together. Jointly develop meeting agendas and share meeting facilitation responsibilities. Share information, identify problems and develop possible solutions in collaboration.
5. Be accessible to staff. Spend time visiting with people on the front lines. Roam the department on a regular basis. Eat in the lunch room. Implement an “open door” policy for staff members who come by and want to talk.
6. Be open to the ideas of all employees. Encourage people to share ideas and have input on procedures or work flow. Create an environment in which people feel comfortable speaking up. And be open to trying new ways of doing things.
7. Create a structure for dialogue and engagement. Make sure time is set aside for partnership meetings, huddles and training.
8. Tell it like it is. Be open and honest in your communication and transparent with information. Share your department’s budget with team members to get their ideas on reducing costs.
9. Recognize and value employees’ contributions. Go out of your way to acknowledge someone who comes up with or implements an idea that has made the department a better place to work and provide care.
10. Develop employees to become department leaders. If union partners or other team members want to help the department succeed by polishing their problem-solving, meeting management or other skills, encourage and support them in their efforts.

Screenings for such diseases as colorectal and breast cancers, high blood pressure, diabetes and obesity help us proactively identify identifying health risks and early signs of disease Here are some ways everyone can help ensure our members stay as healthy as possible.

1. During a visit, print out and review with the patient any screening gaps that are identified on his or her Proactive Office Visit summary.
2. Use KP HealthConnect™ and/or panel management tools to identify and reach out to members who are due for a screening to check for high blood pressure or such diseases as colorectal or breast cancer.
3. Have receptionists keep an eye out for age- and risk-appropriate members during office visits and target them for follow up by care providers.
4. Create outreach scripting that personalizes the importance of preventive screenings.
5. Designate a staff member to contact members who received at-home fecal immunochemical tests (known as FIT kits), to remind them to return them.
6. Capture patients’ attention by posting or mailing brightly colored literature that explains how a test detects early signs of disease and can be life-saving.
7. Work with your local radiology department to identify the best days and times for same-day mammograms, so patients can get the scan without an appointment.
8. Contact hypertensive patients at pharmacy pick-up counters for blood pressure checks and consultations.
9. Have clinical assistants and/or medical assistants increase the number of outreach calls and blood pressure checks.
10. Invite a regional or local expert in prevention and screening to meet with your team to discuss how best to support regional and local initiatives without duplicating efforts.