Northern California

“What’s holding you back?”

Fresno Medical Center leaders asked their 50 unit-based teams that question directly late last year, at the same time they asked the teams to assess themselves on the new Path to Performance standards.

The answers mirrored what facilities everywhere say are challenges: training and sponsorship. Of the seven attributes of high-performing teams laid out in the Path to Performance, those two are consistently the most problematic.

Across the organization, many teams had their Path to Performance ranking lowered as a result of the 2010 year-end assessment—including Fresno, which UBT Tracker identified as having the highest percentage of high-performing teams in the organization. Fresno saw its number of Level 5 teams drop by more than half, from 27 to 14.

But Fresno had a plan for 2011.

“Early on, when we got a look at the Path to Performance, we created a strategy,” says Rick Senneway, Fresno’s director of performance improvement. “The Path to Performance helped focus us. (It) became very clear what we needed to work on.”

Even before they had the assessment results, Fresno leaders devised a 2011 UBT strategy for team development and performance improvement. It includes specific steps for moving teams at both ends of the spectrum along the Path to Performance.

“We’re engaged with our union partners at all levels,” says Jose DeAnda, medical group administrator. “At the UBT departmental level, (and) at the LMP Council level, by having each council member be a sponsor of UBTs and by having the sponsors report out at council meetings on how UBTs are performing.”

The goals were twofold: Move at least six teams up from Level 3 to Level 4 or 5 by the end of 2011, and help five teams achieve measurable improvement. Year-end assessments were not yet finalized when Hank went to press, but there’s optimism about the results.

“We did some good projects this year, and our affinity groups really helped,” says Navneet Maan, Fresno’s UBT consultant, referring to a system where teams working on similar projects met and shared ideas.

With a mandate to increase the number of high-performing teams by 20 percent in 2012, other teams and facilities might glean some ideas from Fresno’s three-pronged approach. 

Improve the support network for teams

One of the first things Fresno did was to revamp its sponsor network, including:

• Assigning sponsors to work in labor and management pairs and matching them so they share similar work areas;
• Reducing the number of teams sponsors work with to no more than four;
• Establishing new agreements that give sponsors more flexibility for how they meet with teams (in person or via email); and
• Setting quarterly deadlines for reporting on team status at LMP Council meetings.

The new agreements clearly defined expectations for sponsors, says Lynn Campama, Fresno’s assistant medical group administrator: “The role of the sponsor is about the performance of teams,” not about team management. “Everybody is accountable.”

Rather than trust that sponsors know how to be effective, Fresno used council meetings as a training opportunity. Sponsors received updated materials, ranging from a new form to help teams with meeting basics to information on the use of metrics and SMART (strategic, measurable, attainable, realistic/relevant, time-bound) goals. They also got forms to help collect team success stories and to help teams better manage UBT Tracker, the organization-wide system that helps teams report on and find effective practices.

In addition, “local resource network” members documented their particular expertise—be it UBT development, performance improvement, issue resolution and interest-based problem solving, attendance, service and workplace safety—and were assigned to teams needing that expertise.

“We took sponsorship to the next level,” says Lorie Kocsis, Fresno’s union partnership representative, LMP Council union co-lead and SEIU UHW member. “We tried to make their role easier for them to understand and to help them feel that they aren’t alone.”

Ron Barba, the director of the outpatient pharmacy and sponsor for the respiratory, inpatient and outpatient and surgery specialties teams, has noticed the difference.

“They gave us the training we needed to help the teams,” Barba says. “I feel more effective.”

Improve team training

To address training gaps identified by the teams, Fresno developed a brochure that puts all the offerings in one place—classroom, “just in time” and web-based training available through KP Learn—and groups the offerings by audience. That makes it easy to see what’s available for team members and what’s there for union and management co-leads.

At the same time, a request form for just-in-time training was developed, and both the brochure and the form were posted on Fresno’s intranet website. A clear process for requesting training was put in place, with team members instructed to submit their requests to Kocsis and Maan.

It didn’t stop there: Teams also got training in key partnership and performance improvement methods. A one-hour, just-in-time version of the eight-hour Consensus Decision Making (CDM) course was conducted with teams that requested or needed it. Teams working on non-payroll projects, such as reduction of inventory, were encouraged to take Northern California’s new business literacy training.

“Training had been one of our big downfalls keeping teams from higher performance,” says Debby Schneider, Fresno’s LMP consultant.

The brochure has heightened awareness of what’s available.

 “It helps us see at a glance what we need to take,” says Jeannine Allen, the administrative services supervisor and co-lead for the Adult Medicine UBT. “It’s been kind of a road map.”

Prioritize projects

To maximize the teams’ performance improvement impact, Fresno guided them toward projects that were achievable, would impact facility or regional goals, and were aligned with the Value Compass.

Teams used a  prioritization matrix to help them pick projects. That exercise sharpened teams’ focus and enabled members to “see how the work they are doing impacts the entire service area—not just their departments,” says Maan.

Teams shared ideas with their sponsors, who connected teams with other resources, including the experts in the newly established local resource networks and the affinity groups.

The experience of the Health Information Management team illustrates why such connections are invaluable. Its SMART goal was to improve customer service by way of a survey. Jeremy Hager, a care experience leader, was assigned to help the team.

He introduced the fishbone diagram to the team co-leads to help them identify which metrics the team should focus on to reduce customers’ complaints. He also helped them correctly interpret survey data. 

The affinity groups also helped teams. The six unit-based teams that made attendance a priority, for example, received tips, tools and specific training around the “six essentials of good attendance” identified by Ann Nicholson, LMP attendance leader for Northern California.

They also looked at their data going back several years, which “really made a difference,” says Eileen Rodriquez, assistant manager for OB/GYN. “It was an ‘aha’ moment.”

The team is meeting its attendance goals. With 6.17 sick days per full-time employee as of the first pay period in December, the team members exceeded the region-wide goal of 6.50. What made the difference? Managers are more flexible, and workers are more aware of the impact of missed days.

Staff members “feel comfortable coming to us,” says Norma Costa, department manager—and the team’s union co-lead, Lisa Madrigal, a medical assistant and SEIU UHW member, concurs.

“I know that if I need to take time off, I can go to my manager and talk with her about it and that she’ll do everything she can to accommodate me,” Madrigal says.

What's next?

Attendance will continue to be a focus of the facility’s UBT strategy for 2012—as will making it easier to use UBT Tracker. Refreshers on UBT basics will be provided, new tools introduced, and new affinity groups created.

And while local union steward elections will affect the sponsor pairings, sponsors will continue to get training and will continue to serve on the LMP Council in labor and management pairs.

Three years ago, when Joann Horton learned her job might be eliminated when HealthConnect™ came online, her first response was fear.

A medical clerk at the Hayward Medical Center in Northern California, Horton needed the income, but she also loved her job. “I was terrified,” she says.

Joyce Lee, an imaging transcriptionist at the Fontana Medical Center in Southern California, found herself in the same boat last year. With KP shifting to a new voice-to-text technology for transcribing radiology results, Lee’s skills were becoming obsolete.

“All of us were figuring out how we were going to do the transition,” she says.

Both of these “changing workplace” stories could have ended badly, especially in today’s shaky economy.

But now, Horton and Lee are fans of the job counseling and retraining provided to partnership union employees through the Employment and Income Security Agreement that allowed them to stay with KP.

Successful retraining 

The two women received one-on-one guidance from career counselors who helped them identify and train for in-demand positions.

Horton, who is now the department secretary for Home Health in Hayward, says career counselor Martha Edwards “gave me what I needed to build my skills up, but she also gave me a lot of emotional support.” Edwards works for the Ben Hudnall Memorial Trust, established under the 2005 National Agreement to provide career counseling and job training to members in 12 of the unions that are part of the Labor Management Partnership.

Lee, who now works as a phlebotomist at the Fontana Medical Center in Southern California, also received services through the Ben Hudnall trust. She says counselor Michele DeRosa “has a gift for networking; for figuring out all the pieces of the puzzle, for being the encourager.”

Ongoing outreach

The partnership’s career counseling benefits have benefited thousands of employees in a short amount of time. From its inception in 2007 through March 2011, roughly 10,000 employees had seen career counselors through the Ben Hudnall Trust, with many more attending workshops or promotional events.

The SEIU UHW-West & Joint Employer Education Fund offers similar services to SEIU-represented employees in the Northern California, Southern California, Colorado and Northwest regions. Since 2006, almost 16,000 KP employees have enrolled in training through the program and 6,885 have received counseling and referral services. 

Those who have used the programs’ services are enthusiastic proponents; however, ongoing outreach is required, Edwards says, especially since the concept of career counseling is new to many employees. 

“I think there’s a lot of mystery around the words ‘career counselor,’ ” she says, “and perhaps some intimidation and confusion.”

Obstacles to career counseling include a fear of being seen as vulnerable or needy, difficulty finding the time for training while working and concern that some managers might not appreciate an employee who is seeking to advance from their current position, Edwards says.

It’s an important part of the counselor’s work to help employees get over these hurdles so the program works best for their needs, she says.

Many employees first learn of the services when facing a major challenge, like Horton and Lee.

However, the programs are designed to offer help in many situations, from employees seeking to change careers to those wanting to gain skills in their field; from those struggling with a manger or co-worker to those struggling with work-family balance.

All services are confidential.

“Our goal is to have something for everyone,” says Lucy Runkel, director of the SEIU UHW fund. “We reach many employees, but we always want more.”

Managers are educational partners

Data from the programs show most employees learn of career counseling through word of mouth. Information also is available at events and online.

Both programs have started boosting educational outreach to managers, whom they view as key allies in spreading the word about the services.

“With a manager, we get more bang for our buck, because they can educate all of their staff,” says Runkel. 

Both Kaiser Permanente and its union-represented employees stand to gain, she says. “We think people who are better trained, happier, and have greater longevity on the job are going to provide better care than someone who is new, or unhappy or poorly trained.”

Career counselor Edwards put it this way: “It helps with Kaiser’s ‘best place to work’; seeing employees vital, motivated, moving and growing is a plus for the whole team.”

Successful unit-based teams take on multiple goals on the Value Compass, get results and move on. But focusing on the right goals—and not getting lost in the process—can be a challenge. Fresno Medical Center, which reports the highest percentage of high-performing UBTs in all of Kaiser Permanente, has developed tools to help teams set priorities. The prioritization matrix, a tool used in performance improvement, is part of a four-step process.

•   Step 1: Identify improvement opportunities with the team. Develop ideas with the help of the team sponsors or UBT consultants, and pay special attention to your Performance Sharing Program (PSP) goals.

•   Step 2: Use the Project Prioritization Matrix to determine project priority.

•   Step 3: Enter project data into UBT Tracker.

•   Step 4: Share project information with the UBT consultant or union partnership representative, who can connect the team with other resources, including “affinity groups” working on similar goals.

“It’s a very simple process that helps teams focus and know why they’re doing what they’re doing,” says Fresno’s Navneet Maan, a UBT consultant.  

“Teams can work through this process during their regular meetings,” she adds. “The project selection becomes a more transparent process, and the tool helps align their work with regional goals that will make a difference to members and patients.”

I am a big proponent of the team approach to medicine. That’s why I am an active participant of my department’s unit-based team.

As the physician co-lead for the Pediatrics unit-based team, I participate in the UBT meetings both to give and to receive ideas. Ideally, a physician brings to a UBT the vision on how to work together to provide the best possible patient care, support for the management co-lead, and the willingness and openness to listen to what other people have to say. 

According to Dr. Atul Gawande, noted author and surgeon, it used to be that doctors were trained to be cowboys. They worked alone and saved the day. In today’s world, what people really need are pit crews, teams of people where everyone’s function is vital to the overall success of the enterprise. Medicine is no longer an individual endeavor—it has grown so complex and multifaceted that no physician can know everything. So we need to foster the team approach to give our patients the best possible care. 

When I first came to Kaiser nearly 10 years ago, the thing I heard that really stuck with me was the KP Service Quality credo: “Our cause is health. Our passion is service. We’re here to make lives better.” I immediately connected with it and have used it to filter everything I do. 

In other words, I always ask myself: Does what we are doing support our cause, passion and goal? If it does, then it’s usually worth doing. 

Advice to other physicians  

• Say "thank you" and say "please." Really go out of your way to appreciate someone who comes up with an idea that has made your life easier. And do it publicly.
• Make time for daily huddles with your staff.
• Create an environment in which people feel free to share their ideas. One of the worst forms of waste is unused creativity.
• Give people the benefit of the doubt; pause and reflect when you feel yourself getting upset.
• Think outside the box. Go to staff members who aren’t at the nursing station to help out when needed. This gives the whole team a sense of ownership over patient care. 

Bottom line? Being a leader isn’t just about being in charge. Just because you’re a physician doesn’t mean you have to spearhead all of the work. If you really want to make a difference or a change, you have to include the entire staff. The work will get done better, faster and easier if we work together. And if you believe in the work that you are doing, then teamwork is a natural expression of patient care.