Culture

Each day, every day, Kaiser Permanente’s 3,500 unit-based teams are providing ever-better patient care and advancing our mission. Now, under the 2015 National Agreement, UBTs will have an even greater role to play—and higher expectations to meet.

The new contract, which took effect Oct. 1, 2015, calls for UBTs to bring the voice of KP members and patients into their work. Teams also will be making total health and safety a greater part of their activities. And they will undergo more rigorous, face-to-face performance assessments.

To help them meet the new expectations, there’s a cadre of expert peer advisors and coaches they can call on—unit-based team consultants and union partnership representatives (UPRs) trained in performance improvement methods. Both UBT consultants and UPRs support unit-based teams, but UPRs, who are coalition union-represented employees, also specifically mentor and support labor in UBT and performance improvement work. Both help teams sharpen their communication, data collection and analysis, and other skills needed to advance on the Path to Performance.

It’s a unique system to support workplace learning and innovation.

“I’ve learned a lot about how to build teams and how to use performance improvement tools,” says Gage Martin, an SEIU-UHW member and union partnership representative at the Santa Rosa Medical Center in Northern California. “I take that learning and help teams do projects in all areas of our Value Compass. It’s a great job.”

The UBT consultant and UPR roles were created, as a test of change, in 2008. Since then, they have helped KP set the standard for quality, service and the workplace experience, and delivered tens of millions of dollars in cost savings.

As we strive to deliver the promise of One KP—providing each member and patient with the best care experience, every time—we also need to have One LMP, with each person working in partnership, having the same resources available to them and the same accountability to upholding the National Agreement. UBT consultants and UPRs help make that happen.

When one of her teams is able to leap over the roadblocks in its path with the grace of an Olympic hurdler, Charisse Lewis finds herself out of a job.

As a UBT consultant for the Baldwin Park Medical Center in Southern California, it’s an occupational hazard that she looks forward to—again and again. Like coaches everywhere, she enjoys seeing her teams take what they’ve learned and make it their own.

“I do a lot of mentoring,” says Lewis, who acts as coach, counselor and head cheerleader for her facility’s 68 unit-based teams, nudging them past milestones on the Path to Performance, the five-stage “growth chart” UBTs use to measure success. “I’m teaching teams how to function without me.”

For example, she recently helped a team of critical care nurses advance from Level 1 to Level 4 by using an array of strategies from team-building activities to involving union representatives. Another team advanced to Level 4 in part because she coached the management co-lead, who was new to Kaiser Permanente, in how to manage effectively in a partnership culture.

A team to help teams

Lewis doesn’t work alone. She’s part of Baldwin Park’s UBT Strategy Group, a SWAT team of union members and managers who target at-risk teams. That team’s goal is to help UBTs excel so they can drive performance to provide the best service, quality, affordability and job satisfaction. Low-performing teams, says Lewis, tend to suffer from poor communication, paltry trust and a lack of transparency.

“It’s hard to get past that stuff,” she says. “They flounder there. They don’t trust each other and it’s hard to be a team.”

Part of Lewis’s talent in helping turn teams around is her skill in assessing stumbling blocks and getting teams engaged with the right resources. She draws on her experience as an LMP coordinator, trainer and improvement advisor to nuture her teams.

“I don’t like to stare at that elephant in the room,” says Lewis. “If it’s a contract issue, then we need a contract specialist. If it’s an HR issue, let’s make sure that HR is involved. I like to address the problem and get the team’s leaders involved, from both labor and management.”

Tops in Southern California

Her approach speaks for itself. Baldwin Park has the highest percentage of high-performing teams in Southern California: Of 68 teams at Baldwin Park, 88 percent are at Levels 4 and 5 on the Path to Performance.

Her passion, integrity and ability to help others overcome their differences and work together to improve member and patient care has earned her praise from LMP leaders throughout Southern California—but Lewis, in turn, credits her success to the many people who support her efforts.

“I have the support of the regional LMP office, and I have a strong support system at the medical center,” she says. “It makes my job easier.”

For years, success eluded the Baldwin Park Critical Care team. Mired in distrust, staff members didn’t participate in unit-based team meetings. As recently as 2011, few in the 49-member department knew the team existed.

“I didn’t even know what UBT stood for,” says Sheryl Magpali, RN, a member of UNAC/UHCP and now the team’s union co-lead. “No one claimed to be part of it. It was pretty much nonexistent until 2013.”

With a new manager on board, interest in the UBT grew. Staff members from the Critical Care Unit and its sister department, the Step-Down Unit, elected 12 representatives, who in turn chose Magpali as the labor co-lead. Celso Silla, RN, the new department administrator, became the management co-lead.

Old issues die hard

It was rough going at first.

Attendance was spotty. When the team did meet, members focused on long-simmering grievances about labor and personnel issues. The team reached out to Charisse Lewis, Baldwin Park’s UBT consultant. While consultants often focus on helping teams with using the Rapid Improvement Model and designing tests of change, they also help teams learn to work as teams—clearing up issues that are distracting them from the work at hand.

Lewis’s first steps were to encourage the team’s union members to meet separately with a labor representative.

“That helped relieve the stressors of the union issues,” Magpali says.  Now, she says, “team meetings focus on changes that affect the unit, rather than things we have no control over.”

The department—nearly all nurses, but also including ward clerks, who are SEIU-UHW members and one of whom is a team representative—began building trust in other ways, too. At Lewis’s suggestion, staff members organized a bowling night and had dinner together. This summer, they held a backpack drive.

Moving the team forward

“Charisse has been good at guiding us—attending our meetings, observing and listening and seeing how we can do better,” says Silla.

Lewis didn’t stop with team-building activities. She coached Magpali, a soft-spoken nurse, to speak up during meetings and make her voice heard, and she helped Silla overcome his reluctance to leave his union co-lead in charge of meetings.

Once trust was established, the team could turn its attention to improving patient care, with remarkable results. UBT members have reduced central line-associated bloodstream infections from five in 2014 to none as of August of this year. Buoyed by that success, they are working to reduce catheter-associated infections.

Silla attributes the improvements to the culture of partnership and putting frontline employees in charge of decisions that affect their work.

“We would have been in limbo” without Lewis’s guidance, Silla says. “Now we’re on the same page. We can be a Level 5 in the future.”

The Mid-Atlantic States region has approximately 220 unit-based teams with more than 5,200 members. 

One problem, though: Some of those who belong to UBTs don’t know it.

The region’s seven UBT consultants, who made a commitment to work together as a UBT themselves, are trying to change that.

“Employees can’t contribute to the success of the team if they don’t know they are part of the team,” says Tracy Schrader, one of KP’s UBT consultants in the region, who is also an improvement advisor and OPEIU Local 2 member. “They don’t realize they can speak up.” 

From their travels around the Capital Beltway to team meetings and huddles, the consultants—each of whom supports about 35 teams—knew there was a disconnect for some UBT members. So when they established their own team’s 2015 goals, they planned two main tactics: to host several UBT Fairs to raise the profile of UBTs, and to improve communications so all UBT members know they are on a team.

The fairs, which the consultants originally were planning to hold at the region’s largest centers over the summer, would showcase the work of the teams at that facility and highlight such LMP initiatives and priorities as Total Health, Workplace Safety and the Ben Hudnall Memorial Trust, which provides a variety of resources for career-advancing education.

“We wanted to hold fairs that would have a strong impact,” says Jennifer Walker, RN, a lead UBT consultant and improvement advisor.

Surprising news

Then—just as happens with frontline teams—they received some data that surprised them. The 2014 People Pulse results showed that some locations the consultants thought would score poorly on UBT-related questions scored well and vice versa. Armed with that data, the consultants decided to hold the first five fairs at the centers that had the most teams with more than 10 percent of members answering “no” when asked “are you in a UBT?”

“It was a real eye-opener,” says Preena Gujral, another MAS UBT consultant and improvement advisor who’s a member of OPEIU Local 2. “Data is very important. It’s perception versus reality.”

The data also led the consultants to combine their two tactics:  The fairs would be the method for communicating the message that all work group members are indeed part of a UBT.

Walker, one of the region’s lead consultants, says it can be difficult to get the message across, especially with large departments. Unlike small departments where everyone participates in UBT meetings, larger departments typically have a core group of employees who attend UBT meetings as representatives of everyone on staff. Employees who aren’t representatives don’t always realize that they are part of the team, too.  

The energy and attendance of the first UBT Fair that the consultants sponsored, held at the end of June at the Fair Oaks Medical Center in Fairfax, Virginia, was higher than they expected, with more than 150 employees stopping by.

“The participation was fantastic,” says Wendy Williams, RN, a UBT consultant and member of UFCW Local 27.

Irene Taliaferro, a gastroenterology nurse practitioner, attended the fair at Fair Oaks in late August. She hadn’t realized she was a UBT member.

“I came to find out more about UBTs. Before I came to the fair, I knew nothing about them,” says Taliaferro. “We have a representative who goes to meetings. I don’t know much about it.”

Providing incentive—and a model

Steve Pereira, UBT consultant and improvement advisor, hopes the blitz of UBT Fairs gives workers like Taliaferro a better understanding of the partnership and an incentive to be more involved.

“People want to know more than their 9-to-5 jobs,” Pereira says. “This is the opportunity for that.”

Because of their commitment to use the same tools as frontline UBTs, the consultants have been using the Plan, Do, Study, Act cycle of the Rapid Improvement Model in planning and holding the fairs.

So, Walker says, “We structured it so the fairs happen before the annual People Pulse is taken again, in September”—that way, the fairs serve as a test of change. Will the communication provided by the fairs improve the score on the “I’m in a UBT” question?

“We’ll look for the next People Pulse results to validate whether this was the best way to go,” she says.

Watch for an update on the consultants’ efforts next year on LMPartnership.org, after the 2015 People Pulse results are in.

You say your unit-based team has reached Level 5 on the Path to Performance? Great, everyone take the rest of the week off!

Your UBT is stuck at Level 1 and has been for years? Just hide in a dark corner and hope no one notices.

Not so fast.

Teams soar. Teams stumble. And we need them all to stay in the game.

Unit-based teams are Kaiser Permanente’s platform for improving performance. They’re also the union coalition’s instrument for amplifying workers’ voices in the workplace. All of which has paid off for KP members and patients, through UBTs’ efforts to improve quality, service and affordability. None of which is easy for teams to pull off.

Enter union partnership representatives and UBT consultants. They are recruited from frontline positions in union and management, so they know firsthand what it takes to deliver high-quality health care. They also receive special training that enables them to coach and mentor unit-based teams.

Our leaders knew teams would need such support. But it’s a balancing act. The tightrope for these folks is to gradually build the skills and confidence among team members, then step back at the right time so teams can fly on their own.

Few of us can truly go it alone. We all benefit from coaching—someone to hold up a mirror and offer frank advice (diplomatically delivered!) on how to improve in our jobs. A consultant’s most important skills are listening and observing. Those are skills we’d all do well to improve.

“This whole project was a mere idea written on a piece of paper only a few months ago,” says Juan Piantino, MD, “and now it’s a reality.”

Shortly after Dr. Piantino, a neurologist, came to Kaiser Permanente in July 2014, he was approached by another member of the department—Debbie Newcomb, an electro-neurodiagnostic technologist and UFCW Local 555 member. Newcomb’s work includes performing electroencephalograms (EEGs), a test that monitors a patient’s brain waves and helps diagnose patients with epilepsy.

She was interested in implementing ambulatory EEGs (AEEGs), an advanced technology that is relatively new. Because the test is conducted over a longer time period than a routine EEG, it is more likely to capture events that provide the medical team with information needed for a good diagnosis. AEEGs also are less expensive than an inpatient telemetry EEG. But Newcomb needed a physician partner to move forward.

“I wasn’t intimidated about approaching him,” says Newcomb, who’s the labor co-lead of the neurology UBT. “The partnership has given me the confidence to speak up—and in fact, I consider it part of my role as a union steward.”

Swift implementation

Dr. Piantino had experience with the test with other health care systems—as did Newcomb—and was enthusiastic. The pair began figuring out how the test could be implemented in the Northwest region. Newcomb collaborated with the staff at the Stanford Comprehensive Epilepsy Center to understand the specific details of its program. She worked with KP Purchasing to identify the type and cost of the machines that would be needed.

Armed with information, Dr. Piantino met with leadership of the Northwest Permanente Medical Group—and within a few short months, in December 2014, the region was equipped to do continuous ambulatory EEGs.

So far this year, 16 patients have had their treatment guided by the ambulatory EEG as outpatients. Because the test is administered with a camera, the physician reading the results can see the patient in real time and correlate the brain activity to the physical movements of the patient. In addition, being able to conduct the test in the patient’s own environment avoids a potentially stressful and expensive hospital stay.

One adult patient had been in and out of the Emergency department five times in two weeks. Newcomb performed the ambulatory EEG on him; he had five events, all pseudo-seizures. “He is now seeing the proper doctor for his problems—no more trips to the ED,” Newcomb says.

By the end of July, the program already had paid for the cost of equipment. The benefits of an accurate diagnosis for the patient are immeasurable.

“It was the positive attitude and the willingness to improve patient care that made this happen in record time,” says Dr. Piantino.