Southern California

Improve service scores. Reduce waste. Retain members. Gain new members. Cut wait times. Work safer. Perfect patient safety. Innovate care.

Teams are juggling constantly, trying to meet their own objectives, move forward on initiatives related to facility, regional and national goals, and comply with regulatory requirements—all in a competitive economic environment.

When the curve ball comes sliding in, it can be one thing too many, derailing a strong team or keeping a struggling team at ground level. So a host of unit-based team supporters are turning their attention to strategies to help unit-based teams prioritize competing demands—from personalized mentoring to intensive workshops for co-leads.

“I see my role as taking away the noise and the chaos…to help them figure out, ‘Realistically, how many things can we work on at once?’” says Denise Johnson, San Jose Medical Center continuum of care administrator and a UBT sponsor. “I have to help them not be crazy, because we don’t want a lot of projects that don’t make a difference.”

Here are four strategies for helping teams.

Strategy #1: Planning pays off

Every year, labor and management sponsors at the San Jose Medical Center sit down with their UBT co-leads to develop an operating plan. The plan flows from Kaiser Permanente’s organizational goals as well as from regional goals, facility priorities, and the needs of the department. Each sit-down includes the service area’s UBT consultant and its union partnership representative. Projects emerge naturally from that plan, with teams turning to the Value Compass and a tool called a PICK chart to fine-tune their priorities.

“They have to figure out what’s in their sphere of influence,” says Eric Abbott, the area’s union partnership representative. “What are the things they can change, and of those things, how much time do they have?”

When Johnson became sponsor of one San Jose team, it was immediately clear to her the UBT had too much on its plate. She worked with the team to winnow eight projects down to two.

“In my experience, people get bogged down with the to-do list and sometimes don’t stop and think about what’s really on that list and what effort does it serve,” she says. “They thought I was crazy. They came from a mentality where ‘more is better.’”

Strategy #2: Urgency can be a tool

Two years ago, San Diego’s interventional anesthesia unit-based team was humming along in its performance improvement work when it got hit with the news that co-pays for patients who suffer from chronic pain would be increasing sharply.

The 14-member team responded with a new service project, a multiphase communication plan to help members understand the new co-pay and their options. And then the next wave broke: The team learned it had a matter of days to move into a new specialty services building. It suspended the co-pay project to plan for and complete the move.

One key performance improvement tool—a process map—proved instrumental. The team created a detailed map that laid out every piece of work that needed to be done in preparation for the transition, from changing procedures to adapting to a new phone system to altering workflows based on the new floor plan.

“They simply became a single-issue team,” says their UBT consultant, Sylvia Wallace, of the 2011 move.

With the process map in hand, the team spotted an opportunity to weave communication about the new co-pays together with communication about the move. As a result, it didn’t miss a beat in providing its members with critical information about available financial assistance.

The comprehensive plan helped the unit’s service scores hold steady through the transition—and then increase at the new facility. The moving plan became a template for other departments, which are still moving into the Garfield Specialty Center.

“Everyone participated. All types of ideas were solicited and implemented,” says Grace Francisco, the assistant department administrator and the management co-lead at the time. “Everyone has a role and accountability for each step.”

Strategy #3: Take time to train

Teams stand a better chance of weathering competing demands when they have a solid understanding of partnership principles and processes as well as performance improvement tools and methods.

In Colorado, the UBT consultants used LMP Innovation grant funds to host a two-day workshop centered on two regional priorities. Co-lead pairs from throughout the region learned how best to serve new members and improve the affordability of KP care by reducing waste and inefficient practices. They walked away with a variety of team improvement tools and resources.

“We are trying to set the teams up to be successful by giving them the time to focus on topics that could have a huge impact in the region in the next few years,” says Linda Focht, a UBT consultant and UFCW Local 7 member.

In San Diego, regular UBT summits bring co-leads together for intensive sessions on given topics. Service area and local union leaders play a major role in structuring the agenda, so the team development matches up with high-level strategy. The joint planning creates a full picture, one that resonates better at the front line and sets up teams to work on projects that make a difference to KP’s reputation.

“Leaders see a lot more than what we see,” says Jenny Button, director of Business Strategy and Performance Improvement in San Diego. “Leaders see what is going on with the competition. They see across all of the different metrics we are working toward. They see at a broad level where our biggest gaps are.”

Strategy #4: One-on-one attention counts

At San Jose Medical Center, sponsors like Johnson and Hollie Parker-Winzenread, an assistant medical group administrator, are coaching UBTs one on one in performance improvement tools to help them set priorities.

 “Teams like to jump to the solution,” says Parker-Winzenread. “But they struggle with the process….The gain falls apart, because the process is not strong.”

San Jose’s clinical laboratory UBT is a success story, jumping from a Level 1 to a Level 4 in less than a year after new co-leads worked together to reach joint agreement on the department’s priorities. The team started with tests of change that made strides in attendance. Today, it has moved on to complex projects that require shifting schedules to accommodate demands for getting lab results earlier in the day.

Guidance from their sponsors has helped keep team members on track.

“We’d come up with all of these ideas and projects, and they made suggestions and really helped prioritize what we worked on so we didn’t bite off more than we could chew,” says Antoinette Sandez, a phlebotomist, the team’s union co-lead and an SEIU UHW member.

“You have to help teams to believe in the process,” Johnson says. “As a sponsor I can’t rush the process and say harder, faster, move, move, move. That won’t get us what we want in the long run. Because we’re looking for sustainability.”

Among the telemetry units at San Diego Medical Center, 5 West had a bad reputation: It consistently had the most patient falls at the hospital. In 2011, for example, it had twice as many as the next-worst unit. Patients were suffering, as was morale. Managers and employees tried all sorts of measures to prevent falls—such as posting pictures of falling leaves on patient doors and using color-coded arm bands on patients to indicate fall risk—but nothing was improving patient safety enough.

Only when the unit-based team launched its “No One Walks Alone” campaign in 2012 did the numbers budge. It’s part of a larger trend in health care to shift from trying to assess a patient’s risk of falling to simply treating every patient as a fall risk and ensuring each patient is accompanied—especially to and from the bathroom, which is when most falls occur.

“This is for everybody, not just some,” says Lucila Gonzalez, RN, a UNAC/UHCP member who serves on the UBT’s representative group. After all, patients newly hospitalized after a stroke suddenly cannot do many things they used to do on their own. And elderly patients who were independent at home might resist getting help. “It takes time to adjust,” says Gonzalez.

Spread what works

The pilot project on 5 West—part of a collaboration with the Joint Commission for Transforming Healthcare that also involves six non-Kaiser hospitals—included installing bed alarms to let staff know when a patient was trying to sit up, so a caregiver could dash over and assist. When patient falls decreased dramatically in the first three months of the effort, the practices were spread in November 2012 throughout the hospital. And the results have stood up. The hospital previously had been averaging 16 falls a month. In October 2013, that figure was three a month.

Some employees had doubts about the initiative when it first started, says management co-lead Estela Enriquez. “They said, ‘Just don’t make it cumbersome.’ Others said, ‘It’s just not going to happen.’” Enriquez says, “For me, as a manager, it was an issue of staffing.” At first, it was harder to ensure nurses got their breaks. UBT members worked on their department budget and hired more unit assistants. They also worked together to build in time during the day for their added responsibilities. “We’d see nurses walking around the unit with the patients,” says Enriquez. “Then there was a sense of, ‘OK, maybe we can manage this.’” 

The inpatient units are sustaining their results by talking in their huddles about the falls that do happen, rounding on patients hourly to get them out of bed and into the bathroom safely, ensuring that bed alarms are activated and celebrating their successes.

Set ambitious goals

The slogan “no one walks alone,” which came from a UBT meeting, is more than a catchphrase, Enriquez says. “It is one that resonates with patients. The wife of a patient said her husband was embarrassed that ‘a big, strong guy’ couldn’t go to the bathroom by himself. The nurse finally got through to my husband when he said, ‘No one walks alone.’”

Jenny Button, director for business strategy and performance improvement at the hospital, says a key to success is to set an ambitious goal. It’s not enough to work to “reduce” falls or get to four a month, she says. “You have to say, ‘We want no falls.’”

A year ago, Susan Miles bid farewell to her diabetes medication—five insulin injections a day, one at each meal and two at bedtime—and cut her dosage of cholesterol-lowering statins in half. And she was only partway down the road toward improving her health.

“I know all about excuses. I’ve used the best of them,” says Miles, the ambulatory nursing director at the Ontario Medical Center in Southern California. Miles, 60, who's been with Kaiser Permanente for 34 years, tapped into the company’s tools and support systems—and her own willpower—to change her life for good. Despite her bad back, herniated disc and an arthritic knee, she has lost 94 pounds, changed her relationship with food and grown closer to family and co-workers.

“That’s really me,” she says, pointing to a picture on her desk of a much heavier woman.

Fat summer, skinny summer

Miles, an RN, always had a weight problem: “I’d have a fat summer, then a skinny summer.” She earned her bachelor’s and master’s degrees in nursing and moved up the career ladder at Kaiser Permanente. But the married mother of two children found it increasingly hard to take care of herself.

“I just didn’t feel good,” she says. “I loved my job, but it was getting harder to do. I had lost my mojo.”

More than two years ago, she tried taking the total health assessment (THA) but raced through it: Yes, her body mass index, or BMI, was almost 38, and of course, she had high cholesterol.

But when the statins got added to her medication regimen, she decided “it was my time to do something.” In February 2012, Miles enrolled in the weekly weight loss class offered at the Ontario facility. She retook the THA, slower, and “entered each and every line.”

“It puts a spotlight on all of your health issues,” says Miles, who used her THA statistics to help monitor her progress. In 16 weeks, she had shed 38 pounds. Her husband lost a few pounds, too, as he mirrored her eating. And the couple began taking weekday bike rides, breaking the cycle of “dinner, chores, bed”—with the bonus that they “rediscovered” each other.

Taking advantage of what’s available

Kaiser Permanente stands out in the field for focusing members on preventive health care and healthy eating, says Miles, who is quick to recommend KP programs—which helped her “reframe how I think about food”—to colleagues who marvel at her transformation.

“I haven’t stopped living, or eating,” she says. “We forget we are members too, not just employees. We need to take advantage of the programs we have. I really appreciate having KP physicians and dietitians at your fingertips to help you when you need it.”

From Miles’ perspective as a manager and an administrator, a healthy workforce is a happy and productive workforce.

“We depend on everyone being healthy and present,” she says. “We need to be models of that for our members.”

With changes this fall promising to bring more health care coverage to millions of Americans—and many more members to Kaiser Permanente—unit-based teams are helping to get member services in top shape.

Managing diseases, slashing wait times and cutting out the high cost of waste are naturally on the radar for caregivers’ UBTs. But operations teams also are working behind the scenes to make sure our services are seamless.

For instance, one team at the California Service Center in San Diego is working to make sure new members have a good “onboarding” experience. Its project aims to make sure that what an employer purchases for its employees is what those workers get when they show up at a medical center for the first time, ID cards in hand. No one wants a new member arriving at a Kaiser Permanente facility and being asked to fork out an unexpected copayment or, worse, being denied a service outright.

“This is the kind of solution that is—and should be—generated from the front line,” says Demetria Williams, a service center manager and the Contract team’s management co-lead.

KP's dual role

Kaiser Permanente is unusual in that we provide both insurance coverage and health care, and so how administrative services are handled affect a member’s overall impression of the organization. The Contracts team enrolls employer groups, entering the details of the lengthy contracts—copay amounts, covered medicines, vision care allowances and so on—that will apply to every employee covered by that particular contract. That sets the stage for the individual employee’s enrollment with Kaiser Permanente. If it’s all done correctly, everything goes smoothly when the new member arrives at one of our facilities.

The job is tough. About 18 account administration representatives refer to the signed contracts they’ve received from Sales and Account managers as they enroll a new employer group—or update an existing one—so the employees will get the right services. The account administration representatives contact the sales people when they find inconsistencies—when, say, the plan that was selected doesn’t include vision coverage, even though the associated contract calls for it.

“We would pick up the phone, but we were not connecting,” Williams says. “We were speaking different languages. We didn’t know what they wanted; they didn’t see what we saw.”

Despite the meticulous work, the team faced a 65 percent discrepancy rate—entries that are likely to cause problems for members when they seek care. So the Contracts UBT used the plan, do, study, act steps to track where the data was misaligned and trace it to specific parts of the process—and team members decided on a small test of change, hosting a “Day in the Life of a Contract” with members of the Sales and Marketing team.

Part of the difficulty was that sales managers and service reps work on different computer systems, with no connection between them. The competing systems were a swamp of alphabet stew: CIDARS, LOB, PA. Since merging the two systems into one isn’t in the offing, staff members found a solution at the unit-based team level.

Cutting through jargon

During two days of face-to-face meetings, the two sides cut through the sea of baffling acronyms and buzzwords and created a cheat sheet of common, acceptable codes.

Jeannie Athey, the Contract team’s union co-lead, an account administration representative for nine years and an OPEIU Local 30 member, said the UBT project was like a foreign student exchange. “We hadn’t seen their system before,” she says—and it was eye opening.

It’s too soon to have updated metrics, but Athey says anecdotal reports indicate the reps need fewer phone consults with sales managers and there has been less frustration between the two groups.

“Members can’t be enrolled until we’ve done our job of setting up the group contract,” says Sherri Saunders, the service center’s operations manager and the team’s sponsor. “If they’re not enrolled, they can’t get services. The contracts are legal documents. We have to get them right the first time, for our members.”

Jeff and Sara Simmons describe themselves as a “pretty average, middle-class” family living in a Northern California suburb with their sons. “We live a Lego life with two boys,” laughs Sara, describing her toy-strewn living room.

But eight years ago, Sara was diagnosed with Type 1 diabetes, thrusting her into a routine of checking her insulin, monitoring her diet—and paying steep bills for medication and medical equipment. Recently, 7-year-old Owen also was diagnosed with the disease. And the family has to plan for the possibility that 5-year-old Griffin might be diagnosed with it as well.   

Even though the family has medical insurance with Kaiser Permanente, the new bills related to Owen’s care overwhelmed them. They applied for help from one of KP’s medical assistance programs, which helped tide them over until they could get a handle on their new reality.

In the months since, the Simmonses have made some tough choices—deciding, for example, to sell their home and move to an area with a lower cost of living. But Jeff, a manager in a major corporation, worries about how families with lower incomes and fewer health care benefits than his would have fared under similar circumstances.

“How do they do this?” he wonders. “How are they surviving all of these curveballs?”

Health care is “absolutely not” affordable for most people, he says—then adds, “Everybody should have affordable health care. Period.”

A difficult equation

The passage of the Patient Protection and Affordable Care Act in 2010 was a major step toward ensuring all Americans have access to health care. As provisions of that act take effect in 2014, Kaiser Permanente will have an extraordinary opportunity to further our historic mission of providing affordable, high-quality health care to working families. But with the opportunity comes a difficult financial reality. Because these incoming new members may not have had access to health care in the past, they may be costly to treat—and federal reimbursements may be on the low side. In addition, the federal government has recently cut the rates for Medicare reimbursements, which typically have provided about one-third of KP’s revenue.

So Kaiser Permanente and unit-based teams face the challenge of treating more—and perhaps sicker—patients with fewer resources while maintaining and increasing the quality of care. Now more than ever, allocating our resources wisely is vitally important.

Frugal power

It’s easy to see how departments with multimillion-dollar budgets play a role in keeping KP affordable. For example, National Facility Services kept an eye on potential energy savings when a new data center was built and saved about $450,000 in electricity costs in 2010 and earned a $300,000 incentive from the local utility company. Another example: KP saved $26 million in 2010 alone by buying safer and more environmentally friendly industrial chemicals. And a redesign of the way KP deploys computer workstations saved $12 million as of August 2011.

But unit-based teams have just as big a role to play, even if most don’t control huge budgets. The fact that there are more than 3,500 UBTs across the organization means savings can add up dramatically.

Some teams are saving “light green dollars,” focusing on efforts that indirectly improve the financial picture. That might be boosting service and quality, which helps us get new members and retain the ones we have, or improving patient safety, which reduces a variety of expenses, including costly hospital readmissions.

Others are tackling “dark green dollars,” direct savings that improve the bottom line right away. In fact, efficiency and non-payroll cost reduction is the fastest-growing category of projects for teams, according to an analysis of UBT Tracker data.

Is your team looking for new ways to save light or dark green dollars—or in need of ideas to get started saving? Read Four Ways to Save.

Fremont’s Operating Room team loved taking the first parts of Northern California’s business literacy training—so much so, it immediately requested the last two sessions, when teams pull out their budgets to review line-item expenses for the department. The review of payroll and non-payroll budgets has caused controversy and concern in some quarters, but the Fremont OR team not only took it in stride, it rode the momentum of the training by developing several performance improvement projects to reduce waste. One of those, streamlining its ready-made surgical supply packs, is projected to save roughly $34,000 a year. The Northern California training began rolling out in 2011. The first three sessions are a tutorial on the basics of Kaiser Permanente business, explaining such things as our integrated business model (how the various KP entities do business together), key sources of revenue, and business concepts like margin goals. The rubber meets the road in the final two sessions, with their look at the department’s financial realities. Team co-leads Yolanda Gho, Operating Room nurse manager, and Gus Garcia, a surgical technologist and SEIU UHW steward, talked with communications consultant Cassandra Braun about the training, its benefits and how it inspired their team to do better.

Q & A

Q. Were you concerned about sharing the department’s payroll and non-payroll budget with staff?

Gho: Not really. I thought, “Why don’t we highlight the areas where we have opportunities to improve, like sutures—ones we can improve on and have control over.” With payroll, my one concern was showing someone’s salary. But it was explained that they didn’t show individuals’ salaries. So I was totally on board.

Q. What was the staff’s reaction to the training?

Gho: The response was quite eye-opening. There was an audible gasp. When they saw [the red lines], they were like, “Oooh, I thought we were doing great. Why do we have all that red on the screen?” What’s great about this group is their minds immediately started running, thinking about what they could do.

Garcia: To me, it’s like: We can fix that, or come up with ideas (for fixing it). That is what melds it all together.

Q. Talk about your project to streamline surgical packs and how it was influenced by the business literacy training.

Garcia: Surgical packs have draping and supplies for each particular procedure. They’re ready-made. So you always had to add things or throw away things that you didn’t want, depending on the procedure. I was trying to see what we need or don’t need. I worked with the supplier and our teams, like general surgery, and I asked their opinion—“What do you need in this thing and what do you not need?” We streamlined the packs to have the bare minimum. So everyone uses everything in the pack.

Gho: After the training, Garcia wanted to revisit this issue, because he had brought this up before.

Garcia: The wheels were turning in my head. If we’re not using it, we’re wasting money.

Q. You also started work on reducing waste of sutures and other supplies?

Gho: Yeah, it was a culture change. In the past, as a nurse or tech, you were trained to always be ready. You were trained that the surgeons shouldn’t have to ask for something. Some people think that if they’re able to do that, they’re seen as efficient and anticipating the needs. But the world is different, the economy is different. Now we have to ask ourselves, “Do we need to have this open to look good or just in case a surgeon asks for it? Or is it OK not to open it, but to have it in the room and ready?” Before, we were all trained that way—anticipate, anticipate, anticipate. We now give ourselves a centering moment before we open sutures or supplies that are not needed immediately for a case.

Q. What advice would you give to other teams thinking about taking business literacy training?

Gho: My advice is to help educate your staff members by being transparent about information that affects them and the team. As a manager, I want to create awareness and understanding of the issues with my staff. It bridges the information and knowledge gap. The more we’re armed with information, the better decisions we make.

Garcia: If it was up to me, I’d have everyone take the class. I think it just gives you a different perspective. It breaks it down and gives you an overall view that staff members don’t get to see all the time. It keeps them informed.

Gho: People tend to complain about things but do nothing about it. In our UBT, you bring solutions. We’re doers. It’s our chance to do something.

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.”