Southern California

Beep! Beep! Beep! The electronic sound of Cary Brown’s alarm clock wakes him at 5 a.m.

The Kaiser Permanente member rises to shower and make breakfast, careful not to disturb his sleeping wife, Elissa, who is recovering at home after surgery on a broken leg at the Woodland Hills Medical Center in Southern California.

On top of completing household chores, the retired Hollywood TV director spends his day making sure Elissa is comfortable and pain-free.

The experience has taken a toll on him.

“The hours of staying awake and the repetitive nature of it—and not having any life at all outside of home—is very difficult,” says Brown, who worked on the hit TV series Doogie Howser, M.D.

Now he’s part of an ambitious effort by the Southern California region to enhance support for caregivers, who play a vital role helping to heal and comfort patients outside the hospital. By reducing caregivers’ social isolation, integrating them into the hospital care team and addressing their health needs, regional leaders hope to improve patient safety and quality in the home.

‘Human-centered design’

Under the initiative, frontline workers, physicians and managers are partnering with KP members and their families to design the ideal in-home care experience for patients and caregivers. Participants are using a creative approach to problem solving known as human-centered design, which starts with the people you’re designing for and ends with solutions that are customized to their needs.

“It’s a way to engage the folks who are most affected from day one,” said Dr. Nirav Shah, senior vice president and chief operating officer for Clinical Operations in Southern California. “No program that I could ever design will be as good as one that had the people who are most affected design it with us. It’s about empathy and understanding.”

Human-centered design is also an ideal tool for unit-based teams to use on performance improvement projects. It delivers on the fundamental concept of the Value Compass—to put the member and patient at the center of decision making—and both frontline workers and Labor Management Partnership leaders, from management and the Coalition of Kaiser Permanente Unions, have been supporting the caregiver project.

Reducing the overwhelm factor

At a meeting in Pasadena, the participants—patients and caregivers, KP employees and physicians—gathered in small groups to share personal tales and draw storyboards to help identify barriers, come up with potential solutions and provide insights to regional Home Health leaders.

Shawna Wallace, a senior physical therapist for Home Health and member of UNAC/UHCP, said the experience was eye-opening.

“I’ve gone into homes where caregivers really care about their loved ones, and they are extremely overwhelmed,” she said. “This is a great opportunity for us to see where we can make better programs for our caregivers and members in these scenarios.”

Brown is hopeful that the approach will give caregivers—and their loved ones—the emotional and physical support they need to thrive.

“If you take care of the family as a unit,” Brown says, “you make it possible for each individual in the family to be better.”

Su-Xian Hu and Runeet Bhasin make partnership look easy. The telemetry team co-leads at Downey Medical Center in Southern California share a relaxed rapport that belies the time, planning and occasional friction that are part of running a busy inpatient unit. 

Together for more than a year, the pair attribute the success of their budding relationship to communication and a commitment to partnership principles—especially consensus decision making. Those core values came in handy recently when a disagreement arose about the best way to educate patients about medications. 

Nurses preferred a less overwhelming one-page sheet, but managers wanted to switch to a detailed three-page form that had been adopted by other units in the hospital. 

“It was a major issue,” says Bhasin, RN, a staff nurse and member of UNAC/UHCP who is the team’s labor co-lead. “We had to come up with a solution to fulfill management’s needs and labor’s needs.”

At the time of the disagreement, UBT members turned to consensus decision making to determine next steps they all could support. A subsequent test of change resulted in a short-term fix: Nurses used the short form with patients, while the longer handout was provided as a resource guide in patient rooms.

New to partnership

Managing in partnership was a new experience for Hu when she joined the team in April 2016 as assistant clinical director and became a co-lead. She previously had overseen a Kaiser Permanente inpatient nursing unit that was not part of the Labor Management Partnership. Bhasin, a co-lead with two years of experience, served as mentor and coach.

“Runeet was wonderful with helping to bring me onboard,” says Hu, who is also an RN. 

Both say LMP training has given them a shared understanding of their roles as co-leads, the purpose of UBTs and how to use consensus decision making. A business literacy class both took proved especially fruitful: With the information they brought back, the team tackled an affordability project that reduced overtime costs by more than $95,000 last year. 

“The UBT classes,” says Bhasin, “made me realize the real meaning of partnership, the collaboration of labor and management to work toward the same goal to provide high-quality care and to have a great work environment.”

The pair’s approach seems to be working. Their 75-member UBT is at Level 4 on the five-part Path to Performance, and it has earned accolades for outstanding patient care and gains in workplace safety and affordability. 

“We want what is best for patients and for staff,” says Hu. “We might have differences, but we always come together with open and professional communication, sitting down together to solve those issues.”

Budget-savvy shoppers know you can save money by buying in bulk—even, it turns out, when you’re buying pharmaceuticals. Just ask the team members of the Zion Outpatient Pharmacy in San Diego.

The unit-based team was able to save more than $1 million over five months by buying drugs in quantity and managing specialty medications better. And, adopting a practice that would make Goldilocks happy, the pharmacy now keeps just the right amount—no more, no less—of high-cost meds in stock. Managing costs helps keep expenses down for members, and the team’s improved communication means better service for patients, whose medications are there when they need them.

Not so long ago, the financial picture looked bleak for the 24-hour pharmacy, which serves discharged hospital patients and other members at the bustling Zion Medical Center. Inventory had swollen to more than $3 million. It was a signal the pharmacy had too much stock on hand and wasn’t turning it over frequently enough. 

“We realized that we needed to do something,” says Nathan Close, outpatient pharmacy supervisor and management tri-lead of the 45-member team, which is at Level 4 on the five-point UBT Path to Performance.

Honest assessment

Team members set a five-month goal to reduce their bloated inventory by $600,000, from $3.2 million to $2.6 million, starting in January 2016. 

Their first step was to review the pharmacy’s ordering and inventory practices. Team members quickly realized they were overstocking oral chemotherapy, Hepatitis C and antiviral medications. At $10,000 a bottle, rarely used pharmaceuticals suck up resources when they sit on shelves. Worse, if they aren’t used or returned to the manufacturer before they expire, they’re a costly mistake.

To get a better handle on prescription trends, team members reached out to ambulatory care pharmacists, who are part of a different team and who collaborate with physicians to treat members with cancer or chronic conditions. By partnering with the pharmacists, the team was able to plan ahead better.

“Once we know what patients are going to need, we make sure that we have that in stock,” says Wesley Frani, a pharmacy assistant and UFCW Local 135 member who is one of the team’s labor tri-leads. 

Key to the team’s success is another labor tri-lead, Jane Corby, an inventory control assistant and also a UFCW Local 135 member. She carefully monitors stock levels to ensure that when patients present their prescriptions, the right medications are on hand.