A South San Francisco pre-admissions team developed this one-page, easy-to-use checklist to help prepare their patients for surgery.
Get a sense of how members experience your department by responding to these sample questions as though you were a KP member or patient rating your team's performance.
Getting patients where they need to go is essential to the operation of a hospital.
But the process of moving them around for tests, X-rays and other services can be a major source of delay, congestion and patient dissatisfaction.
Members of the Inpatient Transport team at the San Jose Medical Center were assigned to specific departments and different floors. Some locations were busier than others, and some transporters were tasked with more work.
And the waits for patients were at best unpredictable. Nurses and technicians often resorted to pushing occupied beds themselves, rather than waiting for a transporter. Workplace injuries rose and attendance became problematic.
San Jose transporter Dharmesh Patel lobbied for a centralized dispatch system, where calls would come into one place and transporters would wait for assignments. The unit-based team agreed to the project, and it worked.
After the change, transporters completed 68 percent more patient trips per day. Timing also improved. Transporters reached the patient’s location within five minutes of the call 90 percent of the time, as the average response time went from about four minutes to 2.46 minutes.
Savings were found in both reduced overtime and sick days.
With fewer nurses and technicians chipping in to transport patients, the team shaved an estimated $200,000 in annual costs for less overtime. In two years, workplace injuries dropped from seven to one, and sick days decreased from a rate of more than 11 days per employee to save another $15,000.
“Overtime is down, sick time is down and the patients are happy,” Patel says.
A San Jose Medical Center UBT has improved patient flow and throughput with a centralized dispatch system for transporters. The new system makes inpatient transport more efficient, effective and safe.
Various interventions have been implemented to increase the rate of colon cancer screenings, including at-home Fecal-Immunochemical Tests or FIT kits. These kits are mailed or handed to patients identified as age- or risk-appropriate and can be completed in the privacy of the member’s own home.
The FIT kit doesn’t require a doctor’s appointment and is returned directly to the lab in a prepaid envelope. Patients who have positive FIT kit results for occult blood are referred for further testing.
“A long time ago, there was no way to track these people,” Kari Russitano, medical assistant, SEIU UHW, says. “Kaiser has done a lot to improve cancer screenings.”
But getting members to take and return the test remains a problem.
In 2009, the Union City Medical Center fell short of its 71 percent return rate goal for colorectal screenings. Kaiser Permanente routinely mass mails the kits to members identified through the electronic medical records database. But many members either don’t return the tests or the ones they return aren’t legible.
“Thirty percent were thrown away because we couldn’t read their name or the medical record number,” Deborah Hennings-Cook, RN, manager, Internal Medicine, says.
Clinical coordinator, Vimi Chand, Department of Internal Medicine, adds, “Obviously mailing alone wasn’t working, so we decided to contact members by phone or secure email. And it worked.”
Of the 1,754 members contacted, more than 63 were referred for further screening.
Having the medical assistants and receptionists make the calls was a hard sell at first, but their peers in the unit-based team stressed the preventive nature of the test.
“It didn’t seem like extra work, because we collaborated together and educated each other to think of it as if ‘this could be your family member,’” Sophia Opfermann, receptionist, OPEIU Local 29, says. “A lot of staff didn’t know what the FIT kits were for, so we educated them about that, too.”
Then frontline staff came up with the idea for the note cards—bright fluorescent notes that read: “This test detects early signs of COLON CANCER.”
“Knowing that many people don’t understand the importance of the test, they made the verbiage strong about ‘saving lives’ and ‘help us help you,’" Hennings-Cook says. "It was something they wanted to do, and it worked.”
One challenge was adding the phone calls and emails to the medical assistants’ existing workload. Lists of patients who hadn’t responded were provided to medical assistants but some had more than others.
“We heard a little bit of flak when the lists first came out and some MAs had huge lists, but they helped each other and just did it,” Chand says.
In the end, the bottom line was helping patients.
“By collaborating together and educating each other, we are helping to saving lives,” Opfermann says.
Internal Medicine team in Northern California increases cancer screenings with the personal touch.
By organizing a healthy eating club, UBT co-leads at the optometry department at the South Bay Medical Center in Southern California build team pride and a healthy work force.
New blue wrap recycling project at Sand Canyon Surgicenter saves money and the environment and helps the disabled.
Looking for ways to make the Sand Canyon Surgicenter in Irvine more efficient, Albert Olmeda wound up learning a lot about blue wrap—like the fact that it makes up nearly 20 percent of the waste generated by hospital surgical services.
The lead Central Services technician and SEIU UHW member also learned that this heavily used hospital product, an industrial strength plastic used to maintain the sterility of medical and surgical instruments until opened, is not biodegradable and persists in the environment.
But recycled blue wrap can be sold as raw material for use in the production of other plastic products. Today, the surgicenter’s unit-based team has gone green with a blue wrap recycling project that is not only saving money and protecting the environment, but also aiding the community.
“The biggest problem with the blue wrap is when we throw it in the landfill, it’s there forever,” says Olmeda. “That’s a big concern especially considering how much blue wrap we use.”
About 600 pounds of blue wrap is collected every week from the center’s six operating rooms. It is picked up free of charge and sorted by Goodwill of Orange County, which sells it to a Houston recycling services company. The company reprocesses the plastic into beads that are used in various products, including railroad ties, pallets and artificial siding for decks, docks and houses.
The surgicenter has been recycling its blue wrap and plastic bottles since September 2009, reducing the facility’s solid waste disposal fee by 10 percent annually. The savings amount to a modest $5,880—but there’s a greater payoff. Proceeds from the sale of blue wrap and other recyclable products enable Goodwill to provide education and training programs for developmentally and physically disabled adults, including a state-of-the-art fitness center.
Peter Bares, business development manager for Goodwill of Orange County, says the relationship with Kaiser Permanente has gone beyond expectations. “It is kind of the perfect storm because of the nature of what we do and why we do it and the materials that the hospital generates,” he says.
As the frontline staff person responsible for the surgery center’s blue wrap disposal, Olmeda—and his fellow UBT members—championed the recycling cause, educating the staff at weekly in-services and UBT huddles. The team got the rest of the department on board by integrating the blue wrap recycling process without creating additional tasks.
“We figured if we changed workflows, staff wouldn’t want to do it.” says UBT co-lead Nicole Etchegoyen, a surgery scheduler and SEIU UHW steward. “But if we asked them, ‘How would this work best for you?’ then everyone would get involved, and they did.”
The team members designated a single container for blue wrap in each operating room. They also placed a larger bin for collecting multiple bags of discarded blue wrap near the soiled utility room, where the trash is taken on its way out of the surgery center.
“It’s not a big deal,” EVS worker and SEIU UHW member George Sollars said, hoisting bags. “We just carry it over here on our way out this door. It’s one of the easiest jobs. And it’s for a really good cause.”
The hardest part was making make sure that other trash didn’t make it into the blue wrap recycling containers accidentally. Labeling the containers with signs reading ‘Recycling Blue Wrap Only’ helped, as did regular reminders by UBT members.
Now, everyone in the operating rooms—from doctors, nurses and surgical techs to nursing assistants and EVS workers—makes sure that the blue wrap containers aren’t contaminated with other trash, Etchegoyen says.
Olmeda does periodic spot checks. “Everybody who plays a role in the operating room has to look out to make sure no trash is going inside the containers,” he says. “It’s a team-building thing.”
“If it wasn’t for the UBT, this wouldn’t be happening,” said Ramin Zolfagar, MD, department head and UBT member. “We are helping the environment by ‘going blue,’ so to speak, and the end result is gym equipment for the disabled—which makes it all the more worthwhile.”
After learning about the project at a recent Orange County UBT fair, other departments are thinking about emulating it.
Visit the Goodwill of Orange County website to find out more about their work.
The team in the Head and Neck Surgery/Audiology department at the South Bay Medical Center had been compiling monthly reports about missed second blood pressure checks.
And this can be a critical point for a patient’s care because high blood pressure is often called “the silent killer.” Those who have it often don’t exhibit symptoms until it’s extremely high, and untreated hypertension can lead to heart disease, stroke and kidney problems.
But the team reviewed the numbers without a follow-up plan.
So, they decided to have morning huddles several days a week to explain the screenings and follow with plans of action.
“We discuss why this is important and what it means to our members, that it can save lives, especially for those who haven’t been diagnosed,” says Kathy Malovich, the department administrator.
UBT leaders provided team members with their individual performance scores on administering needed second blood pressure tests. They customized training and other follow-up plans, including coaching the team on procedures for Proactive Office Encounters (a process that takes advantage of a member’s visit to ensure the member gets any needed tests or appointments).
At huddles, they discussed the importance of controlling high blood pressure for patients. They emphasized that not only was it a strategic clinical goal but a Performance Sharing Program (PSP) goal for the medical center.
“People think they’ve done the second test because they know they should have,” says Leroy Foster, who was the department administrator when the test of change began. “Maybe they got distracted by any number of things.” Foster said the hard data helped motivate the team.
With a low of 35 percent for second blood tests, each team member jumped to 92 percent or better in a year. Four of the six team members hit 100 percent. In 10 months, team scores for second blood tests went up from 84.8 to 92.1 percent.
Huddling was also a key to success.
“I used to think, ‘you guys have way too many meetings,’” Jennell Jones, the union co-lead, says. “But now I see how meeting keeps people connected.”
A speciality department at South Bay Medical Center learns the value of routine screenings and gets results.
The San Diego Ophthalmology group had earned the dubious reputation as a high-injury department.
They had a quarterly injury rate of 23.6 and problems ranged from carpel tunnel to back issues. The majority of complaints was caused by sitting at the computer for long periods, typing and doing repetitive motions like using a mouse.
Medical assistants and technicians also frequently complained about having trouble navigating the cluttered, unsafe vision lanes—the small alcoves where nurses and medical assistants evaluate patients before escorting them to exam rooms.
Being flagged a high-injury department, the team was determined to identify the causes of the injuries and how to prevent them from occurring.
The department took Workplace Safety training and instituted a number of measures to identify and fix potential hazards at all four ophthalmology departments. Those measures included ergonomic evaluations, new chairs and foot rests, and installing stretch break software on all computers.
They conducted regular safety checks and created the “I Spy” program, which has previously injured workers conducting safety observations to identify potential problems.
The team also revamped the department’s vision lanes.
These often were cramped and potentially unsafe environments with electrical cables stretched across the narrow floor. Computers and blood pressure carts created additional tripping hazards.
“You had to maneuver around patients and wheelchairs, and generally feel confined, waiting to trip or bend wrong,” says Anna Garcia, a medical assistant and UBT member.
So, they mounted blood pressure machines and KP HealthConnect computers on the walls, instead of using carts. They purchased new chairs for patients, particularly for older patients who have difficulty getting into narrow spots or are in wheelchairs.
By moving power outlets closer to the mounted equipment, electrical cords were no longer in the way. And they painted the walls that ophthalmologists used during eye examinations.
“The nice thing is if I need to maneuver now, it’s not a move I’m going to regret later on when I get home, when my back is hurting,” Garcia says.
Ophthalmology went 335 days without an injury.
But keeping workplace safety in everyone’s awareness was a challenge.
“The equipment makes a difference, but our behavior also makes a difference. It takes a while for that to happen. It doesn’t happen overnight,” Vickie Lance, assistant department administrator says.
Feedback from people outside the UBT also proved invaluable.
“I’ve been in this department for 15 years and I didn’t know there was a problem. Once we saw it on paper, it made a big impact,” Lance said. “And the visual picture of before and after is wonderful. It makes us feel like we’ve accomplished something.”
San Diego's ophthalmology team reduced ergonomic workplace injuries while also clearing their vision lanes, which had posed serious safety hazards for medical assistants and patients.
Vickie Lance, 619-516-7172
These care cards allow patients to ask questions of their doctors and nurses. Team members can collect completed cards from the patients to address issues and concerns before the patients leave the hospital.
The purpose of this assessment tool is to help a site/area determine its readiness to receive a successful practice from outside of its area.