Southern California

Creating a better workplace turns cynics into champions of unit-based teams. UBTs give workers represented by a union in the Coalition of Kaiser Permanente Unions a way to lead change. They help workers, managers and physicians better serve Kaiser Permanente members and patients. Yet too many people don’t know they are part of a UBT. Truth is, everyone in the unit is a UBT member. And, as you’ll see in this issue, engaging with your team can change lives—including your own. Read on and see how.

Big picture comes into focus

Kimberly Carolina, clinical assistant, OPEIU Local 2, Neurology (South Baltimore Medical Center, Mid-Atlantic States)

"When we first learned about working in partnership, I thought it would be difficult. I was a little skeptical and reluctant. It was hard to work with management because they’re actually your boss. I was part of a hiring team and felt uncomfortable speaking up to say why I thought certain candidates wouldn’t work.

Working as a team was very new to everyone. I wondered if there would be backlash or repercussions. Some employees didn’t feel secure about their jobs and didn’t feel like they even had a voice. One day, I realized they were the same as I was. I had a fear of speaking up and so did the managers. After I realized that, we were able to move forward. Employees, providers and everyone needed to have a voice. We needed to not only talk, but to make things happen. It’s been a lot of learning, a lot of great experience and growth.

When I first started out I didn’t see how you needed each person and each piece to make the company grow. The puzzle came together for me.

Now the communications piece is there. We work to be effective, efficient and see the broad picture. It’s amazing to see everyone come together with one common goal to fix things, such as patient wait times.

I enjoy it better now. I’m learning more. I like the results I have seen. Partnership is like you had a child two decades ago and they’ve grown up to be a successful person."

The Labor Management Partnership operates in seven of Kaiser Permanente's eight operating regions across the United States. These regions serve the needs of their respective KP members and patients, guided by a common set of partnership principles and practices. Learn more about each.

Colorado

Serves 541,000 members in 34 medical offices. Of its 256 unit-based teams, 188 (73 percent) were rated high performing as of June 2021.

Georgia

Serves 316,000 members in 29 medical offices. Of its 108 unit-based teams, 94 (87 percent) were rated high performing as of June 2021.

Hawaii

Serves 258,000 members throughout the islands, in 24 medical offices and one hospital. Of its 60 unit-based teams, 54 (90 percent) were rated high performing as of June 2021.

Mid-Atlantic States

Serves 787,000 members in Maryland, Virginia and the District of Columbia in 39 medical offices. Of its 277 unit-based teams, 213 (77 percent) were rated high performing as of June 2021.

Northern California

Serves 4.5 million members in 249 medical offices and 35 hospitals. Of its 1,347 unit-based teams, 1,006 (75 percent) were rated high performing as of June 2021.

• LMP NCAL [KP intranet]

Northwest

Serves 633,000 members in Oregon and Southwest Washington, in 59 medical and dental offices and three hospitals. Of its 407 unit-based teams, 280 (69 percent) were rated high performing as of June 2021.

• LMP Northwest [KP intranet]

Southern California

Serves 4.7 million members in 257 medical offices and 19 hospitals. Of its 1,115 unit-based teams, 789 (71 percent) were rated high performing as of June 2021.

Washington

Serves more than 688,000 members in the Puget Sound area and east to Spokane with 48 medical facilities and one hospital. The Washington region became part of Kaiser Permanente  in 2017. The region's LMP council held its first meeting in Q2-2019.

• KP Washington LMP [KP intranet]

National Functions

These departments (Finance, Health Plan Administration and IT) serve KP members, patients and staff across the program. Of 81 unit-based teams, 50 (62 percent) were rated high performing as of June 2021.

Most people think about advancing their careers as a personal goal—if and when they get the time and support to map out a plan. But Panorama City’s Emergency Department unit-based team saw that boosting the team’s skills also matters to KP members, patients and the department. It used collaboration—and LMP trust funds—to improve the workflow and put several staff members on a solid career path.

“It’s not just about making more money. It’s also about being able to provide the best care possible,” says Richard Rowland, one of two emergency room assistants finishing courses needed to earn promotions to emergency service technician positions.

Early last year, the unit-based team started a “door-to-doc” project aimed at moving patients more efficiently through the ER. Results soon stalled because many staff members lacked the training or official certifications to help nurses with such triage duties as drawing blood and organizing labs. About that time, Sylvana Hrovatic arrived as assistant department administrator and management co-lead. She was focused on improving patient service and care, and says it was her labor partners who steered the conversation to career development.

With the help of ward clerk transcriber Becky Linares, labor co-lead and an SEIU UHW steward, the UBT reached out to the SEIU UHW-West & Joint Employer Education Fund to create a plan for employee career advancement in the department.

Receptionist Sam Eckstein encourages his co-workers at the Woodland Hills Medical Center lab not only to meet—but to exceed—patient expectations of excellent service. To back up his coaching, he’s using the knowledge he gained in a new LMP course on business and economic literacy.

During the course, Eckstein and about a dozen other workers and managers learned about the rising cost of health insurance in the United States and the trend toward businesses’ shifting more health care costs to employees.

Because patients are paying more, “Their expectations are higher,” says Eckstein, a member of SEIU UHW. “When patients come in without an order [for a lab procedure], we can’t just send them home,” and inconvenience them by making them come back another day, he says. “We have to help meet their needs.”

Eckstein took part in a pilot project to test the Labor Management Partnership’s new approach using popular education techniques to ensure frontline employees and managers have the context and know-how they need to continue improving team performance and keep Kaiser Permanente affordable.

What’s different about popular education?

Popular education turns the old-fashioned schoolroom model of teaching and learning on its head. It is ideally suited to the Labor Management Partnership, which is built on the belief that all employees, managers and physicians bring their expertise and experience to bear on improving service and care at KP. No longer is the teacher or trainer the sole expert in the classroom, there to fill students’ minds with information they passively receive, memorize and repeat.

Instead, popular education taps into participants’ experiences in their communities and workplaces and uses them to generate dialogue. It explores the social and economic context of students’ lives and asks probing questions: What are people happy about? Worried about? Fearful about? Hopeful about? Students are encouraged to analyze that information—and to take action.

Quan Nguyen, DO, learned in seventh grade how devastating a workplace injury can be. His father, a carpenter, severed part of his thumb when he lost control of the power saw he was using. The accident put him out of work for a time and forced the family to stretch its skintight budget even further.

Years later, the memory inspired him to join Orange County’s Workplace Safety Steering Committee, says Dr. Nguyen.

“I’ve witnessed, firsthand, how things at work can lead to pain and suffering for the person and his family,” says Dr. Nguyen, a physical medicine and rehabilitation physician at the Chapman Medical Offices in Orange, California. “We’re like a big family at work and I don’t want to see people hurt.”

Team visits worksites to improve safety

As the sole physician on the 12-member committee, Dr. Nguyen uses his singular perspective to engage physicians and others to build a culture of workplace health and safety.

“He’s very unique,” says Jim Ovieda, assistant medical group administrator and the committee’s management tri-chair. “He brings another voice of authority to the conversation.”

Four years ago, Dr. Nguyen helped form the Tiger Team, a task force of union members and managers who visit units with high injury rates and offer expert advice on how to reduce risks. They developed a simple process to identify and address workplace hazards at the local level (see “Five Tips for Workplace Safety Site Visits”).

“It’s not a punishment. We’re there to help departments succeed and to help our staff and physicians to be safe,” says Dr. Nguyen, who named the Tiger Team in honor of “Tigger,” the fictional tiger character who bounces around and helps others.

Collaborating with frontline union members is vital to keeping everyone safe, says Dr. Nguyen.

“There seems to be two cultures inside the hospital – the physician and non-physician. We’re trying to bridge those two cultures by bringing together a diversity of voices to improve the culture of health and safety for everyone,” says Dr. Nguyen. 

Host teams say the visits and ensuing discussions help create an environment where everyone feels comfortable speaking up—essential to building safety into daily work.

Partnership approach gets results

The team aims for six site visits a year and had conducted 31 visits as of November 2015. Most of those departments reported significantly fewer injuries in the months after the visit; many reduced injuries by 50 percent or more. The approach has gained attention region-wide and other medical centers in Southern California are adopting the practice. The team also presented its partnership approach at the 2016 National Workplace Safety Summit.

“It’s a way of taking the pulse of the department,” Ronald Jackson, a medical assistant, SEIU-UHW member and the steering committee’s labor tri-chair, says of the team's site visits.

“We bring a fresh set of eyes to the department,” says Albert Alota, workplace safety coordinator for Orange County.

Three practical solutions

Recently, the committee’s labor and management members sat side by side reviewing workplace safety records for the Irvine Medical Center’s recovery room. The department had accrued nine injuries in as many months, three of them involving employees and gurneys. The team identified several hazards related to work space and storage and recommended ways to fix them. For example:

• To address heavy traffic down narrow hallways and around blind corners: Provide standardized traffic flow for gurneys, mirrors at key intersections and a recognized verbal cue to alert bystanders to passing gurneys and equipment
• To unclog crowded patient bays that forced staff to work at laptops in busy hallways: Install wall-mounted computers and exam stools to replace the office chairs in the room
• To reduce injuries caused by incorrect use of new gurneys: Ask vendors to help train staff how to safely operate new equipment

Employees appreciate the attention. “It’s good to have the team come in,” says Sol Estrella, RN, a staff nurse and UNAC/UHCP member. “It shows that management and higher-ups are responding to our staff needs.”

For nearly a year now, the Neonatal Intensive Care unit at the Fontana Medical Center has welcomed parents 24 hours a day, thanks to a unit-based team that put the patients’ needs first.

Since April 5, 2011, parents have been able to stay on the unit with the newest member of the family regardless of the hour and even during shift changes and rounding.

“The belief in family-centered care is put into action here,” says management co-lead Annette Adams, RN. “Nothing should come between parents and babies.”

Team members put themselves in the shoes of the parents whose children are treated on the unit: The distress of having a newborn baby staying anywhere other than right by your side, of having to leave your baby in the hands of strangers, and being told when you could come and see your own child.

Making it better for parents

Keeping the service point on the Value Compass in mind, the team looked inward to tackle the problem of concerned parents lacking 24-hour access to the unit.

The UBT began by researching what it takes to have successful open visitation in the NICU and what the benefits are for members and patients. The team found that many NICUs were not truly open to parents 24 hours a day, as parents were asked to leave during change-of-shift reports and physician rounds.

The UBT concentrated on how to make sure parents could remain, despite the concerns.

Shift reports are done at the bedside. But the NICU is one big room where anyone can hear anything. Team members researched how to solve this problem by asking how other Los Angeles-area NICUs, such as Cedars-Sinai Medical Center, handle shift reports without compromising privacy.

Involved in shift hand-offs

Not only do parents now get to see their babies whenever they desire, they are also asked to participate when the physicians round and during the change of shift hand-off, which gives them the opportunity to meet the nurse assuming care of their baby.

“The belief that family-centered care is an essential part of each family’s experience was the driving philosophy behind the progressive move in visiting policy,” says Sheila Casteel, RN, the NICU team’s labor co-lead and UNAC/UHCP member.  

The representative team members enlisted help from the rest of the unit by introducing the concept through the monthly staff newsletter and giving presentations at staff meetings.

Unit staff members were asked for their ideas about how to overcome barriers—real and perceived. Some of the practices adopted included:

• moving the staff hand-off huddle outside the unit to the conference room
• making the relief and admitting nurse available to answer parent questions during hand-offs