Best Place to Work

The theme of the 2012 Union Delegates Conference was “You Gotta Move”—and Amy Edmondson’s advice for the delegates was “you gotta learn.”

The Harvard Business School professor studies what she calls “learning environments.” To support innovation and teamwork, it’s essential the Labor Management Partnership and unit-based teams foster learning environments throughout Kaiser Permanente.

Imagine the ideal learning environment: People feel free to take risks. They feel psychologically safe. They believe they won’t be punished or humiliated for speaking up with ideas, questions, concerns or mistakes. “Without that kind of psychological safety, it’s very hard for an organization to learn,” says Edmondson.

Now imagine the opposite of a learning environment, one where no one speaks up. “Nobody ever got fired for being silent,” says Edmondson. “And yet many bad things happen as a result of silence. Silence is a strategy for individuals to stay safe, but not necessarily for patients to stay safe or for organizations to stay vibrant.”

Creating a learning environment is up to leaders—to those people with influence, whether or not they have a formal leadership role.

“Leaders have to go first,” Edmondson says. They “have to be willing to ask questions themselves, invite participation, acknowledge their own fallibility, and to explicitly state we don’t know everything yet.” These behaviors help an environment where others can take the risks of learning.

But, she cautions, “The learning environment doesn’t live at the ‘organization’ level. For the most part, there are pockets of learning environments.…In a large, complex system, answers don’t come from central headquarters or the CEO. The answers come from the people at the front line doing the work.”

A labor management partnership like the one at Kaiser Permanente “is an important foundation” for building a learning environment, says Edmondson. “A true partnership is completely consistent with the context for mutual learning.”

Both management and union UBT co-leads can help create a learning environment by articulating the unit’s or department’s purpose and goals “in a meaningful way that touches hearts and minds, that motivates and encourages,” she says.

They can—and must—also reduce the fear people experience that makes them reluctant to speak up. The LMP helps develop and support people, helping them be their best and most courageous, Edmondson says.

When your team is on the same page, you all succeed—individually and collectively. By using these team-tested best practices, you can create a proven unit-based team strategy.

1. Provide sponsors and teams with ample and frequent training.

Offer frequent refreshers on Consensus Decision Making, Interest-Based Problem Solving, and the Rapid Improvement Model and its plan, do, study, act steps.

2. Make good use of your local experts.

Work with your management and union leaders and your facility’s project managers to identify their areas of knowledge and assign them to teams needing that expertise.

3. Create one consolidated list.

Include all the just-in-time, classroom and web-based (KP Learn) courses that meet Path to Performance requirements. Make the list and course-request process easily accessible.

4. Involve sponsors and subject matter experts.

They should sit in on the LMP Council and require regular updates. Identify common issues and address them.

5. Have teams do a “project prioritization matrix.”

This should be done annually after year-end assessments. Download the tool at LMPartnership.org.

6. Distribute and use LMP and performance improvement tools.

Everyone should be looking to learn on a continual basis.

The July/August 2011 issue of the Harvard Business Review highlights Kaiser Permanente’s as a model collaborative community that fosters innovation, agility and efficiency. In the issue’s lead article, "Building a Collaborative Enterprise," the authors make the case that KP is among the leading organizations that are reaping rewards from operating as collective communities that "encourage people to continually apply their unique talents to group projects — and to become motivated by a collective mission."

The authors of "Building a Collaborative Enterprise" identify four organizational efforts that are keys to developing a collaborative community:

• Defining and building a shared purpose
• Cultivating an ethic of contribution
• Developing processes that enable people to work together in flexible but disciplined projects
• Creating an infrastructure in which collaboration is valued and rewarded

A shared purose

The authors use the KP Value Compass to illustrate their point about the importance of defining and building a shared purpose. The Value Compass features the patient/member at the center of the compass with four surrounding points: best quality, best service, most affordable and best place to work. It is included in the 2010 national agreement between KP and the 29 local unions that make up the Coalition of Kaiser Permanente Unions and informs work at every level of the organization. As the authors explain, the Value Compass "guides efforts at all levels of Kaiser: from top management’s business strategy, to joint planning by the company's unique labor-management partnership, right down to unit based teams' work on process improvement.

"We must recognize that old ways of doing things will not work in the new world of health care or business in general," says John August, executive director of the Coalition of Kaiser Permanente Unions. "At the KP Labor Management Partnership, we have devoted ourselves to transform our relationships throughout the organization, to collaborate and to learn in the interest of service to our patients, members and our communities. We are on the right path, and it’s fantastic that the Harvard Business Review has recognized our success."

Improving quality, reducing costs

The article also recognizes the accomplishments of a team at KP’s Irvine Medical Center that applied a collaborative approach — dubbed the Total Joint Dance — to reduce the turnaround time between total joint replacement surgeries. By involving nurses, surgeons, technicians and other employees in coming up with solutions, the team was able to devise changes that reduced the average turnaround time between procedures from 45 to 20 minutes, freeing up 188 hours of operating-room time a year at an average annual savings of $132,000 per OR.

The practices have since been adopted by general surgery, along with head and neck, urology, vascular and other specialties at Irvine, the article notes, and the approach has spread to other KP hospitals.

Collaboration as strategy

"This is a great example of how we’ve been able to use a collaborative approach to harness the knowledge of frontline employees, and then spread the effective practices that we develop with that knowledge," says Barb Grimm, senior vice president of the Office of Labor Management Partnership.

The authors conclude that the organizations that will become the household names of the future will be those with a strong collaborative culture. "Few would argue that today’s market imperative — to innovate fast enough to keep up with the competition and with customer needs while simultaneously improving cost and efficiency — can be met without the active engagement of employees in different functions and at multiple levels of responsibility. To undertake that endeavor, businesses need a lot more than minimal cooperation and mere compliance. They need everyone’s ideas on how to do things better and more cheaply. They need true collaboration."

This story was originally published on InsideKP

Managers newly charged with co-leading unit-based teams sometimes need to build team cohesion before diving into the nitty-gritty of setting goals and improving performance.

Brenda Johnson, optical site supervisor at the South Bay Medical Center in Southern California, has found a way to do just that—and improve her staff’s eating habits at the same time.

Inspired by a presentation at a regional leadership conference hosted by Jeffrey Weisz, MD, executive medical director of the Southern California Permanente Medical Group, she launched a healthy eating club in her department. Every week, staffers chip in $12 each—and get four healthy, fresh-cooked meals in return.

At the early spring meeting, Dr. Weisz discussed Kaiser Permanente’s Healthy Workforce initiative and distributed a booklet listing the calorie count of hundreds of food items.

Making change easier

“I looked at the book, and I thought, ‘Oh, my goodness,’” said Johnson, shocked at the number of calories in some of her favorite foods.

“I looked around at my employees,” she said. “Some have health issues. Some drink sodas by the 32-ounce cup every day.” The medical center is ringed by mini-malls with fast food restaurants. “We’ve been eating the same stuff for years,” she said. “The only question was who’s going to go pick it up.”

Gil Menendez admits he was one of the 32-ounce-cup soda drinkers—a habit he gave up when he joined the club. Menendez, an optical dispenser, SEIU UHW member and  labor co-lead of the UBT, was so motivated by the changes in his lunchtime habits that he also began a strict diet and exercise routine. He’s lost 20 pounds.

New ways to work together

Johnson cautions that the healthy eating club isn’t a diet club. She picks recipes out of a pamphlet produced by the California Department of Public Health, Champions for Change, and prepares the ingredients at home. Others sometimes prepare recipes from their families and cultures. She combines ingredients in the morning, steams them in a slow cooker the staff keeps at work, and a meal is ready by lunchtime.

“I have to cook for my family anyway,” says Johnson. At home, “We’ve changed our habits because of high blood pressure. I prepare this food with love because I’m preparing it for both of my families: my family at home and my family at work.” 

About 15 to 20 people participate in the club each week, up from 10 when it first began in May 2010. In addition to its health benefits, the club has helped her department be more productive and collegial, says Johnson.

“It’s going strong,” adds Mendez. “It brings us together.”