Southern California

Want to supercharge efforts to improve performance and help reach Kaiser Permanente’s strategic goals? Then bring unit-based team leaders together for a summit.

UBT consultants at several facilities in Southern California have organized summits that focused on Performance Sharing Program (PSP) goals, performance improvement strategies and affordability projects. All say they are seeing results in the forms of more robust UBT projects, clearer SMART goals, and stronger alignment between top medical center leadership and the work of UBTs.

After seeing teams improve service scores, reduce workplace injuries and save more than $160,000 in just four months in the San Diego service area, Sue Smith, a senior UBT consultant, concludes, “The overall experience was wonderful. Many teams had an exciting opportunity to network with other teams and learn new skills in a fun way.”

This spring, San Diego Medical Center hosted a UBT affordability summit, which brought together co-leads for a half-day to build the skills to tackle a new PSP goal for 2014 in the region: to increase the percentage of UBTs that successfully complete a project with hard dollar savings or improved revenue capture. (The projects are reviewed by finance departments to ensure they could lead to cost savings.)

Seated around large tables, UBT co-leads played a spirited game of “KP-opoly,” which offered a crash course in the organization’s finances. They heard from a UBT whose work resulted in cost savings. And they had time to work on driver diagrams and process maps for their own team’s affordability projects.

Co-leads gain PI skills

The year before, San Diego leaders—inspired by an event at the Riverside Medical Center—had held a more general, daylong UBT summit. That event brought UBT co-leads together for intensive training on performance improvement tools and created a space for them to refine their existing projects. Deadlines were set for finalizing driver diagrams and process maps, beginning tests of change and formulating sustainability plans.

The effort culminated in a UBT fair that showcased the projects that had begun as mere inklings at the summit: The ultrasound UBT demonstrated how it had gone injury-free for six months (it had been having at least one injury per month); the diagnostic imaging department boosted patient satisfaction scores from 87 percent in May 2013 to 93 percent in December.  

Leaders at the Woodland Hills Medical Center followed the same playbook, hosting an LMP summit in April that launched an array of of affordability projects to be showcased at a UBT fair scheduled for mid-July.

Mobilizing on PSP

At Fontana and Ontario medical centers, UBT staff used the summit model to mobilize the workforce around all of the region’s PSP goals. Top leaders from both management and the unions kicked off the day, then gave subject matter experts each 10 minutes to discuss the goal (whether it be service, workplace safety, attendance, etc.) and challenge co-leads to take on a performance improvement project to tackle it. A highlight was an impassioned and dramatic account from Roy Wiles, president of Steelworkers Local 7600, about a union member who did such a good job of saving up unused sick time that he recently retired with a five-figure nest egg in his Health Reimbursement Account.

The key to attracting co-leads to the summits, the consultants say, is to plan well in advance and to enlist top leadership to encourage participation. That lets managers and employees make plans for attending while ensuring their departments’ operational needs are met.

“This is part of their work,” says Priscilla Kania, senior UBT consultant at Ontario. “Your leaders are inviting you. People are excited to be in the room with top leaders.”

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.”

A January UNAC/UHCP steward meeting in Southern California included a traveling version of the Imagining Care Anywhere exhibit, and nurses across Southern California weighed in with their thoughts about the emerging technologies.

Gracie Johnstone, RN
Kern County

Our dermatologist left and we didn’t have one for a while. We did “tele-derm” with a doctor in Orange County. We trained the medical office assistants on how to set up the technology. We could do the biopsies, if needed, at Kern. It evolved really nicely. It saves a visit for the patient. I don’t think all this technology will take jobs from nurses because we still need the human touch. Nurses will become more techno-savvy.

Pam Brodersen, NP
Downey Medical Center

It’s great, but we have to slow down a bit. We don’t want to become an app. We still need that human connection.

Yoshini Perera, RN
Downey Medical Center

I love change, but I’m a little concerned we might get out of touch with the patient. As long as we can listen to and touch and feel the patient, that’s OK.

Nelly Garcia, RN
Panorama City Medical Center

I am concerned about the ability of computer systems to communicate with each other. We need to get the systems to connect in order to provide the best service.

Gerard Corros, RN
Irvine Medical Center

It’s like having a Ferrari all of a sudden. You can drive really fast, but you need speed limits.

Marcella Austin spent her first six years at Kaiser Permanente as a medical assistant. Three years ago, she became a licensed vocational nurse through a partnership between KP, the Ben Hudnall Memorial Trust, Chaffey College and the San Bernardino County Workforce Investment Board that funded a Pathway to LVN project. That gave her the support she needed to advance her career—tuition, books, tutoring and wages. She was one of the first of nearly 50 KP employees to graduate. She was interviewed by LMP Senior Communications Consultant Anjetta McQueen.

Q. What started you on your journey?

A. My father, who is diabetic, had a heart attack when I was in college. My mom and I were the first ones at the ER with him. It was scary, but I remember those nurses and how they took care of him and us. One of the nurses took an orange from her lunch and taught me how to do an insulin injection. I fell in love with nursing. Six months later, I became a medical assistant. I thought that was as close as I would get.

Q. How did you manage school after years of working?

A. I went to school full time and worked in Urgent Care from 5 to 9, getting my 20 hours a week. The Ben Hudnall trust covered the other 20 hours. I never lost a paycheck. It’s not like I could say I didn’t have the funds—the funds were there.

Q. What about the responsibilities at home?

A. I have two kids, a 16-year-old daughter and a son who is 13. I had a husband, mother and mother-in-law all helping me out. I used to be the one who cooked, cleaned and picked up after everyone. All of this helped my kids become more responsible.

Q. College nursing slots are hard to come by. How did Chaffey College help?

A. I have taken one course or another since graduation from high school. I also took time to get married, have children. Chaffey pulled all of my transcripts from everywhere and offered the prerequisite classes I still needed.

Q. Your wages and tuition were covered, but how did you manage all those other costs?

A. We owe a lot of thanks to the county’s Workforce Investment Board. They saw a need for educating people in the community. We didn’t have to worry about transportation, uniforms or supplies during our clinicals. All of that can really add up.

Q. How did the cooperation of your labor management partners help you?

A. Managers and labor leads stayed with us every step of the way. They had meetings with us. They kept asking us how they could help. If there was a barrier, if a schedule needed changing, they would work together to see that it got done. I especially appreciate the help from Susan Rainey, the department administrator for staffing at Ontario; career counselor Michele DeRosa with the Hudnall trust; Margaret Winningham, a senior Human Resources consultant for Fontana/Ontario; and Valerie Robinson, a Local 7600 representative.

Q. What is different about your work now?

A. In the LVN training, you get the basics—biology, anatomy, psychology—but you also learn about nursing care plans, sterile processing, wound care and get hands-on training all while attending school. I can assist RNs in several procedures, do minor surgical assists, order and co-sign documents in KP HealthConnect®.

Q. What is different about you?

A. My confidence has gone through the roof. I was selected to go to the KP Quality Conference, and I was invited to speak in a leadership meeting about my experience. The girls on the unit tease me now, saying they want my autograph.