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If you ask Los Angeles Medical Center sponsors Ilda Luna and Sanjit Sodhi for the secret to successful sponsorship, they’ll agree it boils down to investment—of time, trust and respect—in each other, in their teams and in the collaborative work process.

Luna, a family medicine receptionist, and Sodhi, the chief financial officer for LAMC, didn’t know each other when they were asked to co-sponsor the Health Information Management, Admitting and Patient Revenue, and the local business office teams—teams that were failing to meet performance goals and were entrenched in mistrust between labor and management.

“Sanjit said, ‘Tell me what I need to do to get us up and running,’ ” recalls Luna, a member of SEIU-UHW. “I said, ‘You need to meet with your teams. If you invest time in labor, you’ll get huge dividends.”

Like most investments, success didn’t happen overnight—and it wasn’t guaranteed. But after a year and a half of perseverance, dedicating time and hard work to supporting the work of those teams, the pair has watched the departments go from being in the red in most metrics to seeing huge improvements in areas like attendance and co-pay collection.

“We’re taking on types of projects that we could never have dreamed of a year ago,” Sodhi says. “And when you work though relationship issues and put the focus back on partnership and performance improvement, it’s highly satisfying.”

What’s so special about sponsors?

A 2011 study by Johns Hopkins University, Rutgers University and Kaiser Permanente identified five key characteristics of high-performing teams, including “consistent, aligned and visible sponsorship.” It confirmed what has been seen throughout the organization—strong sponsorship and support from higher levels of leadership are key factors in a team’s success.

The reasons are straightforward. Many frontline workers say simply having leaders’ involvement and support gives their work validation, letting them know that what they’re working on is important, that their contributions matter. In addition:

• Sponsors mentor unit-based teams and connect them with effective practices and other resources to help them do their work.
• They help break down barriers and provide guidance on setting goals that line up with local and national performance goals.
• They act as role models and advocates for working in partnership.

“There are teams that need both management and labor sponsors to model partnership behaviors, who can agree to disagree and who can have some healthy courageous conversations till they get to an outcome,” says Vicki Barkan, the UBT consultant at the Los Angeles Medical Center. “Sometimes teams and co-leads haven’t experienced that, so they need to see it. It really helps to further the team dynamics.”

Sodhi agrees.

“As sponsors,” she says, “we have the same common goals and mutual respect for each other” that team members should have. “It trickles down to the rest of the UBT.”

“Sponsorship is a way to help move UBTs forward,” says Diane Ochoa, the regional director for Medical Group Support Services in Northern California and a former San Jose Medical Center medical group administrator. “It’s just like having a mentor, somebody you can talk to, to help you with issues and celebrate with you, and be there to really acknowledge the work you’re doing.”

So, what’s the problem?

Yet sponsorship is still a developing area in the partnership structure, even though many regions find that without active union and management sponsors, UBTs’ performance improvement work stalls.

Several challenges get in the way, and chief among those is time. Sponsors repeatedly cite the difficulty of finding time in their regular work to mentor teams. Labor sponsors face the added challenge of needing to cover their duties when they’re away from their usual post, lest those duties fall to colleagues.

Even with a commitment from facility and department leadership to backfill her position when her sponsorship work takes her away from her regular job, Luna, who is the union co-lead for the medical center’s LMP Council, says there isn’t enough time for everything she needs to do.

“But you have to make time,” she says. “I put in my own time, during lunch and after I clock out.”

Luna’s partner Sodhi agrees. The time challenge has to be reckoned with—but it’s a challenge worth solving.

“I’ve definitely made it a priority,” she says. “It was tiring devoting all that time, but I knew that I needed to do that to develop my relationships. In order to achieve any results, I knew I had to invest in time.”

“Capacity” is another word that surfaces when sponsors talk about challenges. Identifying people who can be strong sponsors and ensuring they have the tools and skills for the role is not easy. Labor bears the brunt of this barrier, in part because the unionized workforce typically has a smaller pool of leaders to draw from than management has. Many potential labor sponsors lack the consulting and facilitative skills required to mentor a team. As a result, union sponsors are in short supply, and those few become overwhelmed, with too many teams to support.

“I think that with labor, with so much work to do for our regular jobs, this is too much,” Luna explains. “So a lot of my peers didn’t want to do it. (Or) the ones who want to do it couldn’t get released because of operational needs. Patient care comes first, so operational need is a huge barrier.”

Solutions?

Some say successful sponsorship won’t happen until sponsors are held accountable, with their success tied to performance goals and financial compensation.

But in the meantime, many medical centers and regions are wrestling with finding other solutions to these issues. As a first step, some are revamping their training to clarify roles and responsibilities, which many sponsors—both labor and management alike—say have not been clear.

“It will be helpful for people to understand what they are supposed to do and see examples of how that’s done,” Ochoa says. “This is relatively new for some labor folks especially, and the more we can give them the tools to be a good sponsor, we need to do that.”

At the Los Angeles Medical Center, the facility’s LMP Council has made a series of changes in the last year it thinks will help shore up sponsorship. These include establishing criteria for becoming a sponsor, to make sure the right people are in the role and can model partnership and leadership behaviors; aggressively recruiting union co-leads of high-performing teams to become sponsors to increase the labor sponsor pool; and reassigning UBTs so a sponsor has no more than five teams.

Ultimately, time and commitment always will be challenges, but the potential rewards—the culture change and performance improvement work that come with high-performing teams—make the investment worthwhile. If sponsorship remains a barrier, there is a risk that teams will get discouraged.

As Luna says, “To be successful, we need successful sponsors and to build credibility with our teams. And we want to be successful.”

It’s hardly a secret that sponsors are critical to a unit-based team’s performance. Look at any high-performing team, and you’re likely to find an engaged sponsor. The link is so fundamental that teams can’t be rated at Level 4 or 5 on the Path to Performance without sponsors.

That leaves teams with a Catch-22, however, because they can’t control whether they have sponsors or how effective those sponsors are.

Paradoxically, despite the clear links between sponsorship, high-performing teams and results, sponsorship has not received as much attention as other areas in the partnership structure.

“We have had a plan for team development but not a plan for sponsorship,” says John August, the executive director of the Coalition of Kaiser Permanente Unions. But that, he says, is changing with the 2012 National Agreement, which took effect Oct. 1.

The agreement outlines prescriptive measures to strengthen sponsorship organization-wide, mandating that “sponsors will receive more comprehensive support to be effective in their role.”

As a first step, the Office of Labor Management Partnership conducted a study this summer that surveyed more than 8,700 co-leads, sponsors and UBT consultants and included focus groups and dozens of one-on-one interviews.

“This is a great opportunity to impact sponsorship,” says Janet Coffman, the coalition’s director of education and transformation. “Sponsorship can feel so far away when it’s ineffective, but when it works well, it can be the key to UBTs’ success.”

The preliminary results give credence to the anecdotal, recurring complaints about sponsorship. The frequently expressed concerns documented by the study include:

• Multiple and inconsistent training for sponsors.
• Limited leadership development training, tools and resources.
• Poor comprehension and inconsistent use of tools and processes.
• Inconsistent engagement and oversight of sponsors by executive management, physician and labor leaders.
• Few opportunities for sponsor-to-sponsor sharing and networking.
• Limited resources available to assist in addressing complex UBT issues.
• Lack of an organizational plan and commitment to develop UBT sponsorship as a business strategy across management, physician and labor groups.
• Perception of insufficient funds and staffing allocated to sponsorship work.

Andrea Badellebess has been a labor co-sponsor in the Greater Southern Alameda Area (GSAA) in the Northern California region for seven years. She sponsors 37 teams—including EVS, Health Management and the pharmacy UBTs, all of which include OPEIU Local 29 members—by “spreading myself around as much as I possibly can.” In talking with LMP communications consultants Shawn Masten and Cassandra Braun about the challenges and rewards of being a labor sponsor, she introduced the idea of a “family team”—a team that is above even Level 5, when “teams just interact and do what’s needed…It’s a real partnership. And it’s unspoken; it just gets done. It’s not about whose job it is.”

Q. First: How do you sponsor 37 teams?

A. Mostly, I do it electronically. I look at team meeting minutes on the shared drive and look at UBT Tracker to see where they are on projects. For those teams that are unique and need additional pushes, I work with our UBT consultant and visit them more often. If they’re a Level 5 team, I try to get to meetings at least two to three times a year. Then I have teams that need a little more motivation. I have to visit those teams more often to let them know they’re not by themselves. So it’s kind of hard. But you have to let them know you’re there.

Q. What’s the state of sponsorship today?

A. The work of sponsors has evolved slower than the work of unit-based teams. At one point, teams thought their consultants were their sponsors. But that’s the beauty of this whole performance improvement thing—it is its own ongoing small test of change. Everyone is learning as they go. There’s been a whole new culture change.

Q. What about sponsorship needs improving?

A. Here in the GSAA, we have been taking steps to improve union sponsorship especially. There are not enough people who can wear that sponsor hat. So now we are looking for stewards who want to—and have the capacity to—be sponsors. They have to be capable of seeing the common barriers teams face. And they have to either know who can remove those barriers or to point their teams in a different direction. What we’re doing is providing the training and development needed for stewards to succeed as sponsors. This is a significant shift, and one that we hope will make a difference.

Q. What do you like most about being a sponsor?

A. One of my greatest thrills—and sometimes one of my hardest jobs—is helping UBT members recognize that if they speak up they will be listened to. This is still hard for some, especially those skeptical that this whole unit-based team thing isn’t just another experiment that will pass. But this is what I tell them: “You are the experts. Who knows how to do your job better than you?” Once they realize they are the experts and have a say, and they are heard, they become a partner. UBTs make the frontline staff become partners. You’re not just a worker, you’re a partner, and you have a say in what’s going on.

Q. Can you give an example where the workers solved the problem?

A. Our call center operators were having a problem with elderly members getting hung up on or calls being dropped after they were transferred. They came together as a unit-based team and found a solution: Instead of simply putting such calls through, they stayed on the line and would talk with the person at the other end, explain who the member was and why they were calling. They had a problem, they solved it and there was no finger-pointing, no blame.

Words from the front line

“She’s very involved. It’s not like you just see her once a month or every other month. And you can tell that she’s interested in what we’re trying to say and do. If we go out of bounds, she’ll ask, ‘Is this what you meant?’”—Leilani Mejia, Health Information Management specialist, OPEIU Local 29 member and union co-lead, Fremont Medical Center

Linda J. Bodell has a simple formula for being a good sponsor of unit-based teams: Show up. Be of service. Clear a path. Bodell, a former clinical nurse specialist, spent much of her career in critical care settings where patient cases are often unstable and complex. She learned to be watchful and attentive. Today, those lessons define her as a sponsor of four teams at the Fontana Medical Center. She meets with her teams and her labor partners each month. Her personal goal is to understand what works and what doesn’t—and to get to the “why.” Bodell’s teams praise her for guiding them through facility and regional business goals, yet trusting the teams to find solutions that deliver needed results. She talked about being a sponsor with LMP senior communications consultant Anjetta McQueen.

Bodell was clinical director of Medical-Surgical Services at the time this article was written; she is now director of Clinical Care.

Q. Please share one of your best practices.

A. Show up at every team meeting, even if it’s only just one 15-minute window. It’s once a month per team. It’s essential. There is no substitute for being present. Let your teams tell you what they are currently working on. You tell them what’s going on…because they need it to complete their projects successfully. They haven’t had a bloodstream infection in 16 months? They need to hear where they are being successful.

Q. Would you describe an instance when you removed a barrier?

A year and a half ago, an RN and PCA (personal care attendant) from one of my teams asked to get a blood pressure machine that could stay in the patients' rooms. I did that—we had a department closing. I acquired a unit that could stay in one of the isolation rooms. It’s just those little things that make a difference in their work experience every day.

Q. Are there aspects of your past experience that have enhanced your sponsorship?

A. I have served on several nonprofit boards and as a volunteer, in different areas of health care and in Oman and South America, and that’s about taking a service to people, and it’s the same thing I do here as a sponsor. It’s my job to serve them so that they have everything they need to do their job the best they can. I know they care about their patients and their colleagues. They need to know that I care about them and what they do, and that it matters.

Q. Have your teams ever solved something you thought was unsolvable?

A. I would ask them! But the 4 West Med-Surg team was having a difficult time with workflows and getting to their supplies. They work where there are long hallways, where the 34 beds are arranged in a rectangular shape around the unit. This did not look like a process that could be fixed. They did the spaghetti diagram on how many steps nurses take. And the staff, together, made decisions about how to change, where they have their supplies, and how they were arranged. They worked on their workflow. Now the service scores are phenomenal.

Q. What inspires you each day in your duties as a sponsor?

A. So when you know what the goals are and what the actual plans are, and you go out and round on the department, and you can see those in living proof. It’s just exciting to see that this process really affects practice and activity at the unit level.

Words from the front line

“She really has an open door and an open heart. Linda has been a wonderful mentor. She is patient and stays calm under pressure. She knows how to lead you without just handing you the answers. She keeps you focused on what’s important.”—Letty Figueroa, RN, assistant clinical director and management co-lead, 4 East Med-Surg UBT, Fontana Medical Center

Michael Hurley was the education director for the Coalition of Kaiser Permanente Unions for several years, and he and his team designed many of the LMP programs used to support unit-based team education. 

1. Know why we use interest-based problem solving

Interest-based problem solving (IBPS) is a collaborative approach to solving problems, a process for negotiating differences amicably without giving in. When you’re in an ongoing partnership—whether it’s a labor-management partnership or, say, a marriage—you likely have multiple objectives you want to satisfy when resolving differences. Those include not only the desire to solve the problem in a way that meets your needs, but also to solve it in a way that doesn’t cost too much (in time, money or emotional wear and tear), and that leaves the relationship intact or even improves it. Because down the road, you know you’re going to be working together again to solve the next problem that crops up.

2. Understand key terms

Four words are at the heart of the interest-based process. The issue is the problem or subject area to be addressed. A position is a proposed solution. The interest is the underlying need, motivation or concern that may have to be addressed in order to reach a solution; you can tell an interest in part because there is usually more than one way to satisfy it. An option is a potential way to address the issue, in whole or in part.

Your position tells us what you want but not necessarily why you want it.

• A spouse wants to put 5 percent of income into a retirement savings account.
• A parent wants a child in bed by 9:30 on a weeknight.
• A union wants a 3 percent across-the-board wage increase in collective bargaining.

Your interests tell us what is important to you.

• A spouse wants enough saved to have a comfortable retirement.
• A parent wants a child to be well rested for school the next day.
• A union rep wants a compensation package for members that aids recruitment and retention.

3. Ask: Is that ‘interest’ really a position?

What do you do when you’ve got a position masquerading as an interest? Usually, you can get to the interests that underlie a position if you listen carefully and ask the right questions. Find out the needs and concerns behind the position. Here’s an example:

Statement by wife: “I hate living in Los Angeles. We should move to Oregon.”

Reaction to self: “Great, here we go again.”

Question to wife: “Why should we move to Oregon?”

Answer: “We’re in a rut. We’ve lived our whole lives here. I’m tired of it.”

Question: “What else appeals to you about Oregon?”

Answers: “The weather is too hot here, and we spend so much time stuck in traffic. We have to do all our exercising here at the gym. Oregon is cooler and there are prettier roads for biking. We can get to the woods and good hiking faster. People are more relaxed there. “

Interests: Change in weather, less traffic, easier access to uncrowded outdoors, less stress.

By starting with a discussion of interests, the parties can talk about what is important to them without staking out what they want the outcome to be. It opens the door to collaborative problem solving, as opposed to competition or compromise. 

4. Agree on the information

Find agreement on what data to collect and how to collect it, vet it and report it—or you’ll just argue about the data. 

5. Make an action plan

Create an action plan for turning solutions into reality. Be clear on who’s accountable for what. Establish a timeline. 

6. Set ground rules

Remember, interest-based processes don’t always work. In my experience, they have the best chance for success if the parties agree to:

• Focus on the issue, not personalities.
• Share information fully and early.
• Listen actively.
• Work hard to meet interests, not sell positions.
• Be open to options.
• Look for ways to build trust.

In May 1951, Bay Area longshore workers participated in a groundbreaking medical program—the Multiphasic Screening Examination, the first comprehensive health assessment conducted in cooperation with a union.

The trustees of the International Longshore and Warehouse Union–Pacific Maritime Association (ILWU-PMA)Welfare Fund came up with the idea for the tests, thinking it would be a useful corollary to existing medical care by helping detect unsuspected chronic diseases so members could get early and effective treatment. The tests, given in the Local 10 offices, were designed to search out signs of lung cancer, tuberculosis, heart trouble, syphilis, diabetes, anemia, kidney trouble, and sight and hearing defects.

The trustees, together with the Local 10 welfare officer and the ILWU research department, worked out the program with the Permanente Health Plan. ILWU leader Harry Bridges promised results would be confidential and not affect job security, and complete follow-up care was assured as part of health plan coverage.

The patient at the center of the Value Compass isn’t always a KP member, as two Colorado RNs proved on a flight home from the Mid-Atlantic States region last fall—and the experience they shared in the air also brought a fresh appreciation of their shared values and commitment to partnership.

Debbie Zuege, Colorado’s senior director of Nursing and Women’s Health, and Becky Sassaman, a nurse at the Arapahoe After-Hours clinic in Denver, work together as co-leads for the Nursing Partnership Council but had never teamed up clinically. That changed on their return flight from the Mid-Atlantic States, where they had talked about partnership with a group of union stewards.

Shortly after takeoff, Zuege was settling in and starting to read a magazine when something caught her eye.

“A flight attendant came down the aisle, holding an oxygen tank,” Zuege said. She alerted Sassaman, and they joined the flight attendant, who was tending to a woman lying down in the aisle. The woman was pale, sweating excessively and seemed confused. She’d been sick to her stomach. Two physicians on the flight joined in to help move her to the back of the plane.

The hastily formed team concluded the woman was dehydrated. Her pulse was weak. They elevated her feet and gave her liquids to drink; Sassaman placed an IV into her hand to administer fluids they found in the onboard medical kit, and Zuege administered oxygen. The woman responded well, with her pulse and color returning to normal. The doctors and nurses decided she’d be fine for the duration of the flight, and the attendant rearranged passengers so Sassaman could sit with her. The team kept the IV in place, suspending the fluids from a hanger hooked to the overhead bin, and gave her medicine for her nausea. Zuege and the two physicians checked in throughout the flight.

“The lady was so incredibly sweet and grateful,” says Sassaman, who helped her get clean, found her jacket and even lent her a pair of workout pants. “She kept saying ‘Thank you’ and ‘How can you do this?...I made a scene.’ I told her we are nurses, and it is what we do.”