Quality

LaTisha Thompson has nothing but positive things to say about breastfeeding her 1-year-old daughter, Teigen Roberts.

“It was a no-brainer for me,” says Thompson, an on-call pediatrics nurse at Kaiser Permanente’s Capitol Hill Medical Center in Washington, D.C. “I decided to do it because of the benefits that breastfeeding gives to my baby and me.”

Indeed, breastfeeding has many health benefits for babies and mothers. But Thompson stands out among African American mothers, who are less likely to nurse their children than women of other racial and ethnic groups because of cultural beliefs that formula is more filling than breast milk. Many Black moms also lack family support and access to breastfeeding resources.

“It’s a national problem,” says Lori Franklin, RN, a lactation consultant and member of UFCW Local 400 who is working to close the gap with her colleagues at the regional Newborn Care Center in the Mid-Atlantic States.

Learning from moms

To better understand the challenges African American women face, the Level 4 unit-based team surveyed 45 Black moms as part of a “voice of the customer” project in January 2019.

The results were revealing.

“They were looking for prenatal education,” says labor co-lead Francesca Klahr, RN, a lactation consultant and UFCW Local 400 member. “We went back to the drawing board, and when we offered it, they came.”

The team doubled the number of prenatal breastfeeding classes and partnered with ob-gyn nurses to encourage African American women to enroll. The response was dramatic.

The percentage of Black mothers taking prenatal breastfeeding classes jumped from 3% to 15% between September 2018 and September 2019.

Kathleen Fulp, a mother of 2, joined the class after experiencing initial difficulty nursing her firstborn child, Savannah, now 2 years old. She’s glad she did. “I probably would have given up had I not had support.”

Such enthusiasm spells success for Nia Williams, clinical operations manager and the team’s management co-lead.

“We can empower and encourage our African American moms to push through, and that has been really successful.”

As physician assistant Larry Rick, PA-C, made his rounds of the South Bay Medical Center one recent morning, staff stood at the hospital’s main entrance and screened members, patients, and employees for signs of cold- and flu-like symptoms. Like Kaiser Permanente facilities enterprise-wide, the Southern California hospital adopted the new procedure to protect patients and staff from COVID-19, the respiratory illness caused by the novel coronavirus.

A well-established approach is also helping: Frontline workers here say years of working collaboratively with managers as part of the Labor Management Partnership has better prepared them to fight the pandemic. The Partnership has saved money, improved care, and led to better service – and now will literally be saving more lives because frontline workers, managers, and physicians are working together.

An opportunity to speak up

“Partnership is a fantastic tool,” says Rick, a member of UNAC/UHCP, who has 34 years of experience fighting infectious diseases including H1N1, HIV, and sexually transmitted diseases to prevent the spread of HIV. “Every Kaiser Permanente senior leader has been responsive to our requests and has heard us. We’re working together and everybody is leaning in” to treat more patients now, while preparing for an expected surge. In response to unit-based team members’ concerns, for example, tape was placed in 6-foot intervals on pharmacy floors to help members and patients maintain social distancing while standing in line.

“We’re able to speak up as labor and help figure out the solution,” says Alejandra Navarro, a registered nurse in Maternal Child Health and a member of UNAC/UHCP.

Working in partnership together has also built trust between management and labor. That’s been key to maintaining open lines of communication now and helping counter misconceptions spread by social media, say frontline workers.

Education and support

“They’re educating us and giving us a lot of support,” said Lizz Burnett, a licensed vocational nurse in Geriatrics and a member of SEIU-UHW. “If I can help educate someone and they can tell their family, then maybe we can stop this.”

Tynikko Snyder, a registered nurse in Family Medicine at the Gardena Medical Offices, has 2 children with asthma and her mother suffers from chronic obstructive pulmonary disease. She is worried about the impact of her work on her family. “I am afraid, but I know that I need to step up to the plate and do what needs to be done,” says Snyder, who is a member of UNAC/UHCP. Rick says that can-do spirit is needed to combat the spread of the disease: “If we all do our jobs, we will save lives.”

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.”