Senior Orange County executive shares keys to success
Checklist used by turn team captains in San Diego's 2 North/South Med-Surg units when the team turns or lifts a patient, to ensure the procedure is done safely and the chance of injury is minimized.
Checklist used by San Diego's 2 North-South Medical-Surgical teams to help conduct safety observations while the team turns or lifts a patient.
The 2 North-South medical-surgical units in San Diego were identified as high-injury departments.
One year, the combined team saw 16 patient-handling injuries. Before that, the number was 18. Repetitive back and shoulder injuries were most common. As a result, management was told to eliminate injuries—fast.
The first step in the action plan required staff members to undergo Workplace Safety training on how to conduct safety observations. Each person then conducted three observations a week on teams turning patients and submitted those observations to a collection box in the department. The observations were logged into the Workplace Safety web-tracking tool.
Previously, only charge nurses and managers conducted the observations. But getting everyone involved kept proper patient-handling techniques constantly at the forefront of team members’ minds.
Getting buy-in from staff members was another challenge, so it didn’t feel like another thing on top of their regular workload.
“Make sure you communicate—and with some degree of consistency—to everyone,” nurse manager and RN Erlinda Aquino says. “And hard-wiring it so people understand it’s not just the flavor of the month.”
The UBT adapted a checklist of key things that should be done when turning a patient, such as ensuring a patient’s bed rails have been lowered. Turn-team captains referred to this checklist at every patient turning.
To help morale and maintain safe patient-handling techniques, the UBT set small, attainable goals the department could celebrate.
The team had a pizza party when it reached the first 100 days without an injury, then again after accruing no injuries for the month of July, which historically had been the units’ highest injury month.
“In the beginning, you have to consistently remind people,” says Tess Patiag-Limcuando, RN. “People felt that doing those steps just added to the time, not realizing that it would cost them a whole lot more time if they hurt themselves.”
It was also important to focus on the positive.
“Instead of emphasizing the negative, present it like, ‘I care about you; I want you to be safe.’ Versus: ‘You’re in trouble,’” Aquino says.
San Diego's 2 North-South Medical-Surgical team dramatically reduces patient-handling injuries by having all staff members conduct regular safety observations.
A team in South San Francisco that improved the surgery-scheduling process for patients and teams in San Diego that took a hard look at their service scores demonstrate what things look like when teams truly consider what's best for the patient as they make decisions.
This poster reveals how 'Care cards' helped a Med-Surg team in Irvine improve patient satisfaction scores.
By organizing a healthy eating club, UBT co-leads at the optometry department at the South Bay Medical Center in Southern California build team pride and a healthy work force.
New blue wrap recycling project at Sand Canyon Surgicenter saves money and the environment and helps the disabled.
Looking for ways to make the Sand Canyon Surgicenter in Irvine more efficient, Albert Olmeda wound up learning a lot about blue wrap—like the fact that it makes up nearly 20 percent of the waste generated by hospital surgical services.
The lead Central Services technician and SEIU UHW member also learned that this heavily used hospital product, an industrial strength plastic used to maintain the sterility of medical and surgical instruments until opened, is not biodegradable and persists in the environment.
But recycled blue wrap can be sold as raw material for use in the production of other plastic products. Today, the surgicenter’s unit-based team has gone green with a blue wrap recycling project that is not only saving money and protecting the environment, but also aiding the community.
“The biggest problem with the blue wrap is when we throw it in the landfill, it’s there forever,” says Olmeda. “That’s a big concern especially considering how much blue wrap we use.”
About 600 pounds of blue wrap is collected every week from the center’s six operating rooms. It is picked up free of charge and sorted by Goodwill of Orange County, which sells it to a Houston recycling services company. The company reprocesses the plastic into beads that are used in various products, including railroad ties, pallets and artificial siding for decks, docks and houses.
The surgicenter has been recycling its blue wrap and plastic bottles since September 2009, reducing the facility’s solid waste disposal fee by 10 percent annually. The savings amount to a modest $5,880—but there’s a greater payoff. Proceeds from the sale of blue wrap and other recyclable products enable Goodwill to provide education and training programs for developmentally and physically disabled adults, including a state-of-the-art fitness center.
Peter Bares, business development manager for Goodwill of Orange County, says the relationship with Kaiser Permanente has gone beyond expectations. “It is kind of the perfect storm because of the nature of what we do and why we do it and the materials that the hospital generates,” he says.
As the frontline staff person responsible for the surgery center’s blue wrap disposal, Olmeda—and his fellow UBT members—championed the recycling cause, educating the staff at weekly in-services and UBT huddles. The team got the rest of the department on board by integrating the blue wrap recycling process without creating additional tasks.
“We figured if we changed workflows, staff wouldn’t want to do it.” says UBT co-lead Nicole Etchegoyen, a surgery scheduler and SEIU UHW steward. “But if we asked them, ‘How would this work best for you?’ then everyone would get involved, and they did.”
The team members designated a single container for blue wrap in each operating room. They also placed a larger bin for collecting multiple bags of discarded blue wrap near the soiled utility room, where the trash is taken on its way out of the surgery center.
“It’s not a big deal,” EVS worker and SEIU UHW member George Sollars said, hoisting bags. “We just carry it over here on our way out this door. It’s one of the easiest jobs. And it’s for a really good cause.”
The hardest part was making make sure that other trash didn’t make it into the blue wrap recycling containers accidentally. Labeling the containers with signs reading ‘Recycling Blue Wrap Only’ helped, as did regular reminders by UBT members.
Now, everyone in the operating rooms—from doctors, nurses and surgical techs to nursing assistants and EVS workers—makes sure that the blue wrap containers aren’t contaminated with other trash, Etchegoyen says.
Olmeda does periodic spot checks. “Everybody who plays a role in the operating room has to look out to make sure no trash is going inside the containers,” he says. “It’s a team-building thing.”
“If it wasn’t for the UBT, this wouldn’t be happening,” said Ramin Zolfagar, MD, department head and UBT member. “We are helping the environment by ‘going blue,’ so to speak, and the end result is gym equipment for the disabled—which makes it all the more worthwhile.”
After learning about the project at a recent Orange County UBT fair, other departments are thinking about emulating it.
Visit the Goodwill of Orange County website to find out more about their work.
The team in the Head and Neck Surgery/Audiology department at the South Bay Medical Center had been compiling monthly reports about missed second blood pressure checks.
And this can be a critical point for a patient’s care because high blood pressure is often called “the silent killer.” Those who have it often don’t exhibit symptoms until it’s extremely high, and untreated hypertension can lead to heart disease, stroke and kidney problems.
But the team reviewed the numbers without a follow-up plan.
So, they decided to have morning huddles several days a week to explain the screenings and follow with plans of action.
“We discuss why this is important and what it means to our members, that it can save lives, especially for those who haven’t been diagnosed,” says Kathy Malovich, the department administrator.
UBT leaders provided team members with their individual performance scores on administering needed second blood pressure tests. They customized training and other follow-up plans, including coaching the team on procedures for Proactive Office Encounters (a process that takes advantage of a member’s visit to ensure the member gets any needed tests or appointments).
At huddles, they discussed the importance of controlling high blood pressure for patients. They emphasized that not only was it a strategic clinical goal but a Performance Sharing Program (PSP) goal for the medical center.
“People think they’ve done the second test because they know they should have,” says Leroy Foster, who was the department administrator when the test of change began. “Maybe they got distracted by any number of things.” Foster said the hard data helped motivate the team.
With a low of 35 percent for second blood tests, each team member jumped to 92 percent or better in a year. Four of the six team members hit 100 percent. In 10 months, team scores for second blood tests went up from 84.8 to 92.1 percent.
Huddling was also a key to success.
“I used to think, ‘you guys have way too many meetings,’” Jennell Jones, the union co-lead, says. “But now I see how meeting keeps people connected.”
A speciality department at South Bay Medical Center learns the value of routine screenings and gets results.
The San Diego Ophthalmology group had earned the dubious reputation as a high-injury department.
They had a quarterly injury rate of 23.6 and problems ranged from carpel tunnel to back issues. The majority of complaints was caused by sitting at the computer for long periods, typing and doing repetitive motions like using a mouse.
Medical assistants and technicians also frequently complained about having trouble navigating the cluttered, unsafe vision lanes—the small alcoves where nurses and medical assistants evaluate patients before escorting them to exam rooms.
Being flagged a high-injury department, the team was determined to identify the causes of the injuries and how to prevent them from occurring.
The department took Workplace Safety training and instituted a number of measures to identify and fix potential hazards at all four ophthalmology departments. Those measures included ergonomic evaluations, new chairs and foot rests, and installing stretch break software on all computers.
They conducted regular safety checks and created the “I Spy” program, which has previously injured workers conducting safety observations to identify potential problems.
The team also revamped the department’s vision lanes.
These often were cramped and potentially unsafe environments with electrical cables stretched across the narrow floor. Computers and blood pressure carts created additional tripping hazards.
“You had to maneuver around patients and wheelchairs, and generally feel confined, waiting to trip or bend wrong,” says Anna Garcia, a medical assistant and UBT member.
So, they mounted blood pressure machines and KP HealthConnect computers on the walls, instead of using carts. They purchased new chairs for patients, particularly for older patients who have difficulty getting into narrow spots or are in wheelchairs.
By moving power outlets closer to the mounted equipment, electrical cords were no longer in the way. And they painted the walls that ophthalmologists used during eye examinations.
“The nice thing is if I need to maneuver now, it’s not a move I’m going to regret later on when I get home, when my back is hurting,” Garcia says.
Ophthalmology went 335 days without an injury.
But keeping workplace safety in everyone’s awareness was a challenge.
“The equipment makes a difference, but our behavior also makes a difference. It takes a while for that to happen. It doesn’t happen overnight,” Vickie Lance, assistant department administrator says.
Feedback from people outside the UBT also proved invaluable.
“I’ve been in this department for 15 years and I didn’t know there was a problem. Once we saw it on paper, it made a big impact,” Lance said. “And the visual picture of before and after is wonderful. It makes us feel like we’ve accomplished something.”
San Diego's ophthalmology team reduced ergonomic workplace injuries while also clearing their vision lanes, which had posed serious safety hazards for medical assistants and patients.
Vickie Lance, 619-516-7172